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Fla p s
Practical Re co nstructive Surg e ry
Professor Kayvan Shokrollahi, MSc, LLM, FRCS(Plast)
Consultant Burns, Plastic, and Laser Surgeon
Clinical Lead, Mersey Regional Burns Service
Mersey Regional Burns and Plastic Surgery Unit
Whiston Hospital
Liverpool, England, United Kingdom
Professor Iain S. Whitaker, MA(Cantab), PhD, FRCS(Plast)
Professor of Plastic and Reconstructive Surgery
Reconstructive Surgery & Regenerative Medicine Research Unit
Swansea University Medical School
Honorary Consultant Reconstructive Plastic Surgeon
The Welsh Centre for Burns and Plastic Surgery
Swansea, Wales, United Kingdom
Professor Foad Nahai, MD, FACS, FRCS(Hon), FRCST(Hon)
The Maurice J. Jurkiew icz Chair in Plastic Surgery
Professor of Surgery
Departm ent of Surgery
Em ory University
Atlanta, Georgia, USA
with 1401 illustrations
Thiem e
New York • Stuttgart • Delhi • Rio de Janeiro
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Executive Editor: Timothy Hiscock Important note: Medicine is an ever-changing science undergoing continual
Managing Editor: J. Owen Zurhellen IV development. Research and clinical experience are continually expanding
Editorial Assistant: Naamah Schwartz our knowledge, in particular our knowledge of proper treatment and drug
Director, Editorial Services: Mary Jo Casey therapy. Insofar as this book mentions any dosage or application, readers may
Production Editor: Heidi Grauel rest assured that the authors, editors, and publishers have made every e ort
International Production Director: Andreas Schabert to ensure that such references are in accordance with the state of knowledge
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International Sales Director: Louisa Turrell
Director of Sales, North America: Mike Roseman Nevertheless, this does not involve, imply, or express any guarantee or respon-
Senior Vice President and Chief Operating O cer: Sarah Vanderbilt sibility on the part of the publishers in respect to any dosage instructions and
President: Brian D. Scanlan forms of applications stated in the book. Every user is requested to examine
Printer: Asia Paci c O set carefully the manufacturers’ lea ets accompanying each drug and to check, if
necessary in consultation with a physician or specialist, whether the dosage
Library of Congress Cataloging-in-Publication Data schedules mentioned therein or the contraindications stated by the manufac-
turers di er from the statements made in the present book. Such examination
Names: Shokrollahi, Kayvan, editor. | Whitaker, Iain S., editor. | Nahai, is particularly important with drugs that are either rarely used or have been
Foad, 1943- editor. newly released on the market. Every dosage schedule or every form of applica-
Title: Flaps : practical reconstructive surgery / [edited by] Kayvan Shokrollahi, tion used is entirely at the user’s own risk and responsibility. The authors and
Iain S. Whitaker, Foad Nahai. publishers request every user to report to the publishers any discrepancies or
Other titles: Flaps (Shokrollahi) inaccuracies noticed. If errors in this work are found after publication, errata
Description: New York : Thieme, [2017] | Includes bibliographical references will be posted at www.thieme.com on the product description page.
and index.
Identi ers: LCCN 2016035628| ISBN 9781604067156 | ISBN 9781604067163 Some of the product names, patents, and registered designs referred to in
(eISBN) this book are in fact registered trademarks or proprietary names even though
Subjects: | MESH: Surgical Flaps | Reconstructive Surgical Procedures— speci c reference to this fact is not always made in the text. Therefore, the ap-
methods | Microsurgery—methods | Wound Healing pearance of a name without designation as proprietary is not to be construed
Classi cation: LCC RD119 | NLM WO 610 | DDC 617.9/52—dc23 as a representation by the publisher that it is in the public domain.
LC record available at https://lccn.loc.gov/2016035628
Copyright © 2017 by Thieme Medical Publishers, Inc.
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Printed in China by Asia Paci c O set 5 4 3 2 1 This book, including all parts thereof, is legally protected by copyright. Any
use, exploitation, or commercialization outside the narrow limits set by
ISBN 978-1-60406-715-6 copyright legislation without the publisher’s consent is illegal and liable to
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Also available as an e-book: ing, mimeographing or duplication of any kind, translating, preparation of
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Dedicated to the past masters of the art and science of plastic surgery upon whose shoulders we stand;
and also to those now learning, to whom we o er our own shoulders via this book,
so that you may one day stand yet taller and see still further than us.
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Co nte nts
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Menu of Accom panying Videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Acknowledgm ents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
Section I. Planning and Decision Making in Reconstructive Surgery
Chapter 1 B asic Principles of Reconstructive Surgery and Flaps
Parneet Gill and Kayvan Shokrollahi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 M icrosurgery
Christopher G. Wallace and Fu-Chan Wei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Chapter 3 P reoperative Im aging for Reconstructive Flap Planning
Warren M. Rozen and Vachara Nium sawatt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Chapter 4 C urrent Options for Breast Reconstruction Follow ing Mastectomy
Matthew R. Endara and Maurice Y. Nahabedian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Chapter 5 C urrent Options for Perineal Reconstruction
Sachin M. Shridharani, Raja Mohan, and Justin M. Sacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Chapter 6 C urrent Options for Head and Neck Reconstruction
Sachin M. Shridharani, Justin L. Bellam y, Justin M. Sacks, and Anthony P. Tufaro . . . . . . . . . . . . . . . . . . . 79
Chapter 7 C urrent Options for Lower Lim b Reconstruction
Sujatha Tadiparthi and Kayvan Shokrollahi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Chapter 8 Recipient Vessels for Microsurgery
Am ir Sadri, David M. S. Bodansky, and Kayvan Shokrollahi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Chapter 9 T he Internal Mam m ary System as Recipient Vessels for
Breast Microsurgical Reconstruction
Moustapha Ham di and Moham ed Zulf kar Rasheed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Chapter 10 T he Thoracodorsal System as Recipient Vessels for
Breast Microsurgical Reconstruction
Nicolas A. Guay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Chapter 11 P ostoperative Monitoring of Microvascular Free Flaps
Zita M. Jessop, Warren M. Rozen, and Iain S. W hitaker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Section II. Reconstructive Flaps A-to-Z
Chapter 12 A nterolateral Thigh Free Flaps
Christopher G. Wallace and Fu-Chan Wei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter 13 A nterolateral Thigh Pedicled Flaps
Sachin M. Shridharani, Raja Mohan, and Justin M. Sacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Chapter 14 D eep Circum ex Iliac Artery Flaps
Russell J. Corlett and G. Ian Taylor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
vii
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viii Contents
Chapter 15 D eep Inferior Epigastric Artery Perforator Flaps and Super cial Inferior
Epigastric Artery Flaps for Breast Reconstruction
Moustapha Ham di and Ali M. Ghanem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Chapter 16 D eltopectoral Flaps for Head and Neck Reconstruction
Rowan D. Gillies and Pouria Moradi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Chapter 17 F ibula Osteoseptocutaneous Flaps
Christopher G. Wallace and Fu-Chan Wei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Chapter 18 Gastrocnem ius Muscle Flaps for Lower Lim b Reconstruction
Duncan Atherton, Pouria Moradi, Shehan Hettiaratchy, and Jagdeep Nanchahal . . . . . . . . . . . . . . . . . . 224
Chapter 19 G racilis Muscle and Myocutaneous Flaps
Cedric Hunter, Gordon K. Lee, and Michael W. Findlay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Chapter 20 G roin and Super cial Circum ex Iliac Perforator Flaps
Terence Goh, Kok Chai Tan, and Joon Pio Hong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Chapter 21 I nferior Gluteal Artery Musculocutaneous Flaps
Dam ien Grinsell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Chapter 22 J ejunal Flap Reconstruction for Circum ferential Pharyngolaryngectomy Defects
Pouria Moradi, Charles A. T. Durrant, and Sim on H. Wood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Chapter 23 D esign, Principles, and Variations of Keystone Flaps
Michael W. Findlay, Gordon K. Lee, and Felix C. Behan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Chapter 24 K eystone Flaps for Lower Lim b Reconstruction
Michael W. Findlay, Dom inik Duscher, and Gordon K. Lee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Chapter 25 K eystone Flaps for Reconstruction in the Trunk
Michael W. Findlay, Peter C. Neligan, and W illiam M. Kuzon Jr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Chapter 26 K eystone Flaps for Reconstruction in the Upper Lim b
Michael W. Findlay, Zeshaan N. Maan, and Gordon K. Lee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Chapter 27 K eystone Flap Principles, Technique, and Variations in Head and Neck Surgery
Michael W. Findlay, Sarah N. Bishop, and Gordon K. Lee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Chapter 28 L ateral Arm Free Flaps for Head and Neck Reconstruction
Pouria Moradi and Kevin Ho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Chapter 29 L atissim us Dorsi Free Flaps
Sachin M. Shridharani, Adriana G. Ram irez, Raja Mohan, and Justin M. Sacks . . . . . . . . . . . . . . . . . . . . 348
Chapter 30 L atissim us Dorsi Pedicled Flaps
Moham ed Zulf kar Rasheed and Moustapha Ham di . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
Chapter 31 P edicled Om ental Flaps for Sternal Reconstruction
Pouria Moradi, Charles A. T. Durrant, and Sim on H. Wood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Chapter 32 P ectoralis Major Muscle Flaps
Sachin M. Shridharani and Devinder P. Singh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
Chapter 33 P ectoralis Major Myocutaneous Flaps
Sachin M. Shridharani and Devinder P. Singh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Chapter 34 G luteal Thigh Flaps
Sarah I. Fernandez and Bruce A. Mast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Chapter 35 P osterior Thigh Perforator Flaps
Sarah I. Fernandez and Bruce A. Mast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Chapter 36 R adial Forearm Fasciocutaneous Flaps
Terence Goh and Chin-Ho Wong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
Chapter 37 R ectus Abdom inis Muscle Flaps
Terence Goh and Kok Chai Tan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Chapter 38 R ectus Fem oris Muscle Flaps
Sachin M. Shridharani and Anthony P. Tufaro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
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