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Chrelias T, Berkane Y, Rousson E, Uygun K, Meunier B, Kartheuser A, Watier E, Duisit J, Bertheuil N. Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction. J Clin Med 2023; 12:4014. [PMID: 37373707 DOI: 10.3390/jcm12124014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed-12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.
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Affiliation(s)
- Theodoros Chrelias
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
- MICMAC, UMR INSERM U1236, Rennes University Hospital, 35033 Rennes, France
| | - Etienne Rousson
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Korkut Uygun
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bernard Meunier
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Alex Kartheuser
- Colorectal Surgery Unit, Department of Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Jérôme Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Department of Plastic and Reconstructive Surgery, Hôpitaux IRIS Sud, 1050 Brussels, Belgium
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- MICMAC, UMR INSERM U1236, Rennes University Hospital, 35033 Rennes, France
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Clinical reliability of pedicled perforator flaps in the management of adult limb and trunk soft tissue sarcomas: Experience of two French expert centres. J Plast Reconstr Aesthet Surg 2022; 75:4361-4370. [PMID: 36266210 DOI: 10.1016/j.bjps.2022.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Limb-sparing surgery combined with radiation has become the standard treatment for soft tissue sarcomas. Despite the many advantages of reconstruction procedures, such as muscle-sparing flap and local reconstruction, the use of pedicled perforator flaps remains non-consensual due to doubts about their reliability when associated with radiotherapy. This study evaluated their surgical reliability in reconstructive surgery for limb and trunk soft tissue sarcomas, in terms of healing time, wound disorders, and postoperative complications, regardless of radiation timing. PATIENTS AND METHODS We realized a retrospective, observational, bi-center study (Cancer University Institute of Toulouse Oncopole, France and Bergonié Institute Bordeaux, France) and describes pedicled perforator flaps performed between January 2015 and January 2021. RESULTS A total of 74 flaps were included. The median age of the population was 70-year-old. The group consisted of 68.8% (n = 51/74) propeller flaps. We found a partial necrosis rate of 28.4% (n = 21/74), scar disunion of 48.6% (n = 36/74), local infection of 10.8% (n = 8/74), and venous congestion of 13.5% (n = 10/74). Only 16.2% (n = 12/74) required secondary surgical repair to a local complication. The average length of stay was 7.3 days [1.0-25.0]. The mean operating time of our flaps was 133.4 min [38.0-280.0]. CONCLUSIONS Pedicled perforator flaps are a surgical technique that can be used in reconstructive surgery for limb and trunk soft tissue sarcomas in adults, regardless of radiation timing. However, these flaps carry a high rate of postoperative complications so they should be reserved for expert surgeons in referral centers.
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Knee Reconstruction following Sarcoma Resection Utilizing Pedicled Anterolateral Thigh Propeller Flap: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4107. [PMID: 35169531 PMCID: PMC8830920 DOI: 10.1097/gox.0000000000004107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Coverage of knee wounds with exposure or violation of the joint capsule has long been a challenge to plastic surgeons. Wide resection and radiation treatment for soft-tissue sarcomas further this difficulty due to resultant diminished vascularity and soft tissue fibrosis. Traditional muscle flaps such as the gastrocnemius may be within the radiated field, limiting their arc of rotation to the knee. We present a series of exposed knee joint reconstructions using pedicled propeller flaps after sarcoma resection. Three patients diagnosed with soft tissue sarcomas underwent neoadjuvant radiation followed by wide local resection by orthopedic oncology. All patients had underlying knee joint exposure and underwent successful soft tissue reconstruction utilizing pedicled anterolateral thigh (ALT) propeller flaps. The ALT flap is widely used in plastic surgery for reconstruction of soft tissue defects due to its reliable vascularity, long pedicle, versatility, low donor-site morbidity, and large size. As a propeller flap, we demonstrate this is a viable alternative for reconstruction when the vascular plexus around the knee is unreliable after neoadjuvant radiation. Extending the ALT propeller flap with a large proximal skin paddle provides a nonmicrosurgical alternative to traditional muscle flaps at this location. The ALT propeller flap is an excellent option for reconstruction of large defects of the knee, especially in the setting of a radiated wound bed with unpredictable vascularity. In our case series, all three patients underwent successful reconstruction of exposed knee joints after resection of soft tissue sarcoma utilizing ALT propeller flaps.
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Bertheuil N, Leclere FM, Bekara F, Watier E, Flécher E, Duisit J. Superior epigastric artery perforator flap for reconstruction of deep sternal wound infection. Microsurgery 2021; 41:405-411. [PMID: 33844355 DOI: 10.1002/micr.30743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The treatment of deep wound sternal infection requires loco-regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the superior epigastric artery perforator (SEAP) flaps to repair sternal defect. PATIENTS AND METHODS Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53-83) years. The mean length and width of the defect were 16.2 × 7 cm (ranging 8-20 × 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° to cover the defect. RESULTS All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 × 7.3 cm (ranging 14-27 × 6-9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2-years postoperative follow-up all-patients were alive with a successful mediastinal cover. CONCLUSIONS The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.
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Affiliation(s)
- Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France.,INSERM U1236, University of Rennes 1, Rennes, France.,SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France
| | - Franck-Marie Leclere
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU of Poitiers, Poitiers, France
| | - Farid Bekara
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU of Montpellier, Montpellier, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Erwan Flécher
- Department of cardiac and thoracic surgery, CHU of Rennes, Rennes, France
| | - Jérôme Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, St. Luke's Hospital, Sacred Heart Division, 1230 South Cedar Crest Boulevard, Suite 306, Allentown, Pa. 18103,
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Chaput B, Meresse T, Bekara F, Grolleau JL, Gangloff D, Gandolfi S, Herlin C. Lower limb perforator flaps: Current concept. ANN CHIR PLAST ESTH 2020; 65:496-516. [PMID: 32753250 DOI: 10.1016/j.anplas.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022]
Abstract
Following a long period dominated by random fasciocutaneous flaps or muscle flaps, solutions to cover the lower limb have been largely diversified by the advent of so-called "perforator" flaps. Extended knowledge of vascular anatomy has propagated the development of this innovative procedure, in the objective of reducing morbidity. The existence of close to 400 perforator vessels in the body makes it possible to offer new flap perspectives for many defects, which were sometimes previously impossible to manage before except by free flap. For us, perforator flaps have become the current first-line solutions for small to medium size loss of substances. Understanding of vascular physiology and surgical experience are essential in choosing indications, detecting perforators, and modeling flaps to be optimally positioned in the reconstructive decisional algorithm. New skills are needed to master this type of reconstruction and limit failures, which implies a learning curve not only for flap design, perforator detection and surgical procedure, but also for monitoring and management of complications. In this manuscript, we outline the concepts and principles of the majority of the pedicled perforator flaps available for coverage of the lower limb, based on experience of more than 400 perforator flaps suitable for this localization.
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Affiliation(s)
- B Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, 31000 Toulouse, France.
| | - T Meresse
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, 34000 Montpellier, France
| | - F Bekara
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, 34000 Montpellier, France
| | - J L Grolleau
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, 31000 Toulouse, France
| | - D Gangloff
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, 34000 Montpellier, France
| | - S Gandolfi
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, 31000 Toulouse, France; Department of Plastic and Hand Surgery, CHU Charles Nicolle, 76000 Rouen, France
| | - C Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, 34000 Montpellier, France
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Abstract
The use of thermography for the identification of cutaneous "hot spots" that coincide with perforators is not a new concept, but the required professional cameras may be prohibitively expensive. Only relatively recently, incredibly cheap but adequate thermal imaging cameras have become available that work in concert with the ubiquitous cell phone. This can now serve as a rapid, accurate, and complementary method for finding a perforator sufficient to serve as the hub for a perforator pedicled propeller flap. In addition, the preferred direction of rotation about that hub, effect of flap insetting on perfusion, and then postoperative monitoring are possible by proper interpretation of corresponding thermograms. Every reconstructive surgeon should be able to obtain this device, and then easily learn what potential attributes for them are available when planning a propeller flap.
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Affiliation(s)
- Geoffrey G. Hallock
- Division of Plastic Surgery, St. Luke's Hospital–Sacred Heart Campus, Allentown, Pennsylvania
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Ellabban MA, Awad AI, Hallock GG. Perforator-Pedicled Propeller Flaps for Lower Extremity Reconstruction. Semin Plast Surg 2020; 34:200-206. [PMID: 33041691 PMCID: PMC7542202 DOI: 10.1055/s-0040-1715154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reconstruction of the lower extremity is considered a major challenge due to frequent bone exposure and the absence of local tissue redundancy, as well as often due to the presence of vascular insufficiency. Many surgeons have preferred free flaps especially for reconstructing the more distal lower limb defects until the evolution of pedicled perforator flaps and propeller flaps in particular provided a like-with-like reconstruction of the lower extremity without affecting the main vessels of the limb or the underlying muscles, and without the risk of any microanastomosis especially in patients with multiple comorbidities. Perforator-pedicled propeller flaps as local flaps in the lower extremity are best suited for small- and medium-sized defects with minimal donor-site morbidity, regardless of the cause of the defect. Any of the three source vessels of the leg can provide reliable perforators for propeller flap coverage of the distal leg and foot. The three main risk factors that are relative contraindications may be advanced age, diabetes mellitus, and atherosclerotic peripheral vascular disease.
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Affiliation(s)
- Mohamed A. Ellabban
- Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Ahmed I. Awad
- Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Geoffrey G. Hallock
- Division of Plastic Surgery, St. Luke's Hospital – Sacred Heart Campus, Allentown, Pennsylvania
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Cajozzo M, Jiga LP, Jandali Z, Muradov M, Pignatti M, Cordova A, D'Arpa S. Complications and Solutions in Propeller Flap Surgery. Semin Plast Surg 2020; 34:210-220. [PMID: 33041693 PMCID: PMC7542210 DOI: 10.1055/s-0040-1714087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Propeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluation and management of complications.
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Affiliation(s)
- Marta Cajozzo
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Lucian P. Jiga
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Zaher Jandali
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Mismil Muradov
- Department of Plastic Surgery, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan
| | - Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola, DIMES, Bologna University, Bologna, Italy
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Falinower H, Herlin C, Hepner D, Hepner Y, Boissiere F, Chaput B. Is there a place for pedicled perforator flaps in humanitarian plastic surgery? J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32122764 DOI: 10.1016/j.bjps.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Hugo Falinower
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius-Regaud, 1 Av. Irène Joliot-Curie, 31100 Toulouse, France.
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France;; Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France
| | | | - Yves Hepner
- Clinique Jules Verne, 2-4 Route de Paris, 44300 Nantes, France
| | - Florian Boissiere
- Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France;; Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400 Toulouse, France
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Lauer H, Goertz O, Kolbenschlag J, Hernekamp JF. Gluteal propeller flaps - A reliable reconstructive alternative for elderly patients with pressure ulcers of the sacrum. J Tissue Viability 2019; 28:227-230. [PMID: 31645309 DOI: 10.1016/j.jtv.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Henrik Lauer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Martin Luther Hospital Berlin, Caspar-Theyss Str. 27-31, 14193, Berlin, Germany
| | - Ole Goertz
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Martin Luther Hospital Berlin, Caspar-Theyss Str. 27-31, 14193, Berlin, Germany
| | - Jonas Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Jochen-Frederick Hernekamp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Martin Luther Hospital Berlin, Caspar-Theyss Str. 27-31, 14193, Berlin, Germany.
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Anatomical study of the perforator flap based on the acromial branch of the thoraco-acromial artery (abTAA flap): a cadaveric study. Surg Radiol Anat 2019; 41:1361-1367. [DOI: 10.1007/s00276-019-02322-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
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13
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de Bonnecaze G, Chaput B. An innovative reconstruction procedure of total nasal resurfacing with a bipedicled propeller perforator flap. Head Neck 2019; 41:3049-3055. [PMID: 31038813 DOI: 10.1002/hed.25790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A forehead frontal flap is the treatment of choice for complex nasal defects. However, in patients with contra indications for such frontal flaps, few alternatives are available. METHODS We developed a three-stage, nasal reconstruction procedure using a bipedicled, propeller perforator flap based on the modiolus perforators. Here, we describe the flap, the harvesting thereof, and the 6-month outcomes after placement. RESULTS The flap did not exhibit any sign of necrosis or congestion. Six months after reconstruction, the patient had not suffered any esthetic or functional sequela. CONCLUSION Although the indications for our new flap are less numerous than those for a frontal flap, our flap is a useful alternative when frontal flap placement is not feasible (or the patient refuses such a flap) and when placement of a free flap is too risky.
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Affiliation(s)
| | - Benoit Chaput
- Plastic and Reconstructive Surgery Department, University Hospital of Toulouse, Toulouse, France
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Bonte A, Bertheuil N, Menez T, Grolleau JL, Herlin C, Chaput B. Distally Based Medial Plantar Flap: A Classification of the Surgical Techniques. J Foot Ankle Surg 2019; 57:1230-1237. [PMID: 29937338 DOI: 10.1053/j.jfas.2018.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 02/03/2023]
Abstract
The proximally based medial plantar flap is considered to be the reference standard for heel reconstruction. Although less well-studied, a distally based medial plantar flap is a suitable alternative when used to cover a distal foot defect, especially of the hallux, first metatarsal, or metatarsophalangeal joint. Our objective was to provide a complete description and propose a classification of the different surgical procedures used to harvest this flap. A review of the data reported in the MEDLINE database until May 2017 concerning the distally based medial plantar flap was performed. We have illustrated the different surgical procedures through a case series. Three approaches or "types" of flap have been described, and we have proposed a classification for reconstructive surgeons. In type 1, the plantar pedicle is ligatured before division into the medial and lateral plantar artery. In type 2, the medial plantar pedicle is cut proximally just after division. In type 3, the flap is harvested to include the fasciocutaneous perforator vessels, as an advancement flap or a propeller perforator flap. A distally based medial plantar flap affords adequate and reliable coverage of the weightbearing zone. Because the donor site drawbacks are minimal, this flap is a useful option for distal foot reconstruction, and reconstructive surgeons should remember this flap. The type 1 flap appears to be associated with a minimal risk of flap necrosis, even in those with diabetes or arteriopathy, and can cover even the most distal defect.
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Affiliation(s)
- Amandine Bonte
- Surgeon, Department of Plastic, Reconstructive and Aesthetic Surgery, Lille University Hospital, Lille, France
| | - Nicolas Bertheuil
- Surgeon, Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Tiphaine Menez
- Surgeon, Department of Plastic, Reconstructive and Aesthetic Surgery, Bordeaux University Hospital, Bordeaux France
| | - Jean-Louis Grolleau
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil University Hospital, Toulouse, France
| | - Christian Herlin
- Professor, Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Benoit Chaput
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil University Hospital, Toulouse, France.
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The trapezius perforator flap: Versatility for locoregional reconstruction. ANN CHIR PLAST ESTH 2019; 64:61-67. [DOI: 10.1016/j.anplas.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/06/2018] [Indexed: 11/23/2022]
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Chaput B, Bertheuil N, Grolleau JL, Bekara F, Carloni R, Laloze J, Herlin C. Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: A prospective study. Microsurgery 2017; 38:177-184. [DOI: 10.1002/micr.30162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Benoit Chaput
- Department of Plastic and Reconstructive Surgery; Rangueil University Hospital; Toulouse France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery; Hospital Sud, University of Rennes 1; Rennes France
| | - Jean-Louis Grolleau
- Department of Plastic and Reconstructive Surgery; Rangueil University Hospital; Toulouse France
| | - Farid Bekara
- Department of Plastic and Reconstructive Surgery; Lapeyronie University Hospital; Montpellier France
| | - Raphael Carloni
- Department of Plastic and Hand Surgery; CHU Charles Nicolle; Rouen France
| | - Jerome Laloze
- Department of Plastic and Reconstructive Surgery; Rangueil University Hospital; Toulouse France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery; Lapeyronie University Hospital; Montpellier France
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