The pyramidalis muscle free flap

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Presentation transcript:

The pyramidalis muscle free flap K. Van Landuyt, M. Hamdi, Ph. Blondeel, S. Monstrey British Journal of Plastic Surgery Volume 56, Issue 6, Pages 585-592 (September 2003) DOI: 10.1016/S0007-1226(03)00211-X

Fig. 1 Aspect of the M. pyramidalis on both sides of the lower abdominal midline, after removal of the anterior M. rectus abdominis sheath. (With courtesy of Lippincott Co., in Hand Atlas of Human Anatomy, Vol. II, pp. 273, Plate 318). British Journal of Plastic Surgery 2003 56, 585-592DOI: (10.1016/S0007-1226(03)00211-X)

Fig. 2 (A) Case 1, preoperative view. Aspect of the left foot with small ulcer on the dorsolateral side and stigmata of previous skin rotation flap from the dorsum of the foot with STG donor site closure, fasciocutaneous transposition flap from the distal anterolateral leg with STG donor-site closure, and eventual free lateral arm flap anastomosed onto the posterior tibial vessels. (B) Case 1, peroperative view after debridement of the ulcer. (C) Case 1, aspect of the lower abdomen after opening of the medial anterior rectus sheath close to the pubis, showing the left M. pyramidalis. (D) Case 1, isolation of the left M. pyramidalis. (E) Case 1, M. pyramidalis free flap with its pedicle. (F) Case 1, M. pyramidalis sutured in and anastomosed on the anterior tibial vessels, prior to application of a full sheet split thickness skin graft. (G) Case 1, late postoperative result, complete healing. British Journal of Plastic Surgery 2003 56, 585-592DOI: (10.1016/S0007-1226(03)00211-X)

Fig. 2 (A) Case 1, preoperative view. Aspect of the left foot with small ulcer on the dorsolateral side and stigmata of previous skin rotation flap from the dorsum of the foot with STG donor site closure, fasciocutaneous transposition flap from the distal anterolateral leg with STG donor-site closure, and eventual free lateral arm flap anastomosed onto the posterior tibial vessels. (B) Case 1, peroperative view after debridement of the ulcer. (C) Case 1, aspect of the lower abdomen after opening of the medial anterior rectus sheath close to the pubis, showing the left M. pyramidalis. (D) Case 1, isolation of the left M. pyramidalis. (E) Case 1, M. pyramidalis free flap with its pedicle. (F) Case 1, M. pyramidalis sutured in and anastomosed on the anterior tibial vessels, prior to application of a full sheet split thickness skin graft. (G) Case 1, late postoperative result, complete healing. British Journal of Plastic Surgery 2003 56, 585-592DOI: (10.1016/S0007-1226(03)00211-X)

Fig. 3 (A) Case 2, preoperative aspect of the right foot, with unstable scar at the lateral aspect of the heel. (B) Case 2, the defect after debridement (C) Case 2, dissection of the M. pyramidalis pedicle through the M. rectus abdominis (D) Case 2, the isolated free M. pyramidalis and its pedicle, including the distal part of the A. and V. Epigastrica Profunda. (E) Case 2, early postoperative result (one month), with full sheet split thickness skin graft, some residual hypergranulation at the site of partial graft failure. (F) Case 2, early (one month) aspect of the donor scar. British Journal of Plastic Surgery 2003 56, 585-592DOI: (10.1016/S0007-1226(03)00211-X)