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Zheng Y, Zhang S, Hong JP, Hallock GG, Levin LS, Zhang Y, Min P. Medial Plantar Artery Perforator Kiss Flap for Salvage of Extensive Palmar Skin Defect. Plast Reconstr Surg 2024; 153:1348-1357. [PMID: 37400951 DOI: 10.1097/prs.0000000000010909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Flaps based on the medial plantar artery (MPA) accomplish favorable surgical outcomes in palmar resurfacing because of their outstanding texture, pliability, and contour, but primary closure cannot be achieved at the donor site when the flap is designed to be relatively large. In this study, the kiss technique was used for the reconstruction of extensive palmar defects, which minimized donor-site morbidity. METHODS A modified flap surgical strategy was systemically developed based on the perforator distribution of the MPA through a cadaver study. Two or three narrow, small skin paddles based on the MPA were raised and resembled at the recipient site as a larger flap. Static two-point discrimination, hypersensitivity and range of motion, QuickDASH, gait, and patient satisfaction were evaluated 6 months to 12 months after the operation. RESULTS From June of 2015 to July of 2021, 20 cases of reconstruction using the MPA perforator kiss flap were performed for the resurfacing of palmar skin defects. All flaps survived uneventfully, with coverage matching the texture and color of the recipients, except one flap that exhibited venous congestion and recovered after revision. Twelve flaps (60%) were double-paddled, and eight flaps (40%) were triple-paddled, with a resurfacing area of 27.19 cm 2 and 41.1 cm 2 , respectively. All donor sites achieved primary closure without major complications. CONCLUSIONS Versatile kiss flap combinations were developed based on further understanding of the MPA system. Durable and pliable characteristics of the MPA perforator flap provide excellent reconstruction for extensive palmar defects while minimizing donor-site complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Youmao Zheng
- From the Department of Hand and Foot Surgery, Taizhou Hospital of Zhejiang Province, affiliated with Wenzhou Medical University
| | - Shunuo Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan
| | | | - L Scott Levin
- Department of Orthopedic Surgery, University of Pennsylvania
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine
| | - Peiru Min
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine
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Xu X, Wang C, Chen Z, Li J. Medial plantar artery perforator (MPAP) flap is an ideal option for reconstruction of complex soft tissue defect in the finger: Clinical experience from 11 cases. Front Surg 2022; 9:934173. [PMID: 35959121 PMCID: PMC9360503 DOI: 10.3389/fsurg.2022.934173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSoft tissue defects of fingers are common in reconstructive plastic surgery, and reconstruction of the defects remains challenging for plastic surgeons. In our study, we reported our experience in finger reconstruction with a medial plantar artery perforator (MPAP) flap, especially using a lobulated MPAP flap for the complex multifinger soft defect.Patients and methodsFrom the period April 2012 to October 2018, 11 patients (9 males and 2 females) with an average age of 44 years old (ranging from 11 to 58) received finger reconstruction with a free MPAP flap. In total, 11 flaps (8 single-lobulated flaps and 3 two-lobulated flaps) were raised from the ipsilateral or contralateral instep area. Trauma and scar contracture caused hand soft tissue loss in all cases.ResultsThe sizes of the flaps ranged from 2×3 to 5×7.5 cm2. All flaps survived intact with no complications. One donor site was closed primarily, and other donor sites were covered with a full-thickness skin graft. The mean follow-up time was 6 months (ranging from 3 to 8 months). During the follow-up period, the patients were satisfied with their appearance without any traces of flap plastic surgery.ConclusionThe MPAP flap is a reliable and acceptable option for the reconstruction of complex soft tissue defects in the finger. Depending on the two branches of the medial plantar artery, the use of the lobulated MPAP flap holds promise in the treatment of multifinger soft tissue defects.
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Anatomical Study of the Medialis Pedis Flap and its clinical applications in Asian Singaporean Patients. Injury 2021; 52:3124-3131. [PMID: 33674117 DOI: 10.1016/j.injury.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to revisit the medial plantar artery's anatomy and study its distribution for raising the medialis pedis flap. Several investigators have reported their clinical experience with the use of this flap for reconstruction of soft tissue defects of the hand. However, many have reported difficulty raising the flap due to variations in its arterial anatomy and the confusion that exists with respect to the nomenclature in our literature. METHODS This study was divided into 2 parts: an anatomic study and clinical application. In the anatomic study, 12 cadaveric feet specimens from 6 patients were injected with latex and barium-gelatin injections and the medial branch of the deep division of the medial plantar artery distribution was studied. We then described the use of a medialis pedis flap in four clinical cases to cover defects of the digits. RESULTS The anatomic study revealed that the average pedicle length of the deep division of the medial plantar artery was 1.94cm. In the four illustrative clinical cases where the flap was used, the average flap size was 4.5 × 3.75cm. Donor sites were either closed primarily or with skin grafts. The vessels used for this flap were the medial branch of the deep division of the medial plantar artery and venae commitantes, or subcutaneous veins which provided the superficial drainage. All flaps were successful without any significant complications. The study is novel in that it describes the anatomic variability of length of the medial branch of the deep division of the medial plantar artery that exits in nature. CONCLUSIONS This paper describes the medial branch of the deep division of the medial plantar artery and the anatomic variations that exist in the raising of the medialis pedis flap. We have shown how a medialis pedis flap is an ideal option for reconstructing soft tissue defects of the hand because of its texture, bulkiness and pliability in the context of like for like reconstruction.
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周 健, 郑 玉, 魏 在, 聂 开, 肖 顺, 黄 广, 刘 志, 李 海, 金 文, 陈 伟. [Free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1182-1185. [PMID: 34523286 PMCID: PMC8444137 DOI: 10.7507/1002-1892.202104101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the feasibility and effectiveness of free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect. METHODS Between July 2016 and October 2020, 9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap. There were 6 boys and 3 girls, with an average age of 6.8 years (range, 4-13 years). The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases. Among them, there were 3 cases of index finger wounds, 3 cases of middle finger wounds, 2 cases of ring finger wounds, and 1 case of little finger wounds. The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm. The time from injury to operation was 1.3-8.6 hours, with an average of 4.8 hours. The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm. After the flaps were inverted, the veins were used to bridge the finger arteries while repairing the wounds. The donor site of the foot was sutured directly in 4 cases, and repaired with full-thickness skin grafts in 5 cases. RESULTS All flaps survived, and hand wounds healed by first intention; 8 cases of foot donor site wounds healed by first intention, and 1 case had partial necrosis in the marginal area of the skin graft, which healed after dressing change. All 9 children were followed up 3-24 months, with an average of 9 months. The color and texture of the flap were similar to those of the surrounding normal skin, and the protective feeling was restored. The two-point discrimination of the flap was 7-10 mm, with an average of 8 mm. At last follow-up, according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association, the finger function was excellent in 5 cases and good in 4 cases. There was no ulcer formation and scar hyperplasia in the foot donor site, which did not affect walking. CONCLUSION The free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children's finger wounds with digital artery defect. It has the advantages of simple flap extraction, thin flap, similar color and texture to the skin of the hand, and concealed donor site.
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Affiliation(s)
- 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 Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 玉岑 郑
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital 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 Burn and Plastic Surgery, the Affiliated Hospital 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 Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 顺娥 肖
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 广涛 黄
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 志远 刘
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 海 李
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 文虎 金
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital 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 Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
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Efficacy and safety of free medial plantar flap in repair of the high-voltage electrical burns in hands. Eur J Trauma Emerg Surg 2021; 48:1381-1387. [PMID: 34057553 DOI: 10.1007/s00068-021-01700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this work was to validate the efficacy and safety of free medial plantar flap in repair of hand wounds resulted from high-voltage electrical burn. METHODS 22 patients with high-voltage electrical burn wounds were retrieved between July 2016 and July 2018 in the Affiliated Zhengzhou Central Hospital of Zhengzhou University. All the wounds were the entrance of high-voltage electrical current. After thorough debridement, the blood vessels, nerves, tendons, joints were exposed to defects with different degrees. The soft tissue defects were repaired with the free medial plantar flap repair in 12 patients and medium-thickness skin graft in 10 patients. Postoperative management was similar between the two groups. RESULTS All the operations were completed within 6 h. In the free medial plantar flap group, the mean follow-up period was (11.3 ± 2.4) months, ranging from 9 to 15 months, and all flaps survived; there were no vessel crises. Flaps of 10 patients healed without any complications, and local necrosis occurred in two cases, with healing after debridement. The two-point discrimination (TPD) was 7.0-11.0 mm, and the mean DASH score was 45.6 ± 7.4. In the medium-thickness skin graft group, the mean follow-up period was (10.9 ± 1.8) months. All flaps survived, and local contracture occurred in 3 cases. The TPD was 8.0-11.0 mm, and the mean DASH score was 60.7 ± 9.3. CONCLUSIONS The free medial plantar flap is an ideal option for repairing the hand soft defects resulted from the high-voltage electrical burn.
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Systematic reappraisal of the reverse-flow medial plantar flap: From vascular anatomical concepts to surgical applications. J Plast Reconstr Aesthet Surg 2020; 73:421-433. [DOI: 10.1016/j.bjps.2019.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/24/2019] [Accepted: 10/20/2019] [Indexed: 11/17/2022]
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Li X, Cui J, Maharjan S, Lu L, Gong X. Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis. PLoS One 2016; 11:e0167827. [PMID: 27930679 PMCID: PMC5145187 DOI: 10.1371/journal.pone.0167827] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/21/2016] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle. Methods This was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model. Results The overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection. Conclusion Flap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.
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Affiliation(s)
- Xiucun Li
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
| | - Jianli Cui
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
| | - Suraj Maharjan
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
| | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
| | - Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
- * E-mail:
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Abstract
BACKGROUND Fingertip injury requiring flap cover is very common in the modern era. The ideal cover should fulfill both functional and aesthetic improvement. MATERIALS AND METHODS From June 2015 to April 2016, we performed seven free toe pulp flaps for finger defect reconstruction. All patients were males. Five flaps were done in emergency post-traumatic cases, and two were done in elective set up. The cases included reconstruction of three thumbs, one index and one ring finger in an emergency set up and two ring fingers in the elective. Thumb reconstruction was done with great toe lateral pulp and the other digits reconstructed with second toe pulp flap. Follow-up evaluation included both functional and aesthetic assessment. RESULTS Five flaps survived completely, one suffered partial loss, and one flap failed completely. The median follow-up period was 9 months. The median duration of surgery was 255 min (range 210 to 300 min). The median two-point discrimination was 6.5 mm (range 4-8 mm). There was the return of temperature sensation in all patients; two had cold intolerance. The Semmes-Weinstein monofilament score varied from 3.61 to 5.07 (median filament index value 4.31/pressure value of 2 g/mm2). Three patients had delayed donor site wound healing. CONCLUSIONS The free toe pulp flap is an efficient choice for fingertip and volar finger defects reconstruction with an excellent tissue match.
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Affiliation(s)
- Jyoshid R. Balan
- Department of Plastic Surgery, Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
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Chai YM, Wang CY, Wen G, Zeng BF, Cai PH, Han P. Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand. Microsurgery 2010; 31:45-50. [DOI: 10.1002/micr.20817] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 05/28/2010] [Indexed: 11/10/2022]
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Huang SH, Wu SH, LAI CH, Chang CH, Wangchen H, Lai CS, Lin SD, Chang KP. Free medial plantar artery perforator flap for finger pulp reconstruction: Report of a series of 10 cases. Microsurgery 2009; 30:118-24. [DOI: 10.1002/micr.20718] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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