Chapter 6 SURGICAL TECHNIQUE The patient is initially supine. The internal mammary (thoracic) vessels are identifi ed fi rst, to reduce the ischemic time of the fl ap later on, especially in bilateral reconstructions. The patient then is turned in prone position. The dissection starts at the craniomedial (fi g. 6.13), thin origin of the gluteus maximus muscle. Medially is the best starting point because perforators 6-8 cm from the midline, being too short, are not suitable as pedicle for the fl ap. The craniomedial edge of the gluteus maximus is identifi ed and the fascia is opened. 1. m. gluteus medius 2. m. gluteus maximus 3. m. tensor fasciae latae 4. sc perforator 1 4 2 3 Figure 6.13 Craniomedial dissection of the sc-GAP fl ap. Illustration of Greet Mommen, www.greetmommen.be. 103
5. lay-out phd DEFINITIEF_digitaal2
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