An evolutionary perspective on the history of flap reconstruction in the upper. Search the history of over 406 billion web pages on the internet. The deltopectoral flap in chest wall reconstruction. Base of previous dp flap used to protect anastomosis and prevent salivary spillage into the tracheostomy in case of leakage.
Halesowen chronicle newspaper test202001280839 books by language kidderminster chronicle. Figure 3 a total laryngectomy and circumferential pharyngectomy defect in a patient unfit for free flap reconstruction. This disambiguation page lists articles associated with the title deltopectoral. In a third it replaced the excised tonsil fossa and adjacent structures. In another it was used with cartilage to repair a tracheal defect. Pectoralis major myocutaneous flap pocket dentistry. The pectoralis major myocutaneous flap is an axial flap which is versatile, reliable and permits reconstructive surgery for head and neck cancer as a primary procedure. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region.
The flap is of axial pattern, based on the internal thoracic artery perforators, in its medial part and of random pattern in its lateral part. The pectoralis flap has, however, not been relegated to the history books. An example of a regional flap for facial repair is a deltopectoral flap transferred from the anterior chest wall to repair a defect of the lip or cheek. Proximal pedicle transection in our current practice, transection of the base of the deltopectoral flap is rarely needed for its most common uses ie, skin or carotid coverage. This flap was first described by bakamjian in 1965.
Sensory nerve supply is from second to fourth intercostal nerve. It may however be useful in specific situations when other options are unavaila. Twenty shoulders in 20 patients were treated with humeral head resurfacing using the subscapularissparing technique. In one patient the flap replaced a resected cervical esophagus. Deltopectoral flap revisited for reconstruction surgery in. An evolutionary perspective on the history of flap reconstruction in. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2 nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Mcgregor and jackson also translated the deltopectoral flap of. It has definite advantages over other myocutaneous flaps used in this region. Chapters focused on a particular flap will begin with a detailed description of the relevant anatomy and discuss potential applications of the flap before moving into a. However, it remains a very valuable skin flap and should keep its place in the armamentarium of reconstructive surgeons for postburn head and neck reconstruction. After extensive use for head and neck reconstruction, the deltopectoral flap has been supplanted by alternative methods of reconstruction and relegated to historical references. The origins of deltopectoral flaps and the pectoralis major.
From basic explanation of the principles of reconstructive surgery to some of the more advanced and cuttingedge procedural skills, like island flaps, the book covers all aspects of flap surgery in a. A pet door or pet flap also referred to in more specific terms, such as cat flap, cat door, dog door, or doggy door is a small opening to allow pets to enter and exit a building on their own without needing a human to open the door. French flaps on a soft cover book star print brokers. The flap can be raised as an island flap as well as a pedicled flap. Posterior pharyngeal wall previously reconstructed with dp flap. Whenever possible, it is best to use adjacent soft tissue. It contains the cephalic vein, and deltopectoral fascia, which is a layer of deep fascia that invests the three structures that make up the border of the triangle. Mar, 2014 the deltopectoral flap is a transposition flap that transfers skin from the deltoid region. Atlas of regional and free flaps for head and neck. Tubed groin flaps are still useful to cover hand defects and tubed deltopectoral flaps are still. The origins of deltopectoral flaps and the pectoralis major myocutaneous flap. At about the time of the outbreak of the vietnam war, bakamjian 1965 promoted a similar flap.
Originally simple holes, the modern form is a hinged and often springloaded panel or flexible flap, and some. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. Flap selection is based on the quantity and contour of bone required, as well as the volume of soft tissue necessary to accommodate the patients needs. Now reconstructions can be customized to achieve the. The origins of deltopectoral flaps and the pectoralis. Subscapularissparing deltopectoral approach to the. Flaps, moved in a random network of vessels, often required delay or staging to improve the blood supply or to induce the flap to survive on a reduced blood supply. Standard flap size of 10 x 20 cm and delayed flap size of 10 x 27cm.
Caterpillar advancement for partially necrosed deltopectoral. The history of the dp flap is so old that this flap was regarded a useful candidate for head and neck reconstruction in the 1960s. In 1854, years after the first distant flap to the face, hamilton 21 performed the first distant flap to an extremity with his crossleg flap, treating a chronic ulcer in a 15yearold boy with clear reference to plastic operations of the past. Reconstruction of the face following cancer ablation intechopen. Regional plastic and oral surgery unit, canniesburn hospital, bearsden, glasgow g6z iql since it was first described for pharyngeal reconstruction by bakamjian in i965, the role of the deltopectoral flap in head and neck reconstruction has become well. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the dp flap, giving it the benefit of having a wide arc of. Regional plastic and oral surgery unit, canniesburn hospital, bearsden, glasgow g6z iql since it was first described for pharyngeal reconstruction by bakamjian in i965, the role of the deltopectoral flap in head and neck.
In 1965 bakamjian first described a twostage deltopectoral dp flap based on. It may however be useful in specific situations when other options are unavailable or have been exhausted e. All patients who received dp flap reconstruction surgery at the department of surgery, queen mary hospital, between 1999 and 2011 were recruited. The deltoid branch of the thoracoacromial artery also passes through this triangle, giving branches to both the deltoid and pectoralis major muscles. Adding flaps is a custom option not found at printondemand services. The dp flap also left contour deformities in the donor site. The width of a flap can usually be nearly as wide as the book. Uses this approach is preferred for shoulder arthroplasty and for plate. The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. Chiu 34 pectoralis major flap, 396 william ignace wei, chan yu wai expert commentary hungchi chen 35 deltopectoral flap and internal mammary artery perforator flap, e87 j. However, the dp flap is the first choice for closure of neck skin defects because it is thin, pliant, and provides a color and texture match.
Deltopectoral flap figure 4 the dp flap has largely been supplanted by the pectoralis major, free tissue transfer and, to a lesser extent, latissimus dorsi flaps. In 1917, aymard described a deltopectoral flap based on the perforating vessels of the internal mammary artery. Flaps and reconstructive surgery ebook by fuchan wei md. The history of plastic surgery and military surgery. Five cases are reported where face and neck defects created by radical excisions of cancer were repaired using deltopectoral flaps. The deltopectoral flap is beneficial for reconstruction of significant cheek defects, offering up to 250 cm2 of transferable cutaneous tissue to allow reconstruction of the entire cheek. In 1965, vahram bakamjian described the deltopectoral flap and. Comparison of conventional and lextension deltopectoral flaps in. Axillary flap was also raised to cover the chest wall defect in this. The volume is extensively indexed and organized by anatomic region, and chapters follow a uniform format that clearly presents all the information needed on each flapindications, anatomy, blood supply, surgical techniques, complications, safeguards to keep in mind, and advantages and disadvantages of the flap. The pectoralis muscle flap held its position as the workhorse flap in the reconstruction of defects in the head and neck for many years until the introduction of the radial forearm free flap. Respected microsurgeons from around the world describe how to use. An assessment of the anatomical basis of the thoracoacromial.
Bakamjian editorial comment this landmark chapter should be studied with considerable care and detail. Now in its second edition, the atlas of regional and free flaps for head and neck reconstruction delivers clear, heavily illustrated coverage of regional skin, muscle, and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive cases and an easily. Figure 3 deltopectoral flap in the era of microsurgery. The deltopectoral flap tolerates folding very well and allows movement in wide directions. Manual of head and neck reconstruction using regional and free flaps. The cervicopectoral flap is a large rotation flap best used in the reconstruction of large lateral facial defects. Frozen shoulder glenoid bone defect glenoid fractures glenoid microfracture greater tuberosity fracture hagl hemiarthroplasty history of shoulder surgery humeral shaft fracture internal impingement latarjet latissimus transfer little league shoulder massive. The deltopectoral groove is easier to see than to feel.
Piero lercher ablative tumor surgery of the head and neck region often results in severe cosmetic and functional deformities. Discover a revolutionary approach to reconstructive surgery. A brief history of vascularized free flaps in the oral and maxillofacial region. Online shopping from a great selection at books store. Jan 12, 2015 the pectoralis muscle flap held its position as the workhorse flap in the reconstruction of defects in the head and neck for many years until the introduction of the radial forearm free flap. This flap is supplied by perforating branches of internal mammary artery. The incision should begin just above the coracoid process. The few axial flaps previously identified, such as the forehead flap, deltopectoral flap, and neurovascular island flaps in the hand, had very circumscribed uses. Over 250,000 doctors use vumedi to improve patient care and grow their practice. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap.
Deltopectoral approach to the shoulder lennard funk manchester. At about the time of the outbreak of the vietnam war, bakamjian 1965 promoted a similar flap for pharyngeal and esophageal reconstruction. The dp flap was first described by aymard in 1917 as a method for nasal reconstruction 5. Manual of head and neck reconstruction using regional and free. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while. Pectoralis major myocutaneous flap in head and neck surgery. Make a 10 to 15cm straight incision, following the line of the deltopectoral groove. Halesowen chronicle newspaper test202001280839 books by language kidderminster chronicle newspaper harlow star newspaper mk news newspaper additional collections. Now in its thoroughly updated third edition, this classic work is the most comprehensive reference ever published on surgical flaps for reconstructing defects in the head and neck. An evolutionary perspective on the history of flap. In clearly organized chapters, internationally recognized surgeons describe and illustrate every clinically proven flap option available for repairing every routine and unusual defect. Pectoralis major medial and lateral pectoral nerves.
If an internal link led you here, you may wish to change the link to point directly to the intended article. The clavipectoral triangle also known as the deltopectoral triangle is an anatomical region found in humans and other animals. It is an axial flap designed on the anterior chest wall between the line of clavicle and the anterior axillary fold. Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options.
Deltopectoral flap edit the deltopectoral flap is beneficial for reconstruction of significant cheek defects, offering up to 250 cm2 of transferable cutaneous tissue to allow reconstruction of the entire cheek. Reconstruction of the face following cancer ablation. Flaps for head and neck reconstruction johan fagan, ottie van zyl. Deltopectoral flap is a fasciocutaneous type of flap. He described raising a medially based fasciocutaneous flap from the shoulder skin, which was then tubed and used for staged nasal reconstruction. This patient does not give any history of smoking or. The pectoralis major myocutaneous flaps described by ariyan and baek are a hybrid of conleys laterally based deltopectoral flap and huestons inclusion of the pectoralis major muscle in the skin flap. A distant flap is one that is harvested from sites so removed from the face that the pedicle is not sufficiently long to. The deltopectoral flap is a transposition flap that transfers skin from the deltoid region. Perforators can be marked with a pencil doppler to help design the outline of the flap.
It contains the cephalic vein, and deltopectoral fascia, which is a layer of deep fascia that invests the three structures that make. Demographic data, indications for surgery, defect for. This new edition presents 78 photographic case studies the illustrate the techniques of local flap repair for the reconstruction of skin defects. Manual of head and neck reconstruction using regional and. Poor flap appearance may potentially be improved with the use of iv dextran, steroids, andor hyperbaric oxygen. Originally simple holes, the modern form is a hinged and often springloaded panel or flexible flap, and some are electronically controlled.
We describe a novel surgical approach to prevent this complication by detaching only the inferior 30% to 50% of the subscapularis during humeral head resurfacing and present the preliminary results. But, this also depends on the size of the book and therefore, the sheet size on press. In 1917, now 100 years ago, the concept of the distant tubed pedicle skin flap was published. It provides skin and muscle to cover defects after resection of the temporal bone, in. In these cases, microvascular freetissue transfer enables threedimensional.
1298 422 652 1642 820 1541 545 1445 45 1646 741 785 1623 1104 402 1463 744 863 1582 1550 1244 578 856 771 1482 685 40 639 16 47 1298 404 290 1435 1195 83 1415 16 606 429 493 665