Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 11:
The Deltoid Flap
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  E. Vessels to these muscles must be tied to develop additional length to the neurovascular pedicle down to the posterior circumflex humeral artery and vein. Care must be taken in this dissection not to injure the motor portion of the axillary nerve to the deltoid muscle.


PLATE XI-2. Application

A. A severely burned hand, with loss of all fingers and the thumb. The thumb has been reconstructed with a large-toe transplant and the finger stumps have been covered with a thick, insensate groin flap.


B. The insensate groin flap has been replaced with a sensory deltoid flap, anastomosed to the ulnar sensory nerve.


Clinical Cases

CASE 1

This case involves the loss of the entire soft-tissue cover over the calcaneus, the posterior surface of the heel, and the medial and lateral surfaces of the heel. (From Franklin, J.D.: The deltoid flap: Anatomy and clinical applications. In Symposium on Clinical Frontiers in Reconstructive Microsurgery. Vol. XXIV, Edited by H.J. Buncke and D.W. Furnas, St. Louis, C. V. Mosby, 1984.)

  FIG. 11-01. The unstable split-thickness skin-graft cover must be replaced with a durable sensory flap. The posterior vessels and nerves are outlined.


FIG. 11-02. A large deltoid flap is outlined and incised, clearing the anterosuperior border off the deltoid muscle.


FIG. 11-03. The deltoid flap is in place. The sensory branch from the axillary nerve was sutured to the calcaneal branch of the posterior tibial nerve to innervate the flap.


FIG. 11-04. Well-healed protective sensory flap is seen several months later.


FIG. 11-05. The split-thickness skin-graft cover in the donor area on the shoulder. The donor defect remains one of the drawbacks of this flap.


CASE 2

A large melanoma of the sole of the foot required wide excision margins.

FIG. 11-06. Melanoma marked for excision.


FIG. 11-07. A deltoid sensory flap in place. The neurovascular anastomoses were to the posterior tibial vessels and nerves.


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