Anatomy you can turn in your hands

The radial forearm fasciocutaneous flap in three stages: marking and exposing the radial artery at the wrist, raising the paddle with its fascia and dissecting the pedicle proximally, and the harvested free flap with the radial artery, venae comitantes, cephalic vein and palmaris longus.

General principles

The brachial plexus from roots to terminal branches: C5–T1 roots, the upper, middle and lower trunks, anterior and posterior divisions, the lateral, posterior and medial cords, and the nerves each gives off.

Upper limb & nerve

A deep inferior epigastric perforator flap: lower-abdominal skin and fat carried on perforators of the deep inferior epigastric vessels, with the pedicle dissected free of rectus abdominis — the standard autologous breast reconstruction.

Breast

The transverse upper gracilis (TUG) flap: a transverse ellipse of upper medial thigh skin and fat carried on the gracilis muscle and its proximal pedicle from the medial circumflex femoral vessels — an alternative autologous breast reconstruction when the abdomen is not available.

Breast

The pedicled omental flap: the greater omentum freed from the transverse colon and the greater curvature and turned up on the right gastroepiploic vessels to fill a sternal or chest wall wound — a Mathes–Nahai type III flap with two dominant pedicles.

Trunk & perineum

The anterolateral thigh perforator flap raised on the descending branch of the lateral circumflex femoral artery, shown with the skin island lifted away from the thigh and the perforators entering it between rectus femoris and vastus lateralis.

General principles

A transverse section through the distal forearm just above the wrist: radius and ulna, pronator quadratus, the flexor tendons and median nerve on the palmar side and the extensor compartments dorsally.

Hand

An interactive 3D model of the Zitelli bilobed flap: one flap with two lobes at 45° and 90° pivoting on a single point, the primary lobe filling the defect, the secondary lobe filling the primary donor site, Burow's triangle at the pivot and direct closure of the secondary donor.

General principles

Three equal limbs at 60°: how transposing the two triangular flaps lengthens the central limb by ~75% and reorients the scar.

General principles

A 60°/120° rhomboid defect closed by a transposition flap raised from the short diagonal, with four possible flap designs to choose from.

General principles

A semicircular flap rotating about a pivot point to close a triangular defect, with a back-cut or Burow's triangle to ease closure.

General principles

Behan's keystone design: a curvilinear trapezoidal island advanced on perforators, with V–Y closure at each end.

General principles

The annular and cruciate pulleys of the finger with the flexor tendons passing through — A2 and A4 highlighted as the biomechanically critical pulleys.

Hand