Objective To study the influence of the pedicle length on the perforator flaps in hemodynamics. Methods Four mature swine (2 males, 2 females; weight, 23.0±2.0 kg) were applied to the experiment.Two transverse abdominal skin flaps, based on the superior epigastric pedicle orits rectus abdominal muscle perforators, were designed; each swine was used as its own control. At 2 hours and 1, 2, 3 weeks postoperatively, the skin paddle perfusion and the blood stream velocity in the superior epigastric artery were measured by the Laser Doppler Flowmeter and the Color Doppler Ultrasound, respectively. Flap survival percentages were calculated by the grid method at 1 week postoperatively. The swine were euthanatized, and they underwent angiography at 3 weeks postoperatively. Results At 2 hours and 1 week after operation, edema of the perforator flaps with the superior epigastric pedicle was more severe than that of the skin flaps with the rectus abdominal muscle perforator, and the skin perfusion had a statistical difference between the two kindsof flaps (Plt;0.05). The skin paddle viability and the skin perfusion had nostatistical difference after the first week postoperatively (Pgt;0.05). At 2hours and 1 week after operation, the blood stream velocity in the superior epigastric artery in the perforator flap with the superior abdominal artery pediclewas reduced, and there was a statistical difference between the two kinds of flaps (Plt;0.05); however, the velocity was almost the same after the first week postoperatively. Conclusion The excessively long pedicle of the perforator skin flap may have an unfavorable influence on the flap perfusion,especially during the first week after operation, because of the vascular compromise during the dissection of the long pedicle. The blood vessel anastomosis atthis level of the blood vessels may have no relationship with the perforator flap in hemodynamics. This study can also indicate that the ligation of the branches in the recipient vessels cannot make the perforator flaps overperfused.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site.
MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap.
ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking.
ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
ObjectiveTo explore the feasibility and technical essentials of soft tissue defect reconstruction following malignant tumor removal of limbs using perforator propeller flaps.
MethodBetween July 2008 and July 2015, 19 patients with malignant limb tumor underwent defect reconstruction following tumor removal using the perforator propeller flaps. There were 13 males and 6 females with an average age of 53.4 years (range, 20-82 years). The disease duration ranged from 1 to 420 months (mean, 82 months). The tumors located at the thigh in 10 cases, at the leg in 2 cases, at the arm in 1 case, at the forearm in 1 case, around the knee in 2 cases, and around the elbow joint in 3 cases. Totally 23 flaps (from 8 cm×3 cm to 30 cm×13 cm in size) were used to reconstruct defects (from 4 cm×4 cm to 24 cm×16 cm in size). The potential source arteries included the femoral artery (n=2) , profunda femoral artery (n=3) , superficial circumflex iliac artery (n=1) , lateral circumflex femoral artery (n=6) , superior lateral genicular artery (n=2) , peroneal artery (n=2) , anterior tibial artery (n=1) , brachial artery (n=4) , and radial artery (n=1) . The remaining one was a free style perforator flap.
ResultsPartial distal flap necrosis occurred in 3 cases after surgery with rotation angles of 180, 150, and 100° respectively, which were reconstructed after debridement using a free-style perforator flap in 1 case and using free skin grafting in the other 2 cases. The other 20 flaps survived completely after surgery. Primary healing of incisions was obtained at the donor and recipient sites. There was no severe complication such as infection, hematoma, and total flap failure. All patients were followed up 3 months to 5 years (mean, 19 months). One patient with malignant melanoma around the elbow joint had tumor recurrence, and underwent secondary tumor resection. The appearance, texture, and color of the flaps were similar to those at the recipient site.
ConclusionsFor patients with malignant tumor of the limb, the perforator propeller flap can be an alternative option for soft tissue defect reconstruction after tumor resection, with the advantages of relatively simple operation and remaining the main vessels.
ObjectiveTo study the digital anatomy and application value of the thoracic dorsal artery based on CT angiography (CTA).
MethodsBetween September 2012 and June 2014, aorta CTA images were chosen from 10 cases (20 sides) undergoing aorta CTA. By using Mimics 17.0 software for three dimensional (3D) reconstruction of image post-processing, the digital vascular anatomical information were obtained after observing and measuring the origin of the thoracic dorsal artery, the number of perforators, type, inner diameter, and pedicle length; and the body surface location of perforator vessel was determined, and then the thoracic dorsal artery perforators tissue flap harvesting was simulated.
Results3D reconstruction images showed that the thoracic dorsal artery originated from subscapular artery, 76 perforator vessels were found, including 32 perforators (42.1%) from the medial branch of the thoracic dorsal artery and 44 perforators (57.9%) from the lateral branch of the thoracic dorsal artery, of which 69 were intramuscular perforators (90.8%) and 7 were direct skin artery (9.2%). The inner diameter of the thoracic dorsal artery was (1.69±0.23) mm, and its pedicle length was (2.12±0.64) cm. The first lateral perforator of the thoracic dorsal artery located at (1.65±0.42) cm above the horizontal line of the inferior angle of scapula and at (1.68±0.31) cm lateral to vertical line of the inferior angle of scapula. The first medial perforator located at (1.43 ±0.28) cm above the horizontal line of the inferior angle of scapula and at (1.41±0.28) cm lateral to vertical line of the inferior angle of scapula. The thoracic dorsal artery perforators flap harvesting was successfully simulated.
ConclusionCTA is a more intuitive method to study the thoracic dorsal artery in vivo, it can clearly display 3D information of the main blood supply artery course and distribution after flap reconstruction, so it can effectively and accurately guide the design of the flap.
Objective To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm.Results All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. ConclusionThe two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
ObjectiveTo explore the effectiveness of pedicled thoracoacromial artery perforator (TAAP) flap for pharyngocutaneous fistula repair after total laryngectomy and radiotherapy.
MethodsBetween February 2012 and January 2015, TAAP flap was used to repair pharyngocutaneous fistula after total laryngectomy and radiotherapy in 8 patients. The eight patients were male, aged from 46 to 72 years (mean, 51.8 years). The disease duration was 8-62 months (mean, 27.5 months). Fistula size ranged from 4.0 cm×2.5 cm to 6.0 cm×4.0 cm and the skin defect size ranged from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. The flap size ranged from 7.0 cm×4.0 cm×0.3 cm to 9.5 cm×6.0 cm×0.5 cm. The length of pedicle was (8.3±0.5)mm. The distance from pivot point of flap to central point of recipient site was (94.5±1.9) mm.
ResultsAll 8 flaps survived and all incisions healed smoothly. The hospitalization time was 7-14 days (mean, 9.6 days). The barium meal examination showed no fistula or stenosis. The patients were followed up 8-42 months (mean, 28.5 months). During follow-up, the neck appearance was good, and no fistulas or stenosis occurred. Only linear scars were observed at the donor sites, pectoralis major muscle function was normal in all patients.
ConclusionPharyngocutaneous fistula should be repaired as early as possible after total laryngectomy. TAAP flap is suitable for the reconstruction of pharyngocutaneous fistula after total laryngectomy.
Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree III and 18 cases of degree IV according to the standard of the National Pressure Ulcer Advisory Panel(NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm × 6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.
Objective To evaluate 5 different kinds of perforator flaps for repairing soft-tissue defects and reconstructing the breast and tongue after the breast or the tongue resection.Methods From June 2005 to June 2006, 31 free or pedicled perforator flaps were used to repair the softtissue defects or reconstruct the organs in our hospital. The free anterolateral thigh flaps (ALT) were used in 16 cases to repair the soft-tissue defects in the head and neck after resection of malignant tumors, including malignant melanoma in 9, squamous carcinoma in 4, basaloma in 2 and malignant fibrous histocytoma in 1.Among them, 3 ALT flaps were used for reconstruction of the tongue after resection of the tongue (3/4); the maximum area of the flap was 26 cm×15 cm. The deep inferior epigastric perforator flaps (DIEP) were used in 10 cases, and the free transverse rectus abdominis myocutaneous flaps (FTRAM) were used in 2 cases to reconstruct the breast.Secondary reconstruction was performed in9 cases, immediate reconstruction with the skin-sparing mastectomy at the sametime was performed in 3 cases. The bilateral breast reconstruction was performed in 3 cases and the unilateral breast reconstruction was performed in 9 cases. The breast reconstruction was performed in 1 case using the superior gluteal artery perforator flap (SGAP) and the inferior gluteal artery perforator flap (IGAP), respectively. One case had an uncovered bone (6 cm × 4 cm) in the middle andlower parts of the right cnemis, which was repaired by the pedicled local posterior tibial artery perforator flap (PTA,15 cm × 5 cm). The donor sites were sutured directly in 27 cases, the ALT flap in 3 and PTA flap in 1 were covered by the epidermal skin graft. Results The follow-up for 3-6 months revealed that in the 31 cases (33 free flaps, 1 pedicled flap), only 1 had a total necrosis of the transferred ALT flap for the neck defect repair after resection of the neck tumor, which was caused by the venous insufficiency. There was nopartial necrosis in the remaining ALT flaps. There was a partial fat liquefaction in the DIEP flap, and a pain of abdomen in the FTRAM flap. The distal partial necrosis occurred in the pedicled PTA flap (2 cm×1 cm) in 1 case, as a result of the venous insufficiency, which was managed successfully using daily dressings. One SGAP and one IGAP survived. ConclusionAlthough the perforator dissection is difficult and the vascular anatomy is complicated, application of the perforator flaps to repair of the softtissue defects and reconstruction of the organs is still an important step forward becaue of the minimal donor site “cost” and the maximal efficacy.
Objective To investigate a best method of obtaining the sural neurofasciocutaneous flap by observing the models of different pedicles based sural neurofasciocutaneous flaps in rabbits and the effect of different pedicles on the survival of the flaps. Methods Forty adult New Zealand rabbits (male or female, weighing 2.5-3.0 kg) were randomly divided into 4 groups (10 rabbits in each). The flaps of 7 cm × 1 cm were designed at the lateral hind legs, and the pedicle was 0.5 cmin length. In group A, the flaps were elevated based on a single perforator pedicle; in group B, the flaps were elevated based on fascia pedicle; in group C, the flaps were elevated based on perforator-plus fascia pedicle; and in group D, the flaps were elevated and sutured in situ. At 7 days after operation, the flap survival rate was recorded, and the blood flow in the center of the flap was monitored by laser doppler flowmetry. The perfusion unit (PU) was measured. Results After operation, the flaps had no obvious swell ing, and the flaps had good color at the proximal end, but pale at the distal end in groups A and B. Obvious swell ing was observed with pale color at the distal flaps in group C, but swell ing decreased gradually. However, the skin color became dark gradually in group D after operation. The flap survival rates were 74.0% ± 2.7%, 60.0% ± 2.5%, 75.0% ± 3.5%, and 0 in groups A, B, C, and D respectively after 7 days of operation. The PU values were 83.39 ± 4.25, 28.96 ± 13.49, 81.85 ± 5.93, and 8.10 ± 3.36 in groups A, B, C, and D respectively. There were significant differences in flap survival rates and PU values between groups A, B, C and group D (P lt; 0.05). Significant differences were found between groups A, C and group B (P lt; 0.05), but no significant difference between group A and group C (P gt; 0.05). Conclusion The sural neurofasciocutaneous flap based on a single perforator pedicle has a rel iable blood supply and enough venous drainage, which is one of the best methods to obtain the sural neurofasciocutaneous flap.
Objective To introduce the new progress of perforator flaps as an new reconstruction technique. Methods The literature both at home and abroad was reviewed, and the research findings of different perforator flaps were summarized. Results The advantage of perforator flaps versus musculocutaneous flaps was the reduced morbidity of the donor site with preservation of the nerves, muscles and deep fascia. The postoperative complications at donor sites reduced. Conclusion Perforator flap was the new and reliable technique forreconstructionof tissue defect and may be one of the primary choices in the future.
