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

2. Local Vascular Anatomy

3. 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

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

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

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

7. 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

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

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

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

11. 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

12. 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