Anatomical basis for a technic of cutting flaps out of the musculus rectus femoris for creating a rectal sphincter apparatus

As demonstrate the surgical anatomy investigations of the m. rectus femoris performed in 100 preparations, obtained from corpses of persons belonging to various age periods, in connection with sphincteroplasty the vascular-nervous hilus of the muscle is projected at the level of the upper third of its medial part. The ascending branch of the lateral femoral circumflex artery with the vein of the same name and the muscular branch of the femoral nerve get into their composition. The intramuscular course of the vessels and nerves of the I-III orders of branching and that of the muscular fasciculi coincide. For the sphincteroplasty it is expedient to use muscular-tendinous flaps, cut out from the medial part of the musculus.     

Uses of the rectus femoris myocutaneous flap.

The rectus femoris myocutaneous flap is quite useful for definitive immediate coverage of complex wounds within its territorial arc. We describe 4 cases to illustrate the capabilities of this flap. The indications for, the anatomy of, and the surgical technique for transfer, as well as the functional sequelae in two nonparaplegic patients are discussed.     

Donor-site morbidity of the pedicled rectus femoris muscle flap

The rectus femoris muscle flap is well known for its reliable anatomy, the ease with which it can be harvested, and its great versatility. As a pedicled or free flap, it is used to cover soft-tissue defects and to recreate motor function. Although the muscle is very reliable, it is not well respected because of its assumed donor-site morbidity, such as weakened knee extension force and decreased range of motion of the knee. To date, these clinical assumptions have only rarely been quantified in terms of objective scores, concerning force deficit and functional or aesthetic outcome. From 1995 to 2002, the authors treated 24 patients with pedicled rectus femoris muscle flaps. Fourteen patients were followed up. Follow-up time ranged from 3 to 56 months postoperatively. The results were evaluated by a standard questionnaire in which pain in relation to walking distance, subjective feeling of weakness, sensibility disorders, everyday function, and aesthetic aspects were assessed. Range of motion in the hip and the knee was measured. For objective verification of a decrease of maximal voluntary contraction force of the remaining quadriceps muscle and for detecting differences in true muscular capacity and voluntary activation, 10 patients with unilateral rectus femoris flaps were tested using the twitch interpolation technique. The authors' patients assessed the remaining function and the aesthetic result of the thigh as at least satisfactory. Two patients complained about pain and weakness in the thigh. Eight patients reported hypesthesia in the lateral suprapatellar region. The maximal voluntary contraction and true muscular capacity values were reduced by 21.8 percent and 18 percent, respectively, when compared with the healthy leg. The range of motion in the knee and hip was not influenced by muscle harvesting. The twitch interpolation technique revealed a mild voluntary activation deficit, probably caused by inhibitory regulation in the spinal cord. In conclusion, donor-site morbidity of the rectus femoris muscle flap is evident but well compensated. There is no decrease in active range of motion in the knee and hip. Patient satisfaction with the functional and aesthetic outcome was high.     

Correction of extracapsular temporomandibular joint ankylosis with a cervical subcutaneous pedicle flap

A new method of correcting extracapsular temporomandibular joint ankylosis with a cervical subcutaneous pedicle flap is described. In this procedure, a cervical subcutaneous pedicle flap with or without platysma is introduced into the oral cavity through a tunnel to repair the defect after the buccal scar is excised and the normal oral opening is restored. Sixteen consecutive patients underwent the surgery, and good results were obtained.     

Reconstruction of the entire upper eyelid area with a subcutaneous pedicle flap based on the orbicularis oculi muscle

Lagophthalmos caused by trauma or inflammation may damage the cornea and, if not adequately treated, may result in loss of eyesight. Hence surgical intervention is required at the earliest possible stage. We have developed a subcutaneous pedicle flap elevated from the temporozygomatic area and rotated 180 degrees around a small pedicle base that contains the orbicularis oculi muscle. With this flap, the entire upper eyelid can be reconstructed as an aesthetic unit in one stage so that the result is satisfactory not only functionally, but also cosmetically. The operative procedure is presented along with case reports.