Blondeel / Morris / Hallock Perforator Flaps

Anatomy, Technique, & Clinical Applications
3. Auflage 2024
ISBN: 978-1-63853-648-2
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 1192 Seiten, ePub

Expert guidance on the use of perforator flaps for reconstruction from leading pioneers in the field

Nearly two decades ago, the first edition of  was published, thereby filling a gap in the literature, and providing invaluable clinical pearls on the use of soft tissue flaps for reconstructive surgery. Since the publication of the second edition, technological advances including MRI angiography, standard color duplex ultrasound, ultra-high frequency ultrasound, and indocyanine green enabled better understanding of select pertinent physiology and delineation of perforators anywhere in the body. Greater anatomical knowledge and the ability to map the course of individual perforators is reflected in the updated third edition by renowned global experts and editors of the prior editions, Phillip N. Blondeel, Steven F. Morris, Geoffrey G. Hallock, and Peter C. Neligan.

The primary goal of the third edition is to discuss evidenced-based perforator concepts and techniques that have been incorporated into global practice worldwide. Although condensed into a single volume, the new edition follows a similar format as prior editions, with chapters divided into four sections. The first section provides a solid foundation of knowledge with discussion of rudimentary fundamentals. The second section illustrates the use of basic types of local perforator flaps; introduces the vascularized dermal graft; describes routine suprafascial flap dissections with perforators themselves as recipient and donor vessels; lymphatics reconstituted in concert with perforator flaps; and how to minimize donor site morbidity with “kiss” flaps. The third section outlines basic anatomy and techniques for common perforator flaps, while the fourth section provides a brief overview of suggested preferences for clinical applications, with both sections organized by body region.

Key Features

• Fifty-nine chapters with contributions from leading worldwide experts present trailblazing opinions and how-to tutorials
• Sixty-five videos provide invaluable visual insights on how to successfully harvest donor sites, transfer tissue, and create a wide range of perforator flaps
• The latest updates including microsurgery, ICG angiography, lymphedema surgery, skin perforator flaps, and keystone flaps
• Algorithms and summary boxes offer quick access to essential information, while stepwise photos provide additional guidance on challenging techniques

This must-have text and video resource provides reconstructive plastic surgeons with a solid foundation of vascular anatomy knowledge, techniques for particular selections, and utilization of perforator flaps for all clinical situations.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product.

Autoren/Hrsg.

Blondeel, Phillip

Morris, Steven

Hallock, Geoffrey G.

Neligan, Peter

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Plastische, Rekonstruktive & Kosmetische Chirurgie

Inhaltsverzeichnis

Section I Fundamentals
1 History of Perforator Flap Surgery
2 Vascular Territories of the Integument
3 Perforator Flaps: Overview, Definitions, Classifications, and Nomenclature
4 Instructional Models for Learning Dissection Techniques for Perforator Flaps
5 How to Find the Perforator: Preoperative and Intraoperative
6 How to Dissect a Perforator Vessel and Avoid Complications
Section II Variations in Perforator Flap Design
7 Local Perforator Flaps
8 Various Planes for Perforator Flap Elevatoin and the Concept of Perforator-to-Perforator Flaps
9 Perforator Flaps and Lymphatics
10 Pure Skin Perforator Flap
11 Kiss and Sequential Flaps for Perforator Flap Donor Site Primary Closure and Management
Section III Regional Flaps: Anatomy and Technique
Head and Neck
12 Vascular Anatomy of the Integument of the Head and Neck
13 Temporoparietal Artery Perforator Flap
14 Facial Artery Perforator Flap
15 Facial Artery Musculomucosal Flap
16 Submental Artery Perforator Flap
17 The Ascending Helical Rim Flap
18 Supraclavicular Perforator Flap
19 Supratrochlear Artery and Supraorbital Artery Perforator Flaps
20 Chimeric Flaps for the Head and Neck
Upper Extremity
21 Vascular Supply of the Integument of the Upper Extremity
22 Lateral Arm Perforator Flap
23 Posterior Interosseous Artery Perforator Flap
24 Ulnar Artery Perforator Flap
25 Radial Artery Perforator Flap
26 Perforator Flaps of the Hand
Trunk
27 Anatomy of the Integument of the Trunk
28 Thoracoacromial Artery Perforator Flap
29 Internal Mammary Artery Perforator Flap
30 Superior Epigastric Artery Perforator Flap
31 Deep Inferior Epigastric Artery Perforator Flap
32 Superficial Inferior Epigastric Artery Flap
33 Deep Circumflex Iliac Artery Perforator Flap
34 Superficial Circumflex Iliac Artery Perforator Flap
35 Circumflex Scapular Artery Perforator Flap
36 Dorsal Scapular Artery Perforator Flap
37 Thoracodorsal Artery Perforator Flap
38 Intercostal Artery Perforator Flaps
39 Lumbar Artery Perforator Flaps
40 Gluteal Artery Perforator Flaps
Lower Extremity
41 Anatomy of the Integument of the Lower Extremity
42 The Lateral Thigh Perforator Flap
43 Lateral Circumflex Femoral Artery—Tensor Fascia Lata Perforator Flap
44 Lateral Circumflex Femoral Artery—Vastus Lateralis Perforator Flap
45 Superficial Femoral Artery Perforator Flap
46 Profunda Femoris Artery Perforator Flap
47 The Medial Femoral Condyle and Descending Genicular Artery Perforator Flap
48 Superior Lateral Genicular Artery Perforator Flap
49 The Medial Sural Artery Perforator Flap
50 Distally Based Sural Artery Flap
51 Medial Plantar Artery Perforator Flaps with Emphasis on the Medialis Pedis Flap
Section VI Clinical Applications
Head and Neck
52 Flap Options and Technical Considerations in Head and Neck Reconstruction
Upper Extremity
53 Flap Options and Technical Considerations in the Upper Extremity
Trunk
54 Flap Options and Technical Considerations in the Trunk
55 Breast Reconstruction
56 Trunk Reconstruction
57 Perforator Flaps in Pelvic Reconstruction
58 Perineogenital Reconstruction
Lower Extremity
59 Flap Options and Technical Considerations in the Lower Extremity

Leseproben

Contents

1. Title Page
2. Content
3. Video contents
4. Foreword
5. Preface
6. Preface
7. Preface
8. Acknowledgments
9. Section I Fundamentals
10. 1 History of Perforator Flap Surgery
    1. 1.1 Early History
    2. 1.2 Renaissance Period
    3. 1.3 Nineteenth Century
    4. 1.4 Twentieth Century
    5. 1.5 1960s and 1970s
    6. 1.6 1970s to the Present
       1. 1.6.1 Muscle Flaps
       2. 1.6.2 Fasciocutaneous Flaps
       3. 1.6.3 Perforator Flaps
    7. 1.7 Conclusion
    8. 1.8 References
11. 2 The Vascular Territories of the Integument
    1. 2.1 Background
       1. 2.1.1 The Study of the Vascular Anatomy of the Integument
    2. 2.2 The Fascial Arrangement of the Soft Tissue Integument and Its Relevance to Perforator Location and Anatomy
    3. 2.3 Microcirculation of the Integument
    4. 2.4 The Angiosome Concept and Its Importance in Understanding Perforator Flap Survival
       1. 2.4.1 Angiosome Concept
       2. 2.4.2 Venous Drainage
    5. 2.5 The Interconnections between Angiosomes and the Relevance of the Functional Angiosome
    6. 2.6 Identifying True and Choke Anastomoses between Angiosomes
    7. 2.7 Delay
    8. 2.8 Applied Anatomy of These Concepts
       1. 2.8.1 Musculocutaneous Flaps
       2. 2.8.2 Fasciocutaneous Flaps
    9. 2.9 Microvascular Tissue Transfer and Perforator Flaps
    10. 2.10 Anatomic Work on Perforator Flaps
    11. 2.11 Summary
    12. 2.12 Conclusion
    13. 2.13 Pearls
    14. 2.14 Pitfalls
    15. 2.15 References
12. 3 Perforator Flaps: Overview, Definitions, Classifications, and Nomenclature
    1. 3.1 The Pursuit of the Perforator in the Perforator Flap
    2. 3.2 Classification of Soft Tissue Flaps
       1. 3.2.1 Skin Flaps
       2. 3.2.2 Muscle and Musculocutaneous Flaps
       3. 3.2.3 Fasciocutaneous Flaps
       4. 3.2.4 Perforator Flaps
    3. 3.3 Definitions and Nomenclature for Perforator Flaps
    4. 3.4 Definition of a Perforator Flap
    5. 3.5 Basic Nomenclature
    6. 3.6 Secondary Nomenclature
       1. 3.6.1 Paramuscular Perforator
       2. 3.6.2 Perforator Angiosome
       3. 3.6.3 Functional Perforator Angiosome
       4. 3.6.4 Compound Perforator Flaps
       5. 3.6.5 Conjoined Perforator Flaps
       6. 3.6.6 Chimeric Perforator Flaps
       7. 3.6.7 Propeller Flaps
       8. 3.6.8 Perforator-Plus Flaps
       9. 3.6.9 Keystone Flaps
       10. 3.6.10 Capillary Perforator Flaps
       11. 3.6.11 Pure Skin Perforator Flaps
       12. 3.6.12 Hybrid Perforator Flaps
    7. 3.7 Conclusion
    8. 3.8 References
13. 4 Instructional Models for Learning Dissection Techniques for Perforator Flaps
    1. 4.1 Introduction
    2. 4.2 Preoperative Animal Management Considerations
    3. 4.3 Specific Rat Management Requirements
    4. 4.4 Specific Pig Management Requirements
    5. 4.5 Details for the Harvest of Specific Flap Models
       1. 4.5.1 Deep Inferior Epigastric Artery Perforator Flap
       2. 4.5.2 Superior Gluteal Artery Perforator Flap ? [300]
       3. 4.5.3 Intercostal Artery Perforator Flap
       4. 4.5.4 Thoracodorsal Artery Perforator Flap Model
    6. 4.6 Conclusion
    7. 4.7 References
14. 5 How to Find the Perforator: Preoperative and Intraoperative
    1. 5.1 Part A
       1. 5.1.1 Introduction
    2. 5.2 Part B
       1. 5.2.1 Color Duplex/Ultrasound
    3. 5.3 Part C
       1. 5.3.1 CT Angiography and MRI
    4. 5.4 Part D
       1. 5.4.1 Thermography
    5. 5.5 Part E
       1. 5.5.1 Indocyanine Green (ICG)
       2. 5.5.2 References
15. 6 How to Dissect a Perforator Vessel and Avoid Complications
    1. 6.1 Dissecting the Perforator
    2. 6.2 Avoiding Complications
    3. 6.3 Golden Rules to Prevent Complications in Perforator Flaps
       1. 6.3.1 Try to Map the Perforators
       2. 6.3.2 Try to Identify the Main Perforator by Making a Limited Incision
       3. 6.3.3 Preserve Each Perforator until You Encounter a Larger One
       4. 6.3.4 Selection of the Best Perforator
       5. 6.3.5 Consider the Easiest Dissection
       6. 6.3.6 Transect Other Perforators after the Entire Pedicle Is Dissected
    4. 6.4 Flap Dissection
    5. 6.5 How to Deal with Intraoperative Complications
       1. 6.5.1 Variable Vascular Anatomy
       2. 6.5.2 Choice of Recipient Vessels
       3. 6.5.3 “Post”-Anastomotic Problems
       4. 6.5.4 Rare Problems
    6. 6.6 Conclusion
    7. 6.7 References
16. Section II Variations in Perforator Flap Design
17. 7 Local Perforator Flaps
    1. 7.1 Part A
       1. 7.1.1 Introduction to Local Perforator Flaps
    2. 7.2 Part B
       1. 7.2.1 The Peninsular Perforator Flap
    3. 7.3 Part C
       1. 7.3.1 The Perforator Plus Flaps
    4. 7.4 Part D
       1. 7.4.1 The Keystone Perforator Island Flap
    5. 7.5 Part E
       1. 7.5.1 The Propeller Flap Concept
       2. 7.5.2 Acknowledgments
       3. 7.5.3 References
18. 8 Various Planes for Perforator Flap Elevation and the Concept of Perforator-to-Perforator Flaps
    1. 8.1 Introduction
    2. 8.2 Planes for Elevation of Perforator Flaps
       1. 8.2.1 Anatomy of Subcutaneous Fat Tissue
       2. 8.2.2 Preoperative Evaluation
       3. 8.2.3 Flap Elevation Plane: Terminology and Technique
       4. 8.2.4 Conclusions
    3. 8.3 Perforator-to-Perforator Concept and Flaps
       1. 8.3.1 Preoperative Evaluation
       2. 8.3.2 Isolating the Perforator as a Recipient
       3. 8.3.3 Selecting the Flaps Allowing Perforator-to-Perforator Approach
       4. 8.3.4 Anastomosis
       5. 8.3.5 Postoperative Management
       6. 8.3.6 Predictors for Flap Failure When Using Perforator-to-Perforator Supermicrosurgery
    4. 8.4 Conclusion
    5. 8.5 References
19. 9 Perforator Flaps and Lymphatics
    1. 9.1 Lymphatic Perforator Flaps
    2. 9.2 Lymph Node Transfer
    3. 9.3 Lymph Vessel Transfer
    4. 9.4 Lymph-Interpositional-Flap Transfer
    5. 9.5 Summary
    6. 9.6 References
20. 10 Pure Skin Perforator Flap
    1. 10.1 Introduction
    2. 10.2 History of the Thin Flap
    3. 10.3 Various Types of PSP Flaps
    4. 10.4 Anatomy of SCIA-based Pure Skin Perforators
    5. 10.5 Flap Design and Dimension Expectations
    6. 10.6 Preoperative Imaging of Pure Skin Perforators
    7. 10.7 Elevation of a SCIA-based PSP Flap
       1. 10.7.1 Pedicle Dissection and PSP Identification
       2. 10.7.2 Flap Elevation: Supra-Superficial Fascia Elevation
       3. 10.7.3 Flap Thinning: Temporary Clamping and Microdissection
    8. 10.8 PSP Flap Case Example
       1. 10.8.1 Thumb Arteriovenous Malformation
    9. 10.9 Pearls and Pitfalls
       1. 10.9.1 Steps for Safe PSP Flap Elevation
       2. 10.9.2 Back-Up Plan if PSP Flap Aborted
    10. 10.10 Vascularized Areolar Flap Case Example
        1. 10.10.1 Great Toe Donor Site Coverage
    11. 10.11 Conclusion
    12. 10.12 References
21. 11 Kiss and Sequential Flaps for Perforator Flap Donor Site Primary Closure and Management
    1. 11.1 Part A
       1. 11.1.1 The Kiss Flap
    2. 11.2 Part B
       1. 11.2.1 The Sequential Flap
       2. 11.2.2 Introduction
       3. 11.2.3 Indications
       4. 11.2.4 Surgical Technique
       5. 11.2.5 Expert Pearls
       6. 11.2.6 Potential Pitfalls
       7. 11.2.7 Conclusion
22. Section III Regional Flaps: Anatomy and Technique
23. 12 Vascular Anatomy of he Integument of the Head and Neck
    1. 12.1 Overview
       1. 12.1.1 The Head
       2. 12.1.2 The Neck
    2. 12.2 Perforators with Source Vessels
       1. 12.2.1 The Scalp
       2. 12.2.2 The Face
       3. 12.2.3 The Neck
       4. 12.2.4 Nuchal Region
    3. 12.3 Anatomic Basis of Head and Neck Perforator Flaps
    4. 12.4 Flaps in the Head and Face
       1. 12.4.1 Direct Perforator Flaps
       2. 12.4.2 Facial Artery Perforator Flap
       3. 12.4.3 Indirect Perforator Flaps
    5. 12.5 Flaps in the Neck
       1. 12.5.1 Direct Perforator Flaps
       2. 12.5.2 Musculocutaneous Flaps
    6. 12.6 Flap Options
       1. 12.6.1 The Reverse Submental Perforator–Based Flap
       2. 12.6.2 Retroauricular Flap Based on the Upper Auricular Branch of the...