tag:blogger.com,1999:blog-75160898895571195862024-03-14T02:04:14.360-07:00Dr.Fawaz AlBalushi / Plastic & Micro Reconstructive SurgerySultanate Of OmanDr.Fawaz Al-Balushihttp://www.blogger.com/profile/12888204647738169532noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-7516089889557119586.post-62092596637126785752009-08-13T11:10:00.001-07:002009-08-13T11:16:41.479-07:00Kite Flap<div><br /><br /><div><br /></div><div><div><br /><br /></div><div><strong><span style="font-size:180%;">Hand Flaps & Micro Surgery</span></strong> </div><div><br /><strong><span style="font-size:130%;">Kite Flap<br /></span></strong></div><div>Based on the first dorsal metacarpal artery axial pattern flap, which can be sensate if we take the accompanying nerve – to cover a defect at the tip of the thumb. </div><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 247px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369513536773392226" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZAsv3gtkCsNfvo2dyexTGCWIsa0qzMmPQKghXKRSvU-KDiszc4ueAB7wS9kd7VX7u0DQZjdIF0gPTSAWcPv-IJ5aIeYqo4mWRVsl7IRkgcyNtjceelbWc9todw1T4Nr3_VCf0PTsF9Jo/s400/FDMA+flap+1.jpg" /><br /><div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7F4Wn_pA3Kv524_QRgSGCPCrq_rz3i2HR6SO5ckVOJxiUsTlV5yQOUZBlPABB7MxcaCSTQI5sdJcKrKlfJct1wbWt6EKJD-rk1MRXIiVWdo3yQivlWHhoqMEpz4zKpNsJxp3EC191WzA/s1600-h/IMGP3124.JPG"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 331px; FLOAT: left; HEIGHT: 260px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369513290779744626" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7F4Wn_pA3Kv524_QRgSGCPCrq_rz3i2HR6SO5ckVOJxiUsTlV5yQOUZBlPABB7MxcaCSTQI5sdJcKrKlfJct1wbWt6EKJD-rk1MRXIiVWdo3yQivlWHhoqMEpz4zKpNsJxp3EC191WzA/s400/IMGP3124.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEIYrcz68Gyxd_kqo7A00pdTsc673YeaYb2BQ9tpfEg6ioDfW8Db9SzdiwN5k9Ir6K2NP8rNkhPlVNc8OcLOuyuZkJ_Twm6ZPzPDWNGKHqSgZus0ACUgtZN1-MpNof18yqi37jbb4kOiI/s1600-h/IMGP3123.JPG"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 326px; FLOAT: right; HEIGHT: 291px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369513031912518274" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEIYrcz68Gyxd_kqo7A00pdTsc673YeaYb2BQ9tpfEg6ioDfW8Db9SzdiwN5k9Ir6K2NP8rNkhPlVNc8OcLOuyuZkJ_Twm6ZPzPDWNGKHqSgZus0ACUgtZN1-MpNof18yqi37jbb4kOiI/s400/IMGP3123.JPG" /></a><br /><strong><span style="font-size:130%;">Uses</span></strong> </div><div><br /> </div><div>Can be pedicled or free </div><div><br />- To cover defects at the dorsum of the thumb<br />- At the Ulnar aspect of the lateral thumb<br />- Or also rarely at the tip of the thumb<br />- Dorsal hand defects </div><div> </div><div><br /><strong><span style="font-size:130%;">Method</span></strong><br /><br />1) Line and draw ur surgery<br /></div><div>a) Draw a line on the 1st MC and another on the 2nd MC<br />b) The branch artery from the radial is positioned in the center of between the two metacarpals<br />c) FDMA runs parallel to the 2nd MC<br /></div><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 345px; DISPLAY: block; HEIGHT: 240px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369512747579733650" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSjpe75-CrLEhafg8fPF9iF7voLYo7yrVIwnxnjnhZS3bfpISmg7dhGECFoTtqWnGgTD3vcuPEOfuIJGrus3huI-9PjVQBKP6HH8prqz8pMC02JxJzkqiIYnhgLTDnswPTp1KOuIgJcVs/s400/surgical+opening.jpg" /><br />2) Start the incision on your lines of drawing </div><div><br />3) No need to dissect the fascia looking for the FDMA or even to follow it back o the radial artery as it can damage up your flap ( one glance is enough ) have a faith in its presence.<br /></div><div>4) There will be another branch coming out at the level of the 1st Metacarpal head which you will need to ligate or burn. </div><div> </div><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 346px; DISPLAY: block; HEIGHT: 235px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369512581617702594" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtdmCx_sdOC6NGk9JJsjNp5iTSJm-uDgaCFrg4CUTE5VWRInU9qoR_w3y8HQGPTGJysSth9wrCTSeHKMlNYY_s-cMl67J7AVojvxolrv39WAcJDM59Jl4JXEWE6bpvarMWzAhkk00mweU/s400/Branch+to+1st+MC+head.jpg" /><br />5) Cut the flap as if cross finger flap </div><div><br />6) Raise the flap slowly above the paratenon of the extensor tendons<br /></div><div>7) There you will see the nerve supply almost at the centre of the flap – take it with u<br /></div><div>8) Suture the flap over the debrided and clean defect<br /></div><div>9) Close the primary wound and cover the flap site with split thickness skin graft.<br /></div><div>You R Done<br /></div><div> </div><div>Dr. Fawaz N. AlBalushi<br />Hand- Plastic & Micro Reconstructive Surgery </div>Dr.Fawaz Al-Balushihttp://www.blogger.com/profile/12888204647738169532noreply@blogger.com9