|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| B. The muscle has been completely mobilized from the posterior superior margin to the anterior margin. It can then be detached from the lumbodorsal fascia just off the midline and down over the inferior insertion. If the dissection is carried inferiorly to the iliac crest, fascia can be carried with the muscle. The blood supply to the tip of this thin muscle is precarious, however, and should not be depended on to support an overlying skin graft. If it is carried with the transplant and buried under the wound margin of the recipient area, it can survive as a free graft, or rolled onto itself to form a tendinous insertion.
A. The muscle has now been detached from its chest wall and rotated upward on its humeral insertion. The neurovascular pedicle is completely isolated, but it is not transected until the muscle is ready for transfer. It is wise to keep the humeral insertion of the muscle intact until transfer to prevent traction on the vascular pedicle. The branch to the serratus has been tied, as have the circumflex scapular vessels. It is wise to tie these branches long if there is a possibility that internal shunts may be needed for multiple transplants, or flow-through interpositional anastomoses.
PLATE XIX-5. Application
| A. A large unstable wound with an underlying fracture is stabilized with a medullary plate, which is exposed.
|Ch. 19 Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16|