FIG. 25-19

FIG. 25-20. The flap is wrapped around the heel wound and tethered into position before the microvascular anastomoses. Final trimming and inset were performed after revascularization.

FIG. 25-21. Five-year follow-up, after several debulking procedures.

CASE 4

A patient sustained an avulsive injury of the foot, with loss of most of the plantar skin and the medial and plantar nerves. The soft-tissue loss was covered with an unstable split-thickness skin graft. (From Colen, L.B., and Buncke, H.J.: Neurovascular island flaps from the plantar vessels and nerve for foot reconstruction. Ann. Plast. Surg. 4:327, 1984.)

FIG. 25-22. Appearance before surgery.

FIG. 25-23. The tensor fascia lata (TFL) flap has been completely mobilized on its neurovascular pedicle. The vessels can be seen coming into the deep surface of the proximal muscle just above the retractor, while the lateral femoral cutaneous nerve enters the anteromedial edge of the flap held by a nerve hook in the upper right corner.

FIG. 25-24

FIG. 25-25. Final result. The patient required additional protective cover of the first metatarsal head because he lacked protective sensation distally in the flap, one of the primary disadvantages of this flap. (See Chapter 2.)

References

1. Hill, H., Nahai, F., and Vasconez, L.: The tensor fascia lata myocutaneous free flap. Plast. Reconstr. Surg. 61:517, 1978.

2. Caffee, H.H., and Asokan, R.: TFL myocutaneous free flaps. Plast. Reconstr. Surg. 68:195, 1981.

3. Mathes, S.J., and Buchanan, R.T.: Tensor fascia lata, neurosensory musculocutaneous free flap. Br. J. Plast. Surg. 32:184, 1979.

4. O'Hare, P.M., Leonard, A.G., and Brennen, M.D.: Experience with the TFL free flap. Br. J. Plast. Surg. 36:98, 1983.

next page...