Vascular anatomy of muscle and skin

Skin blood flow is from a deep dermal plexus of vessels running parallel to the skin in the superficial fascia. This plexus is principally supplied from musculocutaneous perforators. These vessels are derived from the muscular pedicular vessels. The perforating vessels supply limited areas of overlying skin and form the basis of the 'random pattern' flap (Figure la).

Muscular blood supply is from one or more pedicular arteries. The muscle can be rotated on its pedicle, or the pedicle divided creating a 'free' flap (Figure la). A second pattern of blood supply occurs in defined anatomical regions (such as

Blood Supply Skin And Muscle

Figure 1. Blood supply to the skin, (a) Random pattern and myocutaneous flaps are based on perforating vessels from the muscle. The muscle can be rotated with or without the overlying skin, (b) An axial pattern flap, (c) A fasciocutaneous flap. This figure was first published in the BMJ (Davies DM Plastic and Reconstructive Surgery: Skin Cover, BMJ 1985, vol. 290, pp. 765-767) and is reproduced in modified form by permission of the BMJ.

Figure 1. Blood supply to the skin, (a) Random pattern and myocutaneous flaps are based on perforating vessels from the muscle. The muscle can be rotated with or without the overlying skin, (b) An axial pattern flap, (c) A fasciocutaneous flap. This figure was first published in the BMJ (Davies DM Plastic and Reconstructive Surgery: Skin Cover, BMJ 1985, vol. 290, pp. 765-767) and is reproduced in modified form by permission of the BMJ.

the groin flap on the superficial circumflex iliac artery), where a specific cutaneous artery arising from a large artery, runs superficially to muscle in the subcutaneous fat. These vessels reinforce the musculocutaneous blood supply. The flap is raised so the vessels run axially, which allows the flap to be raised for a greater length than a random pattern flap. Such flaps are known as 'axial pattern' flaps (Figure lb).

Random pattern flap size is limited, but can be increased by raising a flap with the deep fascia. This incorporates the superficial plexus of vessels into the random flap, forming a 'fasciocutaneous flap' (Figure lc).

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