Muscle Vascularized Pedicle Flap and Bone
Y. SHINTOMI
K. NOHIRA
Y. YAMAMOTO
L. O. VASCONEZ
EDITORIAL COMMENT
This procedure may open up new possibilities in coverage of difficult defects. However, as pointed out so aptly by Buncke (2), other methods should be considered that are reliable and involve a single stage.
The introduction of free-tissue transfer and refinements of microvascular techniques have made it possible to reconstruct difficult defects expeditiously; however, available flap donor sites are often limited by local vascular anatomy. This chapter presents a unique technique of allowing the custom design of free flaps that fit the tissue requirements of specific defects. The muscle vascularized pedicle (MVP) flap, which is actually a secondarily vascularized flap, is developed by implanting a vascular bundle surrounded by a small cuff of muscle into a selected donor site (1). With extension of the concept of the MVP flap, any tissue, such as bone, tendon, and nerve, can be revascularized and applied as a source of free tissue transfer (1, 2, 3).
INDICATIONS
When thin flaps are needed for head and neck and upper and lower extremity reconstruction, a free skin flap can be provided that has a thickness of 1 cm or less. The donor site can be chosen so that it provides skin of good color, texture, and volume in facial reconstruction. The donor site also can be chosen not only so that it provides bone of specific contour in maxillary or mandibular reconstruction but also so that it results in as little morbidity as possible.
ANATOMY
Any muscle vascular pedicle can be used. Especially desirable muscles are those that have large, long vascular pedicles providing easy microvascular anastomosis in free tissue transfer, such as the latissimus dorsi and serratus anterior muscle with the thoracodorsal vessels and the rectus abdominis muscle with the inferior epigastric vessels.
FLAP DESIGN AND DIMENSIONS
The cuff of muscle needed to revascularize the custom tissue should be approximately 10% to 20% of the size of the flap. The skin of the lateral thoracic, medial arm, and anterior chest are typically good donor-site choices for facial reconstruction. They are successfully revascularized by implantation of a small cuff of the latissimus dorsi or serratus anterior muscle with the thoracodorsal pedicle. The iliac bone is a typically good donor site choice for maxillary or mandibular reconstruction. It can be successfully revascularized by implantation of a small cuff of the rectus abdominis muscle with the inferior epigastric pedicle.
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