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Dong K, Zhou Y, Xu YQ, Xu XY, He XQ. Anterolateral thigh flow-through flap: A versatile method for reconstruction of complex extremity defects. Microsurgery 2023; 43:685-693. [PMID: 37477288 DOI: 10.1002/micr.31095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Flow-through flaps have been widely applied only for the reconstruction of complex defects in the extremities because they can be used for arterial reconstruction and soft tissue coverage simultaneously. This report attempts to fully demonstrate the role of the anterolateral thigh (ALT) flow-through flap as a versatile method for reconstructing complex defects in the extremities. METHODS From February 2011 to March 2017, we retrospectively analyzed the use of a reconstructive surgical technique based on the ALT flow-through flap to treat complex extremity defects in 87 patients (trauma, n = 79; diabetic ulcers, n = 5; squamous cell carcinoma, n = 3). Emergency surgery was performed in 12 patients to bridge a major artery gap and was followed by elective reconstruction in the remaining patients. Applications of the ALT flow-through flap included bridging major artery gaps, preserving recipient blood vessel integrity, reconstructing blood vessel continuity, protecting vascular anastomoses, avoiding difficult end-to-side anastomoses in the recipient area, and balancing blood flow, as well as combined application with an additional flap. RESULTS The flap size ranged from 6 × 3 cm to 17 × 9 cm. ALT flow-through flaps were used in combination with an additional flap (n = 4) and in vascular reconstruction (n = 83). Three patients required of the microvascular anastomostic reexploration for venous congestion, total necrosis occurred in two patients, and partial necrosis occurred in one patient. At the donor site, there were three cases of infection and two cases of wound dehiscence. At the recipient site, one case of infection and two cases of wound dehiscence were observed. One patient presented with deep infection secondary to renal failure and underwent amputation. During the follow-up period (range, 1-33 months), all other flaps (84 cases) survived uneventfully, with normal texture and color. CONCLUSION The ALT flow-through flap plays many roles as it is a versatile method for reconstructing complex defects of the extremities and serves various other clinical purposes.
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Affiliation(s)
- Kaixuan Dong
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Ya Zhou
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Yong-Qing Xu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force, Kunming, China
| | - Xiao-Yan Xu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force, Kunming, China
| | - Xiao-Qing He
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force, Kunming, China
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Cao Z, Zhang Y, Lipa K, Qing L, Wu P, Tang J. Ilizarov Bone Transfer for Treatment of Large Tibial Bone Defects: Clinical Results and Management of Complications. J Pers Med 2022; 12:jpm12111774. [PMID: 36579496 PMCID: PMC9692871 DOI: 10.3390/jpm12111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUNDS The purpose of this study is to present our clinical experience using the Ilizarov bone transfer technique and free-flap technique in the reconstruction of large tibial bone and soft tissue defects, including an evaluation of both the management of postoperative complications and long-term outcomes. METHODS From January 2010 to May 2020, 72 patients with tibia bone and soft tissue defects were retrospectively evaluated. Either an anterolateral thigh perforator flaps (ALTP) or latissimus dorsi musculocutaneous flaps (LD), solely or in combination, were used to cover soft tissue defects. Once the flap was stabilized, an Ilizarov external fixator was applied to the limb. Follow-up was postoperatively performed at 1, 3, 6, 9, and 12 months. RESULTS Postoperatively, there were two cases of total and five of partial flap necrosis, and two cases of subcutaneous ulcers, which were caused by vascular crisis, infection, and hematoma, respectively. All the patients underwent Ilizarov external fixator surgery after flap recovery. A total of 16 complications occurred, including 3 cases of simple needle tract infection (antibiotic treatment) and 13 cases of complications requiring reoperation. A correlation factor analysis revealed that the main factors affecting the healing time were the defect length and operative complications. All patients with complications treated with the vascularized iliac flap eventually healed completely. CONCLUSIONS The Ilizarov method used together with an ALTP, LD, or a combination thereof yields good clinical results for repairing large bone and soft tissue defects of the tibia, thus reducing the incidence of amputations. However, longer treatment times may be involved, and postoperative complications can occur. The vascularized iliac flap may be a suitable choice for the treatment of postoperative complications of this type of Ilizarov bone transport.
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Affiliation(s)
- Zheming Cao
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yiqian Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Katelyn Lipa
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Liming Qing
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Panfeng Wu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Juyu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Correspondence:
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莫 小, 常 树, 魏 在, 周 健, 曾 可, 陈 伟, 聂 开, 李 书, 邓 呈. [Clinical application of microdissected thin thoracodorsal artery perforator flaps for repair of diabetic foot ulcers]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1266-1272. [PMID: 36310465 PMCID: PMC9626267 DOI: 10.7507/1002-1892.202201037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/18/2022] [Indexed: 01/25/2023]
Abstract
Objective To explore the effectiveness of microdissected thin thoracodorsal arterial perforator flap (TDAP) in repairing diabetic foot ulcers (DFUs). Methods The clinical data of 11 patients with DFUs admitted between March 2020 and February 2021 were retrospectively analyzed, including 5 males and 6 females, aged from 22 to 67 years, with an average of 49.3 years. There were 10 cases of type 2 diabetes and 1 case of type 1 diabetes; the duration of diabetes ranged from 3 months to 25 years (median, 8 months). The duration of DFUs ranged from 6 days to 120 months (median, 1 month). There were 6 cases of grade 3 and 5 cases of grade 4 according to Wagner classification. The tissue necrosis and purulent secretions were found in all ulcer wounds, as well as different degrees of tendon and bone exposure; skin defects ranged from 5 cm×3 cm to 17 cm×6 cm. The DFUs were repaired by microdissected thin TDAP, including 6 cases of flaps (including 1 case of lobulated flap), ranging from 10.0 cm×4.5 cm to 26.0 cm×7.0 cm; 5 cases of chimeric perforator flaps, the range of the flap was 10.0 cm×4.5 cm to 16.0 cm×5.5 cm, and the range of the muscle flap was 6 cm×2 cm to 10 cm×3 cm. The donor site was sutured directly. Results The operation time ranged from 3.42 to 11.17 hours, with an average of 5.92 hours. All 11 flaps survived and no vascular crisis occurred; 1 patient had a sinus at the edge of the flap, and the surgical area healed well after dressing change. All 11 patients were followed up 6-12 months, with an average of 9 months. The flap texture was good, the recipient site was in good shape, and there was no swelling; the foot contour was good, the shoes were comfortable to wear, and the movement was good. The incision at the donor site healed by first intention, leaving only linear and concealed scar, without obvious depression deformity, and the shoulder joint function was good. Conclusion On the premise of ensuring sufficient blood supply to the lower extremities and strengthening perioperative management, the microdissected thin TDAP to repair DFUs wounds can achieve better effectiveness and appearance; however, the prolonged operation time increases the probability of anesthesia and surgical risks in patients with DFUs.
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Affiliation(s)
- 小金 莫
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 树森 常
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 健 周
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 可为 曾
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 伟 陈
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 开瑜 聂
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 书俊 李
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 呈亮 邓
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
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Yu J, Luo Z, Wu P, Tang J. Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three-Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children. Orthop Surg 2021; 13:216-224. [PMID: 33448701 PMCID: PMC7862167 DOI: 10.1111/os.12887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of the present study was to report a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP) to achieve dead space filling, Achilles tendon bridging, and skin resurfacing simultaneously with minimal donor‐site morbidity. Methods From September 2012 to May 2016, a retrospective study was carried out on six pediatric patients with composite soft tissue defects of the heel that were repaired with the chimeric DIEP flap. The chimeric flap design included a flap of the anterior sheath of the rectus, a block of rectus muscle, and a large skin paddle. All the parts were supplied by a common artery. After harvesting the flap, all element parts were inserted at the corresponding sites in a tension‐free manner. With one set of vessel anastomoses at the recipient site, accurate repair with tendon reconstruction, dead space elimination, and wound covering were accomplished. The donor site incisions were closed initially. Data on patient age, medical history, injury severity, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow‐up were collected and reviewed. Results Five of the six chimeric DIEP flaps survived without complications. The remaining one case experienced partial necrosis of the skin paddle caused by venous congestion, which healed after routine dressing changes. Primary donor site closure was accomplished in all cases. The mean follow‐up was 18.6 months (range, 10–36 months). Five patients had satisfactory aesthetic and functional outcomes; one patient needed a secondary debulking procedure. Compared to the unaffected side, the affected side showed no obvious difference for ankle movement, tiptoe function, and patient gait during the follow‐up period. Good ankle function was observed in all patients. There was no donor site breakdown, with only a slightly noticeable linear scar. Conclusion The chimeric DIEP flap reduced the operative time, solved the problem of deficiency of recipient vessels, and attained satisfactory functional and aesthetic outcomes with low donor site morbidity. Therefore, it is a promising option for three‐dimensional reconstruction of composite defects with dead space and Achilles tendon defects as well as skin loss in children.
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Affiliation(s)
- Junyi Yu
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Luo
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Kozusko SD, Liu X, Riccio CA, Chang J, Boyd LC, Kokkalis Z, Konofaos P. Selecting a free flap for soft tissue coverage in lower extremity reconstruction. Injury 2019; 50 Suppl 5:S32-S39. [PMID: 31711654 DOI: 10.1016/j.injury.2019.10.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Goals of lower extremity microvascular reconstruction (LEMR) include the restoration of function, prevention of infection, and optimal cosmesis. Indications for LEMR include large defects that are not amenable to pedicled options, a large zone of injury, and large complex defects. The novice microsurgeon should first master a handful of free flaps to develop an armamentarium of options for addressing such defects. The scope of this review is to provide free flap options for LEMR in any of the thirds of the lower leg. After reading this article, the reader will understand variations, advantages, disadvantages, indications, and tips for raising each of these flaps. METHODS Six most commonly used free flaps for LEMR are described in this paper, including the anterolateral thigh flap (ALT) and its variations, the radial forearm flap (RFFF), the lateral arm flap (LAF), the gracilis muscle flap, the rectus abdominis flap (RAF) and the latissimus dorsi flap and its variations. Indications, advantages, disadvantages and technique tips are discussed for each flap. Moreover, selection of the recipient vessels, preoperative management along with an algorithm are also provided. CONCLUSIONS The ALT flap is a workhorse in covering defects of the leg, foot, and ankle. It's the flap of choice at our institution, especially given the number of traumatic wounds seen as a result of motor vehicles, all-terrain vehicles (ATV), lawnmowers, and gunshot wounds (GSW). At times, the lower extremity zone of injury requires a distant donor site. The RAF can also provide coverage for large soft tissue defects but donor-site morbidity remains its main drawback. The LAF and RFFF provide two pliable options, one that provides pliable soft tissue with minimal donor site morbidity and another that provides a long pedicle. The free gracilis flap is an excellent choice for crossing the ankle joint. Lastly, the free latissimus dorsi is indicated for large defects of the lower extremity independently of the location.
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Affiliation(s)
- S D Kozusko
- Department of Plastic Surgery, University of Tennessee Health Science Center Memphis, TN, 38163, USA
| | - X Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center Memphis, TN, 38163, USA
| | - C A Riccio
- Department of Plastic Surgery, University of Tennessee Health Science Center Memphis, TN, 38163, USA
| | - J Chang
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - L C Boyd
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Z Kokkalis
- Department of Orthopaedic Surgery, University of Patras, Patra, Greece
| | - P Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center Memphis, TN, 38163, USA.
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Sung IH, Jang DW, Kim SW, Kim YH, Kim SW. Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps. Microsurgery 2018; 38:674-681. [DOI: 10.1002/micr.30314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Il Hoon Sung
- Department of Orthopaedic Surgery, College of Medicine; Hanyang University; Seoul Korea
| | - Dong Woo Jang
- Shanghai MK Medical Cosmetic Surgery Clinic; Shanghai China
| | | | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine; Hanyang University; Seoul Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine; Seoul National University, Seoul National University Hospital; Seoul Korea
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Liu Z, Tang X, Wang D, Wei Z, Jin W, Deng C, Qi J. [Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1106-1110. [PMID: 29798570 PMCID: PMC8458423 DOI: 10.7507/1002-1892.201704047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/18/2017] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S 1 in 2 cases, S 2 in 6 cases, S 3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.
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Affiliation(s)
- Zhiyuan Liu
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Xiujun Tang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003,
| | - Dali Wang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Zairong Wei
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Wenhu Jin
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Chengliang Deng
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Jianping Qi
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
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Ozcan Akcal A, Ünal K, Gorgulu T, Akif Akcal M, Bigat Z. Reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap following gunshot injuries: Report of two cases. Microsurgery 2016; 36:598-603. [DOI: 10.1002/micr.30099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Arzu Ozcan Akcal
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Akdeniz University; Antalya Turkey
| | - Kerim Ünal
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Akdeniz University; Antalya Turkey
| | - Tahsin Gorgulu
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Bulent Ecevit University; Zonguldak Turkey
| | - Mehmet Akif Akcal
- Department of Orthopedic and Traumatology; Ataturk State Hospital; Antalya Turkey
| | - Zekiye Bigat
- Faculty of Medicine, Department of Anesthesiology and Reanimation; Akdeniz University; Antalya Turkey
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Coverage of Amputation Stumps Using a Latissimus Dorsi Flap With a Serratus Anterior Muscle Flap. Ann Plast Surg 2016; 76:88-93. [DOI: 10.1097/sap.0000000000000220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim SW, Youn DG, Kim JT, Kim YH. A thoracodorsal artery perforator chimeric free flap for prevention of microvascular pedicle compression in lower extremity reconstruction. Microsurgery 2015; 38:46-50. [PMID: 26419784 DOI: 10.1002/micr.22504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/30/2015] [Accepted: 09/09/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Chimeric flaps are often used in reconstructive fields for multiple defects, different functional defects, and extensive defects. In this article, we present the results of the use of thoracodorsal artery perforator (TDAp) chimeric flaps including a latissimus dorsi (LD) or serratus anterior (SA) muscle to prevent pedicle compression for lower extremity reconstruction. METHODS Nineteen TDAp chimeric flaps were used to prevent pedicle compression. Seven were female and 12 male. Patients' age ranged from 32 to 73 years. After harvesting TDAp skin flap, LD or SA muscle could be harvested along with the thoracodorsal vessels. Skin flap was incorporated into the main defect and muscle cuffs were positioned along the vascular pedicle. RESULTS In 11 cases, there were two components, a skin flap and a muscle flap, and the other 8 were three components, a skin flap and two muscle flaps. The dimensions of the skin flaps ranged from 8 × 5 to 18 × 10 cm, and the muscle flaps ranged from 3 × 2 cm to 8 × 6 cm. The recipient vessel was anterior tibial artery or dorsalis pedis artery. All flap survived. Five cases suffered minor complications including donor site wound disruption, skin flap wound disruption, partial loss of the skin flap, and partial loss of the SA muscle flap. The mean follow-up was 13.9 months. All the patients were able to wear shoes without debulking procedures. CONCLUSION The TDAp chimeric flaps including LD or SA muscle flaps were useful for covering the vascular pedicle and relieved vascular compression during lower extremity reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery, 38:46-50, 2018..
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Affiliation(s)
- Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea
| | - Dong Geun Youn
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul, Korea
| | - Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Free Latissimus Dorsi Muscle–Chimeric Thoracodorsal Artery Perforator Flaps for Reconstruction of Complicated Defects. Ann Plast Surg 2015; 74:565-72. [DOI: 10.1097/sap.0b013e3182a6363c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J Plast Reconstr Aesthet Surg 2015; 68:565-70. [DOI: 10.1016/j.bjps.2014.12.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/16/2014] [Accepted: 12/13/2014] [Indexed: 11/24/2022]
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13
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Han SE, Lee KT, Mun GH. Muscle-chimaeric medial sural artery perforator flap: A new design for complex three-dimensional knee defect. J Plast Reconstr Aesthet Surg 2014; 67:571-4. [DOI: 10.1016/j.bjps.2013.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/14/2013] [Accepted: 09/13/2013] [Indexed: 11/16/2022]
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14
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Reconstruction of extensive lower limb defects with thoracodorsal axis chimeric flaps. Plast Reconstr Surg 2013; 132:470-479. [PMID: 23897343 DOI: 10.1097/prs.0b013e318295898e] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive defects of the lower extremities are usually reconstructed with microvascular free flaps because of inadequate local tissues and wound complexity. Many attempts have been made to reconstruct such defects using the chimeric flap concept, enabling flaps with larger surface areas to be used while maintaining economical tissue use. The latissimus dorsi chimeric flap is one of the most useful tools for resurfacing extensive limb defects. METHODS Twelve patients with extensive lower leg defects underwent reconstruction with latissimus dorsi chimeric flaps between January of 2008 and March of 2012. A skin flap based on the cutaneous perforators, a latissimus dorsi muscle flap based on the muscular branches, and a serratus anterior muscle flap based on the branch from the thoracodorsal artery were harvested accordingly; the flap design depended on the dimensions and characteristics of the defect. RESULTS A total of 12 chimeric flaps were harvested and used, with the average surface area, including skin and muscle components, being 614 cm. The mean surface area of the skin flaps used was 355.6 cm. The mean area of the latissimus dorsi muscle flap was approximately 228 cm, and the surface areas of the three serratus anterior flaps used were 56 cm, 70 cm, and 180 cm. Flaps survived in all cases. Primary closure was used for all of the donor sites except one, and there was minimal donor-site morbidity. CONCLUSION The authors' results show that the latissimus dorsi chimeric free flap is a useful and versatile reconstructive option for extensive defects of the lower extremities. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
In the last decade, the medial sural artery perforator flap (MSAP) has emerged as one of the most popular reconstructive options for multiple body sites. The versatility of the flap hinges on the ability to harvest multiple tissue components in various combinations but from the same wound. The flap can be used as a pedicled, free, or chimeric design, or even may be used in sequential order. Anatomic anomalies of these perforators are rare compared with other perforator flaps, but well-prepared preoperative planning and the identification of perforators remain the cornerstone of successful flap harvest. So far, the MSAP has been proved to be an excellent alternative for skin resurfacing and functional reconstruction in head and neck as well as in the extremities. In this review, the anatomy, preoperative planning and flap design, harvest technique, and its clinical application in multiple body sites are summarized. Both the advantages and disadvantages are also included.
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Topalan M, Guven E, Demirtas Y. Backup perforator flap derived from a previously transferred musculocutaneous free flap. Microsurgery 2010; 30:457-61. [DOI: 10.1002/micr.20755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Karaaltin MV, Erdem A, Canter I, Çavdar G, Baghaki S. The bipedicled latissimus dorsi myocutaneous free flap: Clinical experience with 53 patients. Microsurgery 2009; 30:179-84. [DOI: 10.1002/micr.20724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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