Clinical application of thoracodorsal artery perforator flap in repair of serious scar contracture of opisthenar_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAO Haitao , WANG Huaisheng , LIU Yong , ZHANG Yuting ,  LIU Xiaoxue ,  XU Xuewen

Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

LIU Xiaoxue, Email: liuxiaoxue0930@126.com; XU Xuewen, Email: xxw_0826@163.com

Keywords：

Thoracodorsal artery perforator flap; scar contracture; opisthenar; repair

DOI：

10.7507/1002-1892.201809091

Video：

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Objective To investigate the feasibility and effectiveness of thoracodorsal artery perforator (TDAP) flap for repairing serious scar contracture of the opisthenar. Methods Between March 2015 and June 2017, 7 cases of serious scar contracture of opisthenar were repaired with TDAP flaps. There were 5 males and 2 females with an average age of 31 years (range, 11-48 years). The time from injury to operation was 8-67 months, with an average of 42 months. After the relocation of the joint and release of the scar, the size of soft tissue defect ranged from 5 cm×4 cm to 10 cm×8 cm. The size of TDAP flap ranged from 5.5 cm×5.0 cm to 10.5 cm×9.0 cm. Results All flaps survived completely with primary healing at both donor site and recipient site. The flaps of 3 patients were bulky and underwent second-stage skin flap thinning at 3 months after operation. All 7 patients were followed up 6-32 months, with an average of 15 months. The skin flaps were soft and elastic. According to the upper limb function evaluation system recommended by Chinese Society of Hand Surgery, sensory function was classified as in 2 cases, in 1 case, in 3 cases, and in 1 case. The hand function was excellent in 2 cases, good in 4 cases, and fair in 1 case. There was no significant effect on shoulder movement. Conclusion The TDAP flap is an ideal method for serious scar contracture of opisthenar.

Citation： XIAO Haitao, WANG Huaisheng, LIU Yong, ZHANG Yuting, LIU Xiaoxue, XU Xuewen. Clinical application of thoracodorsal artery perforator flap in repair of serious scar contracture of opisthenar. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(6): 717-720. doi: 10.7507/1002-1892.201809091 Copy

1.	閆濤, 黎立, 喬為民, 等. 前臂骨間背側動脈逆行島狀皮瓣修復手部創面. 中國修復重建外科雜志, 2011, 25(3): 377-378.
2.	White CP, Steve AK Jr, Buchel EW, et al. Reverse radial artery flap perforator anatomy and clinical applications. Ann Plast Surg, 2016, 77(3): 345-349.
3.	吳焱秋, 柴家科, 孫天俊, 等. 腹部攜帶皮瓣在瘢痕性爪形手畸形修復中的應用. 感染、炎癥、修復, 2008, 9(3): 165-167.
4.	Azizeddin A, Choong PFM, Grinsell D. Reconstructive options for large back free flap donor sites. ANZ J Surg, 2018, 88(10): 1066-1070.
5.	張鐵慧, 童致虹, 楊衛東, 等. 游離股前外側皮瓣修復四肢軟組織缺損. 中華顯微外科雜志, 2006, 29(1): 9.
6.	王相, 張凱威, 毛根蓮, 等. 端側吻合動脈的游離上臂內側皮瓣修復手背皮膚缺損. 中華手外科雜志, 2014, 30(1): 72-73.
7.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-134.
8.	Brown M, Chung KC. Postburn contractures of the hand. Hand Clin, 2017, 33(2): 317-331.
9.	Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg, 1995, 96(7): 1608-1614.
10.	尹路, 宮可同, 殷中罡, 等. 游離穿支皮瓣聯合游離植皮修復足踝部軟組織缺損的療效觀察. 中國修復重建外科雜志, 2017, 31(3): 319-322.
11.	Thomas BP, Geddes CR, Tang M, et al. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg, 2005, 116(3): 818-822.
12.	李濤, 陳振兵, 翁雨雄, 等. T形血管吻合的游離胸背動脈穿支皮瓣的臨床應用. 中華手外科雜志, 2015, 31(1): 56-60.
13.	Shaw RJ, Ho MW, Brown JS. Thoracodorsal artery perforator-scapular flap in oromandibular reconstruction with associated large facial skin defects. Br J Oral Maxillofac Surg, 2015, 53(6): 569-571.
14.	孫濤, 王曉峰, 周堅龍, 等. 胸背動脈穿支皮瓣修復手部皮膚軟組織缺損35例. 中華顯微外科雜志, 2016, 39(3): 221-224.
15.	莊加川, 張振偉, 李敏姣, 等. 胸背動脈穿支皮瓣修復手部皮膚缺損的臨床應用. 中華手外科雜志, 2018, 34(3): 161-163.
16.	龐夢茹, 肖海濤, 王懷勝, 等. 應用不同皮瓣修復手掌重度瘢痕攣縮畸形的臨床分析. 中國修復重建外科雜志, 2016, 30(3): 382-384.
17.	姚志浩, 黃馗, 羅世洪, 等. CT 血管造影輔助設計股前外側(肌)皮瓣修復口腔頜面部軟組織缺損. 中國修復重建外科雜志, 2017, 31(6): 702-708.
18.	Tashiro K, Yamashita S, Araki J, et al. Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators. J Plast Reconstr Aesthet Surg, 2016, 69(3): 346-350.
19.	Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.

1. 閆濤, 黎立, 喬為民, 等. 前臂骨間背側動脈逆行島狀皮瓣修復手部創面. 中國修復重建外科雜志, 2011, 25(3): 377-378.
2. White CP, Steve AK Jr, Buchel EW, et al. Reverse radial artery flap perforator anatomy and clinical applications. Ann Plast Surg, 2016, 77(3): 345-349.
3. 吳焱秋, 柴家科, 孫天俊, 等. 腹部攜帶皮瓣在瘢痕性爪形手畸形修復中的應用. 感染、炎癥、修復, 2008, 9(3): 165-167.
4. Azizeddin A, Choong PFM, Grinsell D. Reconstructive options for large back free flap donor sites. ANZ J Surg, 2018, 88(10): 1066-1070.
5. 張鐵慧, 童致虹, 楊衛東, 等. 游離股前外側皮瓣修復四肢軟組織缺損. 中華顯微外科雜志, 2006, 29(1): 9.
6. 王相, 張凱威, 毛根蓮, 等. 端側吻合動脈的游離上臂內側皮瓣修復手背皮膚缺損. 中華手外科雜志, 2014, 30(1): 72-73.
7. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-134.
8. Brown M, Chung KC. Postburn contractures of the hand. Hand Clin, 2017, 33(2): 317-331.
9. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg, 1995, 96(7): 1608-1614.
10. 尹路, 宮可同, 殷中罡, 等. 游離穿支皮瓣聯合游離植皮修復足踝部軟組織缺損的療效觀察. 中國修復重建外科雜志, 2017, 31(3): 319-322.
11. Thomas BP, Geddes CR, Tang M, et al. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg, 2005, 116(3): 818-822.
12. 李濤, 陳振兵, 翁雨雄, 等. T形血管吻合的游離胸背動脈穿支皮瓣的臨床應用. 中華手外科雜志, 2015, 31(1): 56-60.
13. Shaw RJ, Ho MW, Brown JS. Thoracodorsal artery perforator-scapular flap in oromandibular reconstruction with associated large facial skin defects. Br J Oral Maxillofac Surg, 2015, 53(6): 569-571.
14. 孫濤, 王曉峰, 周堅龍, 等. 胸背動脈穿支皮瓣修復手部皮膚軟組織缺損35例. 中華顯微外科雜志, 2016, 39(3): 221-224.
15. 莊加川, 張振偉, 李敏姣, 等. 胸背動脈穿支皮瓣修復手部皮膚缺損的臨床應用. 中華手外科雜志, 2018, 34(3): 161-163.
16. 龐夢茹, 肖海濤, 王懷勝, 等. 應用不同皮瓣修復手掌重度瘢痕攣縮畸形的臨床分析. 中國修復重建外科雜志, 2016, 30(3): 382-384.
17. 姚志浩, 黃馗, 羅世洪, 等. CT 血管造影輔助設計股前外側(肌)皮瓣修復口腔頜面部軟組織缺損. 中國修復重建外科雜志, 2017, 31(6): 702-708.
18. Tashiro K, Yamashita S, Araki J, et al. Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators. J Plast Reconstr Aesthet Surg, 2016, 69(3): 346-350.
19. Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of thoracodorsal artery perforator flap in repair of serious scar contracture of opisthenar

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