Skip to main content

Advertisement

SpringerLink
Log in

Medial triceps brachii free flap in reconstructive surgery: a prospective study in eight patients

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

In this study, we present a prospective series of medial triceps free flaps for ankle and foot complex defects coverage and discuss its numerous advantages.

Materials and methods

Between January 2011 and December 2012, eight patients, two women and six men underwent medial triceps brachii (MTB) free flap procedure to cover defects localized at the ankle and foot in our department. Patient mean age was 37.3 ± 15.2 years at the time of surgery (range of 13–53 years). Mean defect size to be covered was 21.8 ± 9.9 cm2. The bone was exposed at the level of the calcaneum in six cases, at the level of the forefoot in one case, and at the level of the lateral malleolus in one case. Special attention was accorded to intra-operative findings. Flap survival and complications on both the donor and recipient site were prospectively evaluated.

Results

Mean MTB flap raising time was 51.3 ± 6.0 min. All the flaps survived and there was no partial flap necrosis. A skin graft was performed after a mean time of 11.8 ± 2.1 days post-operative. The mean follow-up was 18.1 ± 3.8 months. Complications at the donor site level included one hematoma and a case of hypertrophic scar. Complete healing of both the donor and recipient sites was achieved in all cases.

Conclusions

MTB free flap appears to be a useful option for covering small to medium defects in lower limb extremities. Due to the constant anatomy of the MTB nerve, we suggest that the flap could also be used as an innervated free flap for small or medium muscular reanimation such as sequelae of forearm and hand muscle impairment, or facial palsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Parrett BM, Pribaz J (2010) Lower extremity reconstruction. Rev med clin condes 21:66–75

    Google Scholar 

  2. Ramkrishna R, Kulkarni BD (2013) Procedures used for reconstruction of lower extremity soft tissue defect. Indian J Appl Res 8:383–386

    Google Scholar 

  3. Hierner EL, Corterier C, Hierner R (2013) Lateral supramalleolar flaps for reconstruction in the ankle and foot. Oper Orthop Traumatol 25:122–130

    Article  CAS  PubMed  Google Scholar 

  4. Giessler GA, Schmidt AB (2013) Muscular and osteomuscular peroneus brevis flaps. Oper Orthop Traumatol 25:131–144

    Article  CAS  PubMed  Google Scholar 

  5. Kneser U, Beier JP, Dragu A, Arkudas A, Horch RE (2013) Peroneal artery perforator flap. Oper Orthop Traumatol 25:170–175

    Article  CAS  PubMed  Google Scholar 

  6. Knobloch K, Herold C, Vogt PM (2012) Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity. Oper Orthop Traumatol 24:122–130

    Article  CAS  PubMed  Google Scholar 

  7. Leclère FM, Schoofs M, Buys B, Mordon SR (2010) Outcomes after 1.9-microm diode laser-assisted anastomosis in reconstructive microsurgery: results in 27 patients. Plast Reconstr Surg 125:1167–1175

    PubMed  Google Scholar 

  8. Leclère FM, Schoofs M, Buys B (2011) Mordon SR (2011), 1.9 µm diode laser assisted vascular microanastomoses: experience in 40 clinical procedures. Lasers Surg Med 43:293–297

    Article  PubMed  Google Scholar 

  9. Leclère FM, Schoofs M, Auger F, Mordon S (2010) Blood flow assessment with magnetic resonance imaging after 1.9 µm diode laser assisted microvascular vein anastomosis. Lasers Surg Med 42:299–305

    Article  PubMed  Google Scholar 

  10. Wang L, Fu J, Li M, Han D, Yang L (2013) Repair of hand defects by transfer of free tissue flaps from toes. Arch Orthop Trauma Surg 133:141–146

    Article  PubMed  Google Scholar 

  11. Leclère FM, Schoofs M, Auger F, Mordon S (2011) Blood flow assessment with magnetic resonance imaging after 1.9 mum diode laser assisted arterial micronastomoses. Ann Chir Plast Esthet 56:540–547

    Article  PubMed  Google Scholar 

  12. Leclère FM, Martinot V, Schoofs M, Mordon S (2011) Thirty years of laser-assisted microvascular anastomosis (LAMA): what are the clinical perspectives? Neurochirurgie 57:1–8

    Article  PubMed  Google Scholar 

  13. Leclère FM, Schoofs M, Mordon S (2011) Historical review and future orientations of the conventional vascular microanastomoses. Ann Chir Plast Esthet 56:232–240

    Article  PubMed  Google Scholar 

  14. Hallock GG (1999) Minimally invasive harvest of the gracilis muscle. Plast Reconstr Surg 104:801–805

    Article  CAS  PubMed  Google Scholar 

  15. Tobin GR, Moberg AW (1981) The split latissimus dorsi myocutaneous flap. Ann Plast Surg 7:272–280

    Article  CAS  PubMed  Google Scholar 

  16. Van Landuyt K, Hamdi M, Blondeel P, Monstrey S (2003) The pyramidalis muscle free flap. Br J Plast Surg 56:585–592

    Article  PubMed  Google Scholar 

  17. Hwang K, Han JY, Chung IH (2004) Topographical anatomy of the anconeus muscle for use as a free flap. J Reconstr Microsurg 20:631–636

    Article  PubMed  Google Scholar 

  18. Medalie DA, Llull R, Heckler F (2011) The iliacus muscle flap: an anatomical and clinical evaluation. Plast Reconstr Surg 127:1553–1560

    Article  CAS  PubMed  Google Scholar 

  19. Piquilloud G, Villani F, Casoli V (2011) The medial head of the triceps brachii. Anatomy and blood supply of a new muscular free flap: the medial triceps free flap. Surg Radiol Anat 33:415–420

    Article  PubMed  Google Scholar 

  20. Leclère FM, Casoli V (2014) Reconstruction of a traumatic plantar foot defect with a new free flap : the medial triceps brachii free flap. JCLT [Epub ahead of print]

  21. Villani F, Piquilloud G, Casoli V (2012) The medial head of triceps brachii: a muscular flap. J Plast Reconstr Aesthet Surg 65:263–264

    Article  Google Scholar 

  22. Chan JK, Harry L, Williams G, Nanchahal J (2012) Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg 130:284–295

    Article  Google Scholar 

  23. Harry LE, Sandison A, Pearse MF, Paleolog EM, Nanchahal J (2009) Comparison of the vascularity of fasciocutaneous tissue and muscle for coverage of open tibial fractures. Plast Reconstr Surg 124:1211–1219

    Article  CAS  PubMed  Google Scholar 

  24. Liu R, Schindeler A, Little DG (2010) The potential role of muscle in bone repair. J Musculoskelet Neuronal Interact 10:71–76

    CAS  PubMed  Google Scholar 

  25. Gonzalez M, Weinzweig N (2005) Muscle flaps in the treatment of osteomyelitis of the lower extremity. J Trauma-Injury Infect Critical Care 58:1019–1023

    Article  Google Scholar 

  26. Wei W, Zuoliang Q, Xiaoxi L et al (1999) Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation. Plast Reconstr Surg 103:473–480

    Article  CAS  PubMed  Google Scholar 

  27. Yang D, Morris SF (1999) Neurovascular anatomy of the rectus femoris muscle related to functioning muscle transfer. Plast Reconstr Surg 104:102–106

    Article  CAS  PubMed  Google Scholar 

  28. Chuang DC, Mardini S, Lin SH, Chen HC (2004) Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis. Plast Reconstr Surg 113:126–132

    Article  PubMed  Google Scholar 

  29. MacQuillan A, Horlock N, Grobbelaar A, Harrison D (2004) Arterial and venous anatomical features of the pectoralis minor muscle flap pedicle. Plast Reconstr Surg 113:872–876

    Article  PubMed  Google Scholar 

  30. Godat DM, Sanger JR, Lifchez SD et al (2004) Detailed neurovascular anatomy of the serratus anterior muscle: implications for a functional muscle flap with multiple independent force vectors. Plast Reconstr Surg 114:21–29

    Article  PubMed  Google Scholar 

  31. Taylor GI, Cichowitz A, Ang SG, Seneviratne S, Ashton M (2003) Comparative anatomical study of the gracilis and coracobrachialis muscles: implications for facial reanimation. Plast Reconstr Surg 112:20–30

    Article  PubMed  Google Scholar 

  32. Leclère FM, Casoli V. Medial Triceps Brachii Free Flap in Reconstructive Surgery: Donor Site Morbidity. In Review

Download references

Conflict of interest

The authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Plastic Surgery and Burns Unit, University Hospital of Bordeaux FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France

    Anaïs Delgove, Franck Marie Leclère & Vincent Casoli

  2. Department Hand and Plastic Surgery, INSELSPITAL Bern Bern University, Bern, Switzerland

    Franck Marie Leclère

  3. Department Plastic Surgery, IRCCS Policlinico San Donato San Donato Milanese, Milan, Italy

    Federico Villani

  4. Department Plastic Surgery, CHAL Hôpital d’Annemasse, Annemasse, France

    Gael Piquilloud

  5. Department Plastic Surgery Edouard Herriot Hospital, University of Lyon, Lyon, France

    Ali Mojallal

Authors
  1. Anaïs Delgove
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franck Marie Leclère
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federico Villani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gael Piquilloud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Mojallal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vincent Casoli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franck Marie Leclère.

Additional information

A. Delgove and F. M. Leclère contributed equally to this study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPT 11171 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Delgove, A., Leclère, F.M., Villani, F. et al. Medial triceps brachii free flap in reconstructive surgery: a prospective study in eight patients. Arch Orthop Trauma Surg 135, 275–282 (2015). https://doi.org/10.1007/s00402-014-2102-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2102-9

Keywords

Search

Navigation