TFL and Rectus Femorus Reid Chambers July 19, 2012 Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012

Local Vascular Anatomy

Tensor Fascia Lata Muscle and Fascia Flap Class – Type 1 muscle flap Uses Local – groin/perineum, abdo, trochanter, ischium, sacrum, vulva Free – Breast, H+N, extremties, abdo* *thickness of the fascia lata over the TFL muscle provides a strong fascial donor site for recon of the adbo wall

Anatomy Origin/Insertion – ASIS/iliotibial tract to lateral condyle of tibia Artery – Ascending branch of LCFA (1.5-2.5mm) up to 10cm pedicle Venous – Vena comitantes Innervation – LFCN – sensory, Distal SGN -motor

Variations Muscle, fascial, myofascialcutaneous Chimeric Flap with ALT +/- rectus femoris Can include outer table of iliac crest

Landmarks Anterior limit - Line from ASIS to lateral patella Post limit – axis of femur Pedical enters flap at juntion of prox/middle third

Elevation From distal to proximal in sub fascial or sub muscular Identify descending branch of LFCA between vastus lat and rectus – follow this back to isolate the pedicle Dissect out proximal portion Primary closure can lead to compartment syndrome if too large a flap is taken

Rectus Femoris Class – Type II Uses Local – inferior abdo, groin, perimeum, ischium Free – Adbo wall, Facial reanimation (more historical as too bulky)

Anatomy Origin/Insertion-AIIS+acetabulum/Patella Artery – Decending LCFA 5cm pedicle, 2mm Venous – venae comitantes Inervation – sensory ant. Fem. Cutaneous. Motor – femoral nerve branch

Variations Myocutaneous – overlying skin paddle in midanterior 2/3rds of thigh up to 12x20cm Functional Muscle Flap

Elevation A line is drawn from ASIS to midanterior patella Distal identification of muscle bellies/tendons of vastus med/lat and tendionous rectus insertion – this is divided prox to patella Elevate in prox direction to prox 1/3 of thigh Pedicle is identified approx 8-10cm below AIIS Dissect laterally off TFL to level of AIIS Trace back pedicle to required length – for free flap divide muscle proximally and dissect back to LCFA

Issues Distal skin island is unreliable as this area is predominantly tendinous Functional loss of terminal leg extension May not be viable in patients with PVD