The Neurovascular Territories of the Skin and Muscles: Anatomic Study and Clinical Implications

Taylor, G. Ian; Gianoutsos, Mark P.; Morris, Steven F.

doi:10.1097/00006534-199407000-00001

Cited by 169 publications

(70 citation statements)

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“…3,24 The development of true hernias in the postoperative setting is attributed to regional compromise of the vascular supply, which is not likely to occur in anterolateral approaches to the spine because the abdominal wall has abundant vascular anastomoses. 28 Therefore, it is more likely that abdominal flank bulging after anterolateral approaches to the spine is attributable to a denervation injury.…”

Section: Postoperative Abdominal Flank Bulgementioning

confidence: 99%

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Fahim

Kim

Cho

et al. 2011

SPI

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Object The thoracolumbar junction is frequently accessed through an anterolateral approach with the incision and muscle dissection extending from the lower thoracic region to the lateral border of the rectus abdominis muscle. This approach is frequently associated with the subsequent development of an unsightly and uncomfortable relaxation of the ipsilateral abdominal wall, or flank bulge, caused by denervation injury to the intercostal nerves. However, the etiology of this complication is not widely recognized by spine surgeons. The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature. Methods The authors performed 32 cadaveric dissections and 6 intraoperative electromyography (EMG) evaluations. Results The cadaveric dissection studies and intraoperative EMG evaluations provided detailed anatomy of the anterolateral abdominal wall and its innervation. Cadaveric dissections revealed that the most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12. Electrophysiological confirmation of these findings was accomplished through intraoperative stimulation in 6 patients undergoing anterolateral retroperitoneal approaches to the thoracolumbar junction. The authors confirmed T11 and T12 innervation of the anterolateral abdominal wall musculature by direct intraoperative EMG recording in all 6 patients. Conclusions The authors classified the 3 potential zones of injury that can be affected during an anterolateral approach to the thoracolumbar junction. Modifications to the operative technique are suggested to avoid the complication of flank bulge. The most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12.

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Section: Postoperative Abdominal Flank Bulgementioning

confidence: 99%

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Fahim

Kim

Cho

et al. 2011

SPI

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“…Therefore, a perforator flap planned incorporating perforasomes of perforators arising from the same source artery may be safer than that combining perforasomes of perforators from different source arteries. For the same reason, after identifying a large perforator at the desired flap base, Taylor et al [21] look for another perforator close to the first perforator in all radial directions and combine both perforators on a line drawn in between; this line is going to be the flap axis. They believe that this kind of flap planning is safe [21].…”

Section: Flap Circulationmentioning

confidence: 99%

“…For the same reason, after identifying a large perforator at the desired flap base, Taylor et al [21] look for another perforator close to the first perforator in all radial directions and combine both perforators on a line drawn in between; this line is going to be the flap axis. They believe that this kind of flap planning is safe [21]. The anatomical territory of a cutaneous perforator is defined as the zone that connects the perforator with adjacent perforators in all directions and is separated from the anatomical zones of other perforators by the anastomotic zone between each anatomical territory.…”

Section: Flap Circulationmentioning

confidence: 99%

Perforator Flaps: Principles and Techniques

Tenekeci¹

2018

Issues in Flap Surgery

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Evolution of flaps has continued after the introduction of fasciocutaneous and musculocutaneous flaps. Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. As a result, widespread use of perforator flaps, either pedicled or free, has become possible. Perforator flaps have provided freedom of flap design with over 350 perforators all over the body, reliability, and reduced donor site morbidity. However, success begins with planning and continues with operative procedure. Here, in this relatively new field of reconstructive surgery, the following are discussed: the correct planning of perforator flaps, microanatomy of perforators, and what to do during the operation based on previous reports. Lastly, some brief information and examples of perforator-based workhorse flaps are given.

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“…Taylor distinguished the patching of defects with muscle, from the provision of functional repairs. 2 Operations using native or conditioned muscle flaps to perform work, necessitate formalising this subdivision. The term functional muscle transfer is already used otherwise; therefore, I suggested a sub-classification using the terms 'passive' (classical, defect-filling) and 'active' (work-performing) flaps.…”

Section: What Are Active Muscle Flaps?mentioning

confidence: 99%

“…Muscle perfusion and oxygenation were not correlated, nor was there correlation between either parameter and fibre type. The actual values of resting skeletal muscle pO 2 and perfusion have been discussed in detail elsewhere. 16,17 Mobilised muscle flaps Pedicled tibialis anterior muscle flaps were raised in six rabbits and compared with unmobilised muscles in seven weight-matched controls.…”

Section: Baseline Tissue Measurementsmentioning

confidence: 99%

The nutrition of active muscle flaps

Greenbaum¹

2005

Ann R Coll Surg Engl

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In the last 25 years, techniques utilising muscle flaps to perform mechanical work have become part of the reconstructive surgeon's repertoire. In this paper, these techniques and the particular physiological challenges faced by active flaps are discussed and a sub-classification of muscle flaps into passive and active is proposed. A series of experiments are described that were designed to compare local pO 2 and gaseous perfusion, at multiple sites in pedicled tibialis anterior muscle flaps and controls, using specially developed dual amperometric microelectrodes, in an in vivo rabbit model. No significant difference in perfusion was found comparing flaps and controls until the flap's vascular pedicles were divided and ligated, and then flap perfusion fell to zero. Flap and control oxygenation varied significantly only during mobilisation and again, after pedicle division and ligation (F[13,55] = 12.3; P < 0.001)]. This absence of functional ischaemia as a consequence of mobilisation in the model used suggests the practice of delaying electrical conditioning of muscle flaps in dynamic cardiomyoplasty and neoanal sphincteroplasty might be unnecessary if these data are reproduced in human latissimus dorsi muscle. The relevance of these findings to free flap oxygen consumption and to the delay phenomenon is discussed.

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The Neurovascular Territories of the Skin and Muscles: Anatomic Study and Clinical Implications

Cited by 169 publications

References 0 publications

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Perforator Flaps: Principles and Techniques

The nutrition of active muscle flaps

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