This flap was first described by bakamjian in 1965. Tubed groin flaps are still useful to cover hand defects and tubed deltopectoral flaps are still. Sensory nerve supply is from second to fourth intercostal nerve. 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. An evolutionary perspective on the history of flap. The deltoid branch of the thoracoacromial artery also passes through this triangle, giving branches to both the deltoid and pectoralis major muscles. 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 one patient the flap replaced a resected cervical esophagus. Adding flaps is a custom option not found at printondemand services. It may however be useful in specific situations when other options are unavaila. It has definite advantages over other myocutaneous flaps used in this region.
In another it was used with cartilage to repair a tracheal defect. 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. 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. The width of a flap can usually be nearly as wide as the book. Perforators can be marked with a pencil doppler to help design the outline of the flap. At about the time of the outbreak of the vietnam war, bakamjian 1965 promoted a similar flap. 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. 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. 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. The pectoralis flap has, however, not been relegated to the history books. The deltopectoral groove is easier to see than to feel. Figure 3 a total laryngectomy and circumferential pharyngectomy defect in a patient unfit for free flap reconstruction. Originally simple holes, the modern form is a hinged and often springloaded panel or flexible flap, and some are electronically controlled. The deltopectoral flap is a transposition flap that transfers skin from the deltoid region.
The deltopectoral flap tolerates folding very well and allows movement in wide directions. Dominant pedicle of flap is largely based on first, second and perforating branches of internal mammary artery. 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. Bakamjian editorial comment this landmark chapter should be studied with considerable care and detail. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. The origins of deltopectoral flaps and the pectoralis major myocutaneous flap. All patients who received dp flap reconstruction surgery at the department of surgery, queen mary hospital, between 1999 and 2011 were recruited. Pectoralis major myocutaneous flap pocket dentistry. 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 includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while. But, this also depends on the size of the book and therefore, the sheet size on press. 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. The cervicopectoral flap is a large rotation flap best used in the reconstruction of large lateral facial defects. 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. The few axial flaps previously identified, such as the forehead flap, deltopectoral flap, and neurovascular island flaps in the hand, had very circumscribed uses. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. The flap can be raised as an island flap as well as a pedicled flap. Five cases are reported where face and neck defects created by radical excisions of cancer were repaired using deltopectoral flaps. Twenty shoulders in 20 patients were treated with humeral head resurfacing using the subscapularissparing technique. Atlas of regional and free flaps for head and neck.
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. In 1917, now 100 years ago, the concept of the distant tubed pedicle skin flap was published. 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. Deltopectoral approach to the shoulder lennard funk manchester. 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 history of plastic surgery and military surgery. 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.
Posterior pharyngeal wall previously reconstructed with dp flap. This new edition presents 78 photographic case studies the illustrate the techniques of local flap repair for the reconstruction of skin defects. In 1965 bakamjian first described a twostage deltopectoral dp flap based on. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region. Purchase flaps and reconstructive surgery 2nd edition. 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. French flaps on a soft cover book star print brokers. Now reconstructions can be customized to achieve the.
Deltopectoral flap revisited for reconstruction surgery in. The clavipectoral triangle also known as the deltopectoral triangle is an anatomical region found in humans and other animals. An evolutionary perspective on the history of flap reconstruction in the upper. Make a 10 to 15cm straight incision, following the line of the deltopectoral groove. Demographic data, indications for surgery, defect for.
The origins of deltopectoral flaps and the pectoralis. At about the time of the outbreak of the vietnam war, bakamjian 1965 promoted a similar flap for pharyngeal and esophageal reconstruction. 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. Mar, 2014 the deltopectoral flap is a transposition flap that transfers skin from the deltoid region. Reconstruction of the face following cancer ablation. A distant flap is one that is harvested from sites so removed from the face that the pedicle is not sufficiently long to. 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. Reconstruction of the face following cancer ablation intechopen.
Poor flap appearance may potentially be improved with the use of iv dextran, steroids, andor hyperbaric oxygen. Discover a revolutionary approach to reconstructive surgery. Halesowen chronicle newspaper test202001280839 books by language kidderminster chronicle. Mcgregor and jackson also translated the deltopectoral flap of. It is an axial flap designed on the anterior chest wall between the line of clavicle and the anterior axillary fold. The dp flap also left contour deformities in the donor site. The deltopectoral flap in chest wall reconstruction. An evolutionary perspective on the history of flap reconstruction in.
He described raising a medially based fasciocutaneous flap from the shoulder skin, which was then tubed and used for staged nasal reconstruction. A brief history of vascularized free flaps in the oral and maxillofacial 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. Standard flap size of 10 x 20 cm and delayed flap size of 10 x 27cm. The dp flap was first described by aymard in 1917 as a method for nasal reconstruction 5.
In these cases, microvascular freetissue transfer enables threedimensional. 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. In 1965, vahram bakamjian described the deltopectoral flap and. Uses this approach is preferred for shoulder arthroplasty and for plate. Flaps for head and neck reconstruction johan fagan, ottie van zyl.
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. In 1917, aymard described a deltopectoral flap based on the perforating vessels of the internal mammary artery. The incision should begin just above the coracoid process. Comparison of conventional and lextension deltopectoral flaps in.
Over 250,000 doctors use vumedi to improve patient care and grow their practice. Flaps and reconstructive surgery ebook by fuchan wei md. 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. Base of previous dp flap used to protect anastomosis and prevent salivary spillage into the tracheostomy in case of leakage. 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. Respected microsurgeons from around the world describe how to use. This patient does not give any history of smoking or. Subscapularissparing deltopectoral approach to the. Axillary flap was also raised to cover the chest wall defect in this. In clearly organized chapters, internationally recognized surgeons describe and illustrate every clinically proven flap option available for repairing every routine and unusual defect. 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.
Piero lercher ablative tumor surgery of the head and neck region often results in severe cosmetic and functional deformities. It may however be useful in specific situations when other options are unavailable or have been exhausted e. In a third it replaced the excised tonsil fossa and adjacent structures. 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. Fuchan wei and samir mardini, explains how to achieve excellent results while performing all major conventional and perforator flaps used as both pedicled and free flap procedures. 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. Manual of head and neck reconstruction using regional and. Figure 3 deltopectoral flap in the era of microsurgery. The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. Pectoralis major medial and lateral pectoral nerves. An assessment of the anatomical basis of the thoracoacromial. Pectoralis major myocutaneous flap in head and neck surgery. This flap is supplied by perforating branches of internal mammary artery. When the authors develop what appears to be a new surgical technique, the authors are prone to be excited.
Caterpillar advancement for partially necrosed deltopectoral. 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. 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 deltopectoral flap preceded the pectoralis major flap in head and neck reconstruction, and although it is not as reliable as the latter for intraoral resurfacing or in postradiation patients, the versatility and reach of the. Halesowen chronicle newspaper test202001280839 books by language kidderminster chronicle newspaper harlow star newspaper mk news newspaper additional collections. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery. 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. If an internal link led you here, you may wish to change the link to point directly to the intended article. 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. The origins of deltopectoral flaps and the pectoralis major. Manual of head and neck reconstruction using regional and free. Deltopectoral flap is a fasciocutaneous type of flap.
Originally simple holes, the modern form is a hinged and often springloaded panel or flexible flap, and some. Search the history of over 406 billion web pages on the internet. It contains the cephalic vein, and deltopectoral fascia, which is a layer of deep fascia that invests the three structures that make. Whenever possible, it is best to use adjacent soft tissue. This disambiguation page lists articles associated with the title deltopectoral. Manual of head and neck reconstruction using regional and free flaps.
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. It provides skin and muscle to cover defects after resection of the temporal bone, in. 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. Online shopping from a great selection at books store.
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