Pectoralis major myocutaneous flap in head and neck reconstruction 1. Pectoralis major myocutaneous flap and myofascial flap see also. Pectoralis major muscle flaps for closure of sternal defects. The origins of deltopectoral flaps and the pectoralis. A split flap that slides backwards, before hinging downward, thereby increasing first. Keywords head and neck cancer intraoral cancer temporal bone resection myocutaneous flap reconstruction pectoralis major chest wall orbital exenteration. The history of flap surgery dates as far back as 600 bc, when sushruta samita described nasal reconstruction using a cheek flap. Pectoralis major myocutaneous flap in head and neck reconstruction. A slit was made in the quad tendon proximal to the rupture, and the flap was brought through the slit in the tendon. The term flap originated in the 16th century from the dutch word flappe, meaning something that hung broad and loose, fastened only by one side. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive. Ariyan7,8,9 introduced the pectoralis major myocutaneous flap to head and neck surgery. A docking trench in the patella was created by using a rongeur without violating the patellar implant.
They have added flaps, revolving parts, and other movable pieces to. Originally simple holes, the modern form is a hinged and often springloaded panel or flexible flap, and some are electronically controlled. Get cozy and expand your home library with a large online selection of books at. A novel technique of raising a pectoralis major myocutaneous flap through the skin paddle incision alone article in journal of surgical oncology 862. Hueston was the first to combine a skin flap and pectoralis major muscle for repair of the large defects of the chest wall. Pectoralis major myocutaneous pmmc flap, based on the thoracoacromial artery, whose first description is commonly attributed to ariyan in 1979 who exhaustively described the technique and its anatomical basis 1, was however reported in 1977 by at least two authors 2 3. Our priority is to fulfil all existing orders whilst ensuring the health and wellbeing of our colleagues and customers alike. The myofascial flap variation carries no skin paddle and is utilized primarily to close small mucosal defects, to protect major vascular structures. Optimization of 2d flap geometry using matlab and fun3d gregory d. The pectoralis major myocutaneous pmmc flap has been considered the workhorse reconstructive flap for head and neck defects since its initial description in the late 1970s.
A novel technique of raising a pectoralis major myocutaneous. The proximal tendon is cauterized to detach it from the ischiopubic ramus and the distal muscle is transected with cautery near the insertion or at the distal wound, depending on the length needed. Another wonderful book by usborne, full if fascinating facts. Learn about the pectoralis major flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Use of pectoralis major myocutaneous flap for resurfacing the. Some flaps use multiple slots to further boost the effect. Feb 18, 2020 flappe is a term from the 16th century denoting something that hangs broad and loose, attached by only one side. Since the beginning of the 1980s, until the end of the 1990s, the indications for pectoralis major flaps have progressively broadened, made possible by the unprecedented reconstructive possibilities they offered, which were further increased by the above cited. The origins of deltopectoral flaps and the pectoralis major. It has been considered for decades the workhorse for head and neck reconstruction, and is still. Established uses include esophageal luminal augmentation, reconstruction of oral. Nippleareola reconstruction using the double opposing flap.
Galea can be included when a thicker flap is desired. Pectoralis major turnover versus advancement flap for. The pectoralis major myocutaneous flap pmmf is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications. Home october 2011 volume 128 issue supplement 4s pectoralis major turnover versus advancement flap for sterna. Keywords head and neck cancer intraoral cancer temporal bone resection myocutaneous flap reconstruction pectoralis major. Nippleareola reconstruction using the double opposing flap technique surgical technique similar to most local flaps, double opposing flaps should be created after the projection of the new breast is stabilized during the second or third breast reconstruction. Medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap.
Pectoralis major myocutaneous flap in head and neck. Perssonelli editorial comment this flap is based on the same principle as the temporoparietal fascial flap. This is especially important if the mastectomy was done through a central scar and the scar is completely adherent to the pectoralis major. British journal of plastic surgery 1980, 33, 318 323 0007122680. Optimization of 2d flap geometry using matlab and fun3d. His printing business, begun in 1877, was capable of producing works by all of the major processes of the time.
He described raising a medially based fasciocutaneous flap from the shoulder skin, which was then tubed and used for staged nasal reconstruction. Originally simple holes, the modern form is a hinged and often springloaded panel or flexible flap, and some. An important new flap for head and neck reconstruction by bryan c. All patients who received dp flap reconstruction surgery at the department of surgery, queen mary hospital, between 1999 and 2011 were recruited.
Detailed case studies illustrate how to optimize every aspect of care for the reconstructive surgery patient, including the postoperative period and longterm followup. The slotted flap was a result of research at handleypage, a variant of the slot that dates from the 1920s, but was not widely used until much later. 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 hemisoleus rotational flap provides a novel superior. The pectoralis major myocutaneous flap pmmf is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. 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. Flappe is a term from the 16th century denoting something that hangs broad and loose, attached by only one side.
Pectoralis major flap vula university of cape town. The germanlanguage volume, digitised for the first time, uses paper flaps to demonstrate the different layers of the human body. The pectoralis major is the most commonly used flap as a backup for repair and reconstruction following the loss of free flap reconstruction. The pectoralis major myocutaneous flap pmmf is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is. Pectoralis major turnover versus advancement flap for sterna. Pharyngeal peconstruction surgery by konstantinos apostolopoulos. No bone grafts, omentum flaps or skin grafts have been needed in more than 20 patients. Case example of pectoralis myocutaneous flap general considerations. Pectoralis major myocutaneous flap in head and neck surgery. The aim was to evaluate the feasibility of pectoralis major myocutaneous pmmc flap in reconstruction of defects in the head and neck region. In 1979, ariyan was the first to describe the use of the pmmc flap in head and neck reconstruction.
Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction 1. The flap was then passed from the posterior compartment to the anterior compartment through a medial subcutaneous incision. Use of pectoralis major myocutaneous flap for resurfacing. Another technique, the delayed flap, involves undermining portions of the flap without moving it from the donor bed. Honorary assistant plastic surgeon, alfred hospital, melbourne, australia it is the authors belief that the. In addition, some cases had fat injected prior to the revision to ensure adequate flap thickness and ease the dissection and separation of the pectoralis major from the overlying skin envelope. Q1 flap book latitude, longitude, equator, prime meridian q1 practice page students will color in geographical features q1 assessment with rubric including locating greece q2 flap book rocky mountain range and appalachian mountain range q2 practice page students will color in geographical features q2 assessment with.
Aponeurotic galeal flaps can be used for the correction of. Prepectoral revision breast reconstruction for treatment. Novelty books in the childrens books collection koninklijke. Honorary assistant plastic surgeon, alfred hospital, melbourne, australia it is the authors.
The postop pictures were taken 1 year after her mastectomies. The pectoralis major myocutaneous flap pmmf is a commonly used flap for reconstructive head and neck surgery. The study also outlines types of other tissue required, the donor site morbidity and the technical details of the operative procedure. Dept of periodontics periodontal flaps presented by, shiji margaret d. The department continued to reinforce academic exchanges and to promote training and medical research with institutes in mainland china.
Howe1 georgia institute of technology, atlanta, ga, 30332 this paper describes work done in the process of creating a workable system for the optimization of twoelement highlift airfoil. In unilateral breast reconstructions, the position of the. Pectoralis major flap for head and neck reconstruction. The muscle is then freed of all soft tissue attachments except for the pedicle. The pectoralis major myocutaneous pmmc flap has always been considered the workhorse flap for oral, head, and neck reconstruction. Anatomy of pectoralis major the pectoralis major is a flat triangular fan shaped muscle lying on the anterior and superior aspect of the chest wall. In its long history, the pectoralis major flap has seen alternating indications.
The pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the under lying ribs. A history of popup books, books with interchangeable figures and other. Ariyan was among the first to use this pedicle flap for head and neck defects 1,2. This elearning course provides a step by step approach. Contemporary role of pectoralis major regional flaps in. This unit correlates with the georgia geography standards. Includes highquality illustrations of regional anatomy, flap anatomy, and stepbystep flap dissections, as well as clear photographs demonstrating successful reconstructions. Pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects. Improve your surgical skills by following this elearning module. Pectoralis major myocutaneous flap and myofascial flap iowa.
Pectoralis major myocutaneous flap in head and neck reconstruction by dr. The layout and flaps make the book fun for children, and my 4 year old soaks up the facts, regularly. The history of flap surgery dates as far back as 600 bc, when sushruta samita described nasal reconstruction using a. Evaluation of the pectoralis major flap for reconstructive head and. All patients who received dp flap reconstruction surgery at the department of surgery, queen. The department of otorhinolaryngology, head and neck surgery officially formed in august and became a full academic department of faculty of medicine, the chinese university of hong kong. Pectoralis major myocutaneous flap pocket dentistry. She underwent bilateral latissimus flap and tissue expander reconstruction and the expanders were exchanged for 600 cc gel implants. A split flap that slides backwards, before hinging downward, thereby increasing first chord, then camber. A reliable and simple technique involving the use of pectoralis major muscle flaps is described for the closure of sternal and costal cartilage defects caused by debridement for chronic osteomyelitis following median sternotomy. Nowadays, free flaps are more common due to improved microsurgical techniques, but in several cases the pmmf still has its advantages, including its proximity to the head and neck, the. The degree of paralysis of pectoralis major may be helpful in gauging the extent of a brachial plexus injury p. In ear reconstruction, the thinner fascial flap by itself is preferable. Indications the pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures that can include coverage of mucosal andor cutaneous defects.
Feb 27, 2011 the pectoralis major myocutaneous flap pmmf is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. Q1 flap book latitude, longitude, equator, prime meridian q1 practice page students will color in geographical features q1 assessment with rubric including locating greece q2 flap book rocky mountain range and appalachian mo. Definition a periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Established uses include esophageal luminal augmentation, reconstruction of oral cavity and oropharyngeal defects, lateral. Dec 31, 2016 the pectoralis major is the most commonly used flap as a backup for repair and reconstruction following the loss of free flap reconstruction. The serratus anterior muscle takes origin from the lateral scapula and fans anteriorly as it inserts into the first nine ribs. The muscle is a medial rotator of the arm and, in combination with the muscles of the posterior axillary fold, particularly the latissimus dorsi, a powerful adductor of the arm. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and high. Nippleareola reconstruction using the double opposing. In clearly organized chapters, internationally recognized surgeons describe and illustrate every clinically proven flap option available for repairing every routine and unusual defect. Evaluation of the pectoralis major flap for reconstructive. Works by apianus are among the earliest examples of rotating flap books that have.
Pectoralis major myocutaneous flap and myofascial flap. Medial sural artery perforator free flap msap british. The evolution of the flap courses tortuously over the centuries, illustrating the intense drive for humans to reconstruct deficient anatomy and create form where originally absent. Lifttheflap questions and answers about our world lifttheflap. Usborne history books help children learn about britains past, and that of the wider world, with flap books and sticker books packed with historical detail, and. Howe1 georgia institute of technology, atlanta, ga, 30332 this paper describes work done in the process of creating a workable system for the optimization of twoelement highlift airfoil design based on a fixed cruise configuration baseline. Only a portion of the muscle is used for flap reconstruction. 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. Three papers given in memory of jocelyn toynbee newnham college, cambridge s. Demographic data, indications for surgery, defect for. Department of otorhinolaryngology, head and neck surgery.
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