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Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al. | ||
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| The location of an appropriate recipient sensory nerve for donor axons for the flap must also be determined. If the posterior tibial nerve distally or any of its plantar or calcaneal branches are available and expendable because of previous injury, these may be used as recipient sensory nerves. The superficial peroneal, saphenous, and sural nerves may also be rerouted, if necessary, as a source of recipient sensory axons.
Some key landmarks in the tensor fascia lata dissection are as follows: 1. The anterior superior iliac spine and the greater trochanter are important landmarks for the tensor fascia lata flap. Longitudinal lines extended down the thigh from these points approximate the anterior and posterior borders of the flap, respectively. The flap position begins in the superolateral thigh below the iliac crest and extends reliably down the anterolateral thigh to a distance approximately 5 cm above the knee. 2. The lateral femoral cutaneous nerve pierces the deep fascia just anterior and inferior to the anterior superior iliac spine in the groove between the sartorius and tensor fascia lata muscles and continues down the thigh in the subcutaneous plane to supply sensation to the skin of the lateral thigh. This nerve is found to enter the flap at its superomedial border.
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3. The rectus femoris and vastus lateralis muscles are important landmarks in the dissection of this flap. The dominant vascular pedicle to the tensor fascia lata from the lateral femoral circumflex artery emerges in the fatty areolar layer between the rectus femoris and vastus lateralis muscles. The pedicle lies in this plain approximately 12 cm below the anterior superior iliac spine.
4. The fascia lata of the thigh is a distinct fascial sheet that must be separated from the distal fascia over the vastus lateralis and rectus femoris muscles in the dissection of this flap. 5. In the very proximal portion of flap dissection, the tensor fascia lata muscle must be differentiated from the nearby gluteus medius muscle, which receives its blood supply from the same vascular pedicle. This will be encountered as dissection proceeds in a distal-to-proximal fashion. Operative Sequence PLATE XXV-1. Anatomy |
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