Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yangjian ^1,2 , HUA Zuguang ² , WEI Peng ² , REN Tiantian ² , XU Yi ² ,  XU Youjia ¹

1. Department of Orthopaedics, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215004, P.R.China;
2. Department of Reparative and Reconstructive Surgery, Ningbo First Hospital, Ningbo Zhejiang, 315010, P.R.China;

Corresponding?author：

XU Youjia, Email: xuyoujia@suda.edu.cn

Keywords：

Propeller flap; free-style perforator flap; malignant tumor; wound repair; thigh

DOI：

10.7507/1002-1892.202104052

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Objective To explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh.Methods Between December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade.Results The distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal.Conclusion Based on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.

Citation： WANG Yangjian, HUA Zuguang, WEI Peng, REN Tiantian, XU Yi, XU Youjia. Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1177-1181. doi: 10.7507/1002-1892.202104052 Copy

1.	劉元波, 王欣, 張世民, 等. “帶蒂穿支皮瓣常見并發癥原因分析與防治” 專家共識. 中華顯微外科雜志, 2017, 40(2): 105-108.
2.	唐舉玉, 汪華僑, 章一新, 等. 關注皮瓣供區問題——減少皮瓣供區損害專家共識. 中華顯微外科雜志, 2018, 41(1): 3-5.
3.	韓婷璐, 臧夢青, 朱珊, 等. 以旋股外側動脈不同分支來源的穿支為蒂的螺旋槳皮瓣手術設計和臨床應用. 中華整形外科雜志, 2019, 35(9): 854-861.
4.	Iida T, Yoshimatsu H, Koshima I. Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Ann Plast Surg, 2017, 79(4): 385-389.
5.	Liu Y, Ding Q, Zang M, et al. Classification and application of the distally-based thigh flap based on the lateral circumflex femoral artery system. Ann Plast Surg, 2017, 78(5): 497-504.
6.	Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
7.	Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
8.	Chaput B, Bertheuil N, Grolleau JL, et al. Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: a prospective study. Mrcrosurgery, 2018, 38(2): 177-184.
9.	Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: a comparison. J Plast Reconstr Aesthet Surg, 2019, 72(2): 181-187.
10.	Falinower H, Herlin C, Laloze J, et al. Use of the propeller lumbar perforator flap: a series of 32 cases. Plast Reconstr Surg Glob Open, 2020, 8(1): e2522. doi: 10.1097/GOX.0000000000002522.
11.	周慧霞. 9例隆突性皮膚纖維肉瘤的臨床病理特征分析. 實用癌癥雜志, 2019, 34(6): 1044.
12.	Levine SM, Shapiro RL. Surgical treatment of malignant melanoma: practical guidelines. Dermatol Clin, 2012, 30(3): 487-501.
13.	陳林海, 林光豪, 魏鵬, 等. 體表軟組織惡性腫瘤根治術后創面的一期顯微修復. 中華顯微外科雜志, 2018, 41(6): 529-533.
14.	Luz FB, Ferron C, Cardoso GP. Surgical treatment of basal cell carcinoma: an algorithm based on the literature. An Bras Dermatol, 2015, 90(3): 377-383.
15.	王揚劍, 李學淵, 王勝偉, 等. 術前多普勒定位的自由式穿支螺旋槳皮瓣設計. 同濟大學學報 (醫學版), 2016, 37(4): 109-114.
16.	徐毅, 王揚劍, 陳芝武, 等. 跨區帶蒂腓動脈穿支皮瓣局部并發癥血流動力學相關原因分析. 中華整形外科雜志, 2019, 35(12): 1221-1225.
17.	Blondeel PN, Morris SF, Hallock GG, et al. Perforator flaps: anatomy, technique and clinical applications. 2nd ed. St. Louis: Quality Medical Publishing (Missouri), 2013: 668-684.
18.	陳永中, 黃俊英, 薛蘭, 等. 跨區皮瓣切取后choke血管管徑的定量分析及MMP-2與MMP-9的表達. 中國臨床解剖學雜志, 2017, 35(5): 526-531.
19.	李文波, 張超, 石杰, 等. 穿支皮瓣中choke?vessels的新生過程研究及 “血管體” 概念. 中國組織工程研究, 2018, 22(8): 1261-1266.
20.	Cormack GC, Lamberty BG. Cadaver studies of correlation between vessel size and anatomical territory of cutaneous supply. Br J Plast Surg, 1986, 39(3): 300-306.
21.	唐茂林, 劉元波. 穿支皮瓣的解剖學研究進展. 中華整形外科雜志, 2018, 34(9): 785- 790.
22.	Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg, 1991, 44(1): 53-54.
23.	Pignatti M, Ogawa R, Hallock GG, et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg, 2011, 127(2): 716-722.
24.	趙書明, 劉亞明, 劉娜, 等. CT血管造影輔助下逆行股前外側穿支皮瓣修復膝周或小腿近端皮膚及軟組織缺損的臨床效果. 中華燒傷雜志, 2021, 37(4): 356-362.

1. 劉元波, 王欣, 張世民, 等. “帶蒂穿支皮瓣常見并發癥原因分析與防治” 專家共識. 中華顯微外科雜志, 2017, 40(2): 105-108.
2. 唐舉玉, 汪華僑, 章一新, 等. 關注皮瓣供區問題——減少皮瓣供區損害專家共識. 中華顯微外科雜志, 2018, 41(1): 3-5.
3. 韓婷璐, 臧夢青, 朱珊, 等. 以旋股外側動脈不同分支來源的穿支為蒂的螺旋槳皮瓣手術設計和臨床應用. 中華整形外科雜志, 2019, 35(9): 854-861.
4. Iida T, Yoshimatsu H, Koshima I. Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Ann Plast Surg, 2017, 79(4): 385-389.
5. Liu Y, Ding Q, Zang M, et al. Classification and application of the distally-based thigh flap based on the lateral circumflex femoral artery system. Ann Plast Surg, 2017, 78(5): 497-504.
6. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
7. Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
8. Chaput B, Bertheuil N, Grolleau JL, et al. Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: a prospective study. Mrcrosurgery, 2018, 38(2): 177-184.
9. Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: a comparison. J Plast Reconstr Aesthet Surg, 2019, 72(2): 181-187.
10. Falinower H, Herlin C, Laloze J, et al. Use of the propeller lumbar perforator flap: a series of 32 cases. Plast Reconstr Surg Glob Open, 2020, 8(1): e2522. doi: 10.1097/GOX.0000000000002522.
11. 周慧霞. 9例隆突性皮膚纖維肉瘤的臨床病理特征分析. 實用癌癥雜志, 2019, 34(6): 1044.
12. Levine SM, Shapiro RL. Surgical treatment of malignant melanoma: practical guidelines. Dermatol Clin, 2012, 30(3): 487-501.
13. 陳林海, 林光豪, 魏鵬, 等. 體表軟組織惡性腫瘤根治術后創面的一期顯微修復. 中華顯微外科雜志, 2018, 41(6): 529-533.
14. Luz FB, Ferron C, Cardoso GP. Surgical treatment of basal cell carcinoma: an algorithm based on the literature. An Bras Dermatol, 2015, 90(3): 377-383.
15. 王揚劍, 李學淵, 王勝偉, 等. 術前多普勒定位的自由式穿支螺旋槳皮瓣設計. 同濟大學學報 (醫學版), 2016, 37(4): 109-114.
16. 徐毅, 王揚劍, 陳芝武, 等. 跨區帶蒂腓動脈穿支皮瓣局部并發癥血流動力學相關原因分析. 中華整形外科雜志, 2019, 35(12): 1221-1225.
17. Blondeel PN, Morris SF, Hallock GG, et al. Perforator flaps: anatomy, technique and clinical applications. 2nd ed. St. Louis: Quality Medical Publishing (Missouri), 2013: 668-684.
18. 陳永中, 黃俊英, 薛蘭, 等. 跨區皮瓣切取后choke血管管徑的定量分析及MMP-2與MMP-9的表達. 中國臨床解剖學雜志, 2017, 35(5): 526-531.
19. 李文波, 張超, 石杰, 等. 穿支皮瓣中choke?vessels的新生過程研究及 “血管體” 概念. 中國組織工程研究, 2018, 22(8): 1261-1266.
20. Cormack GC, Lamberty BG. Cadaver studies of correlation between vessel size and anatomical territory of cutaneous supply. Br J Plast Surg, 1986, 39(3): 300-306.
21. 唐茂林, 劉元波. 穿支皮瓣的解剖學研究進展. 中華整形外科雜志, 2018, 34(9): 785- 790.
22. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg, 1991, 44(1): 53-54.
23. Pignatti M, Ogawa R, Hallock GG, et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg, 2011, 127(2): 716-722.
24. 趙書明, 劉亞明, 劉娜, 等. CT血管造影輔助下逆行股前外側穿支皮瓣修復膝周或小腿近端皮膚及軟組織缺損的臨床效果. 中華燒傷雜志, 2021, 37(4): 356-362.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh

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