What Is a Myocutaneous Flap?

Myocutaneous flap is a composite tissue flap, which uses a muscle (or part of the muscle) of the body together with its superficial subcutaneous tissue and skin to cut the blood vessels that enter the muscle as the pedicle for transfer and is used for larger wounds Repair of defects or reconstruction of muscle function. Myocutaneous flaps have abundant blood supply, strong anti-infective power, easy survival, and abundant tissues. They are one of the tissue flaps commonly used in plastic and reconstructive surgery.

Myocutaneous flap

Right!

Myocutaneous flap is a composite tissue flap, which uses a muscle (or part of the muscle) of the body together with its superficial subcutaneous tissue and skin to cut the blood vessels that enter the muscle as the pedicle for transfer and is used for larger wounds Repair of defects or reconstruction of muscle function. Myocutaneous flaps have abundant blood supply, strong anti-infective power, easy survival, and abundant tissues. They are one of the tissue flaps commonly used in plastic and reconstructive surgery.

Chinese name

Myocutaneous flap

Meaning

Composite tissue flap

Make use of

A muscle (or part of a muscle) in the body

Indication

Skin and deep tissue defects

1. Defective skin and deep tissues.

2. The local blood circulation of the lesion is poor, the nutritional status is poor, and wounds that are difficult to heal or with tissue defects are formed, such as chronic radiation ulcers, chronic osteomyelitis with large areas of skin scars, bedsores, and deep important tissue structures or organs exposed.

3 Tissue and organ reconstruction, such as breast reconstruction after breast cancer surgery.

4 For muscle function reconstruction, such as sequelae of polio, elbow flexion, wrist muscle loss and so on.

The extraction of the myocutaneous flap must comply with the following principles :

1. The muscles must have a main blood supply.

2. Blood is supplied to the skin by muscles or intramuscular arteries.

3 Synergistic muscles can compensate for their function without causing significant dysfunction in the donor area after muscle removal.

4 With the vascular pedicle as the axis, there is a considerable range of movement or rotation.

In addition, the selection of myocutaneous flaps should also follow the principles of taking materials nearby, transferring them nearby, and minimizing damage to muscle movement and innervation.

[Design and method of myocutaneous flap surgery]

1. According to the size, location and shape of the wound surface, a suitable myocutaneous flap is designed.

Generally, with the vascular pedicle of the muscle as the center, draw the range of the muscle and its supporting skin flap, and measure the end of the transfer flap according to its rotation arc, so that it can reach the farthest end of the receiving area, and it is appropriate to have a little margin. The simplest way to transfer is a single-pedicled muscle flap with muscles. If you need to extend the rotation distance of the myocutaneous flap, you can cut off the skin pedicle, or cut off part of the muscle pedicle. If there is a normal tissue separation between the recipient area and the donor area, an island muscle flap can be formed and transferred to the recipient area through a subcutaneous tunnel.

2. The musculocutaneous flap was excised by antegrade or retrograde.

The surgical method should be different according to the myocutaneous flap that is transferred from different areas. The main points are:

(1) When the myocutaneous flap is excised, the skin, subcutaneous tissue and deep fascia are incised and separated from the muscle space. In order to prevent shear perturbation damage to the percutaneous vascular perforator, the skin and muscle edges on the surface should be temporarily sutured fixed.

(2) If an antegrade cut is taken, it should be carefully separated according to the anatomical position. The main nutritional blood vessels of the pedicle are first exposed and protected, and then the myocutaneous flap is cut distally according to the pre-design.

(3) For retrograde cutting, first cut off the distal end of the myocutaneous flap, then dissect freely proximally. After finding the vascular bundle of the human muscle, dissect the vascular pedicle along the vascular bundle to the proximal side.

(4) After the musculocutaneous flap is transferred, the distal end of the musculocutaneous flap is sutured at an appropriate position in the receiving area. Observe the tension of the pedicle and blood circulation of the skin margin before suture. If excessive tension affects blood circulation, it can be slightly separated at the base of the muscle and sutured until the blood circulation is satisfactory. Drain the muscles deep. The skin flap was exposed or covered with a soft dressing during bandaging to observe blood flow after surgery. The limbs were fixed with a plaster cast. The donor site was sutured directly. If it is still difficult, then take a skin graft for transplantation.

(5) If it is necessary to repair the function of the defective muscle, attention should be paid to the anatomy and protection of the motor nerves that control the muscle.

According to the needs of repairing defects, pedicled transfer or anastomosis of vascular nerves is used.

1. Within 48 hours after surgery, pay attention to observe the flap color, temperature, and capillary reactions. If there is edema, raise the local area to promote reflux, and pay attention to the presence of hematoma under the myocutaneous flap. If a blood circulation crisis occurs, it should be further processed in time.

2. The receiving area should be fixed until healed. For inconvenience caused by immobilization to patients, life care should be strengthened, and patients should be persuaded to actively cooperate with treatment.

1. After the muscle is cut from the attachment point, its volume will be reduced, so the muscle flap should be large enough during the preoperative design.

2. Full attention should be paid to anatomical variation, and the radian of rotation should be estimated to be sufficient when designing, so that there are sufficiently large myocutaneous flaps and long enough pedicles to transfer the defects covering the far part.

3 Preoperative muscle flaps are designed to avoid muscles with poor blood supply.

4 When using some muscles to form a myocutaneous flap, avoid damaging the blood vessels and nerves that dominate the other muscles. ^[1]

The position of the brachioradialis muscle is superficial. The main blood supply comes from the radial accessory artery and the radial recurrent artery. The nerves are taken from the radial nerve. This muscle only assists elbow flexion and pronation function, and can be used as a dynamic muscle transposition instead of paralyzed biceps brachii.

Applied Anatomy of the Brachioradialis Musculocutaneous Flap

The recurrent radial artery [1] starts from the radial artery [2], rises outward through the radial nerve [3], and conforms to the radial accessory artery, and branches along the way [4] dominate the brachioradialis [5]

The anterior rotator muscle is located on the deep side of the forearm. The main blood supply comes from the anterior interosseous blood vessels. This muscle cannot form a muscle (skin) flap. As a muscle flap, it can repair adjacent soft tissue defects, but because of its deep location, it is inconvenient to remove and is rarely used.

Applied anatomy of anterior rotator musculocutaneous flap

The anterior rotator muscle [1] is located on the far side of the forearm, on the deep side of the long flexor hallucis longus [2] and the deep flexor digitus longus [3], and it lies directly in front of the radius and ulna [4]. Jichengfang

The deltoid muscle flap is a tissue flap with the posterior brachial artery as the blood supply and inner arm epithelial nerve innervation. Local transfer can repair soft tissue defects on the ipsilateral shoulder, upper back, and axilla.

Anatomy of deltoid muscle flap

The posterior brachial artery passes through the four holes and surrounds the posterolateral side of the humerus surgical neck to separate the deltoid branch [1] and the posterior marginal branch [2]. The former is the muscular branch that enters the deltoid muscle [3].

The little finger abductor muscle skin flap is located in the small fish area, and is mainly used for functional repair of the large fish area. It is used for thumb or palm plastic surgery or abduction plastic surgery. After this muscle is removed, the fish muscle will lose its abduction function.

Applied Anatomy of the Little Finger Abductor Musculocutaneous Flap

The abductor of the little finger [1] starts from the pea bone [2] and parallel to the pea hook ligament and ends at the ulnar tubercle at the base of the proximal phalanx of the little finger. Musculovascular nerves come from ulnar movement

Little finger abductor muscle flap surgery (5 photos)

Vein [3] and deep branch of ulnar nerve [4]. The ulnar artery is located on the radial side of the ulnar nerve at the crocus, and a branch [5] is accompanied by the little finger abductor branch [6] of the ulnar nerve and enters the muscle at about 1 cm below the crocus. In addition to the superficial skin, the percutaneous branch from the ulnar artery is directly supplied in addition to the percutaneous branch from the deep muscle.

Design of incision of the little finger abductor muscle flap

Taking the thumb extensor muscle flap reconstruction of thumb-to-palm function as an example, incisions a and b were made on the ulnar and radial sides of the palm, respectively.

Myofascial muscle flap extraction

First make an incision a to expose the little finger abductor muscle [1]. Cut the tendon distally, in the superficial layer of the little finger flexor [2] and the little finger to palmar muscle [3], lift the muscle flap from far to near, and pay attention to protect the vascular and nerve pedicles that enter the muscle near the crocus [4] .

Abductor hallucis abductor

A radial incision was made to expose and free the short abductor hallucis muscle [1].

Little finger abductor muscle flap transposition

A wide subcutaneous tunnel is made from the radial incision to the ulnar incision, and the free little finger abductor muscle [1] is led out from the radial incision. Suture the little finger abductor tendon [2] with the short abductor hallucis tendon [3] in the palm of the thumb abduction. After the operation, the thumb was fixed in the abduction with the cast support for 4 weeks.

Anatomy Essentials of the Little Finger Abductor Musculocutaneous Flap

The vascular nerve pedicle of the abductor of the little finger is constant, and the origin of the vascular nerve pedicle should be taken as the axis when designing the surgery, that is, the position equivalent to the hook of the hook

Pay attention to protect the vascular and neural pedicles that enter the muscles by the hooks;

The subcutaneous tunnel should be wide to facilitate the passage of muscle flaps.