Principles of Microvascular Surgery.

• The most common -
Free flaps - muscle
» Latissimus dorsi and Rectus abdominis.
• Reliable.
• Large caliber.
• Long vascular pedicles.
• Relatively low donor site morbidity.
• Histology - muscle fibers that are not reinnervted
gradually degenerate and eventually replaced by
fat cells.
• Functional muscles -
Free flaps - muscle
» transfer of skeletal muscle by microvascular
anastomosis + reinervation by microsurgical technique.
» The working strength of a skeletal muscle is directly
proportional to the cross-section area of the contracting
muscle fibers.
» The range of muscle contraction is a factor of fiber
length.
» The donor muscle nerve should match the anatomy of
the recipient nerve as possible.
» Terzis, J Hand Surg 1978 - in rabbit rectus femoris -
despite 100% patency of the anastomosis, only 25%
working capacity.
» Importance of reestablishing correct resting tension.
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