B.

C. The groin flap is fitted into the defect; it is secured, and the circulation is re-established by anastomosing the flap vessels to the anterior tibial vessels, end to side for the artery and end to end for the nerve.

Clinical Cases

CASE 1

This case involved a defect of the skull secondary to a deep burn with a split-thickness skin graft directly on the dura over the central bony defect. The patient required thick soft-tissue cover and reconstitution of the bony defect. (Reprinted by permission of the publisher from Chater, N.L., Buncke, H.J., and Alpert, B.S.: Reconstruction of extensive tissue defects of the scalp by microsurgical composite tissue transplantation. Surg. Neurol. 7:343, 1977. Copyright 1977 by Elservier Science Publishing Co., Inc.)

FIG. 6-01. Template of the soft-tissue flap needed to replace the thin skin-graft cover.

FIG. 6-02. The soft-tissue defect with the bony defect filled in with barrel stays of rib.

FIG. 6-03. Concurrent with the scalp dissection, the template is used to define the flap needed for coverage.

FIG. 6-04. The flap, elevated from lateral to medial, is isolated on the superficial circumflex iliac system. Excellent capillary refill is present.

FIG. 6-05. Vascular pedicle. Once it is incised and isolated, the flap shrinks appreciably.

FIG. 6-06. Excellent capillary refill is present in situ.

FIG. 6-07. Inserting of the flap over the rib grafts.

FIG. 6-08. The healed groin flap overlies the reconstituted skull defect. In this case, the groin-flap vessels are anastomosed to the occipital vessels in the postauricular region because the superficial vessels in the preauricular region had been destroyed. Vein grafts were needed to extend the vascular pedicle.

FIG. 6-09. X ray shows the split-rib grafts in the bony defect.

CASE 2

next page...