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Immaneni S, Harvey DT, Delgado F. Reuse of the paramedian forehead flap pedicle: A case
report. SAGE Open Med Case Rep 2023; 11:2050313X231160913. [PMID: 36968993 PMCID: PMC10031607 DOI: 10.1177/2050313x231160913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
The paramedian forehead flap is an axial flap which utilizes vascular support
from the supratrochlear artery to repair extensive nasal defects. Adverse
outcomes including flap necrosis, infection, alar rim pull, and poor cosmesis
can be seen with this flap. We report an 85-year-old woman with chronic
obstructive pulmonary disease who underwent a staged paramedian forehead flap
repair with a cartilage inlay complicated by moderate left alar rim necrosis and
pedicle notching. In this patient, we were able to salvage the original pedicle
and reposition it to achieve a satisfactory functional and cosmetic outcome.
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Affiliation(s)
- Supriya Immaneni
- Supriya Immaneni, Department of
Dermatology, Emory University School of Medicine, 1525 Clifton Road, NE 4th
Floor, Atlanta, GA 30322, USA.
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2
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Hallock GG. Recycling the keystone flap. J Plast Reconstr Aesthet Surg 2021; 75:439-488. [PMID: 34736854 DOI: 10.1016/j.bjps.2021.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/22/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, St. Luke's Hospital, Sacred Heart Division, Allentown, PA USA.
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3
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Zhang W, Li X, Li X. A systematic review and meta-analysis of perforator flaps in plantar defects: Risk analysis of complications. Int Wound J 2021; 18:525-535. [PMID: 33675188 PMCID: PMC8273610 DOI: 10.1111/iwj.13552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to identify the risk factors for complications of perforator flaps in plantar reconstruction. A systematic review was performed by searching the PubMed, Cochrane Library, MEDLINE, and EMBASE databases from their inception date up to October 2020. Only studies on reconstructing plantar defects with perforator flaps were included, and specific data were required for each patient in the included studies. A total of 14 studies involving 111 flaps were identified and included in the meta‐analysis. Our meta‐analysis identified two risk factors for postoperative complications: flap size over 50 cm2 (risk ratio [RR] = 3.12; P = .02), diabetes mellitus foot (RR = 3.26; P = .03). No significant differences were found regarding heel defects (P = .34), single perforator (P = .57), age older than 60 years (P = .19), chronic aetiology (P = .13), trauma (P = .33), tumour resection (P = .60), ulcer (P = .84), and burn (P = .76). Although more high‐quality studies with adequate sample sizes are needed, this meta‐analysis indicated that flap size over 50 cm2 and diabetes mellitus foot were significant risk factors for postoperative complications of perforator flaps in plantar reconstruction.
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Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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4
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Jeng SF, Papadakis M, Shih HS. Freestyle Local Island Pedicle Flap in Lower Leg Reconstruction. Clin Plast Surg 2021; 48:193-200. [PMID: 33674041 DOI: 10.1016/j.cps.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The freestyle local perforator flap is an advanced version of the conventional island pedicle flap. Intramuscular dissection can provide a longer pedicle, which allows restoration of defects that are future from the donor site. Without microsurgery, the flap can be either rotated or advanced toward the defect, making it particularly useful for reconstructing soft tissue defects in the lower third of the leg. Careful preoperative design with vessel mapping, skillful intramuscular dissection of the pedicle, and a well-considered backup plan in case of unexpected difficulty are crucial for freestyle local perforator flaps to be successful.
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Affiliation(s)
- Seng-Feng Jeng
- Department of Plastic and Reconstructive Surgery, E-Da Hospital, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan.
| | - Marios Papadakis
- Department of Plastic and Reconstructive Surgery, E-Da Hospital, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
| | - Hsiang-Shun Shih
- Department of Plastic and Reconstructive Surgery, E-Da Hospital, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
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5
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Comparison of the surgical outcomes of free flap reconstruction for primary and recurrent head and neck cancers: a case-controlled propensity score-matched study of 1,791 free flap reconstructions. Sci Rep 2021; 11:2350. [PMID: 33504947 PMCID: PMC7840944 DOI: 10.1038/s41598-021-82034-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
This study was designed to compare the outcome and analyze the operation-related risk factors in free flap reconstruction for patients with primary and recurrent head and neck cancers. A 1:1 propensity score-matched analysis of the microsurgery registry database of the hospital. The primary outcome of the free flap reconstruction had a higher failure rate in the recurrent group than the primary group (5.1% vs. 3.1%, p = 0.037). Among the 345 pairs in the matched study population, there were no significant differences between the primary and recurrent groups regarding the rate of total flap loss (3.5% vs. 5.5%, p = 0.27) and secondary outcomes. This study revealed that free flap reconstruction had a higher failure rate in the recurrent group than the primary group, but such a difference may be attributed by the different patient characteristics.
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6
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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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7
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Jain RK, Jain A. Coverage of residual defects by using previous flaps: Flip flap puzzle flap. J Clin Orthop Trauma 2020; 11:S631-S635. [PMID: 32774040 PMCID: PMC7394779 DOI: 10.1016/j.jcot.2020.05.013] [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: 04/29/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Terminal flap necrosis and flap retraction is a difficult problem faced by surgeons. These require some other flap for coverage of defect with limited local tissue availability. Flip flap puzzle flap is an option for small defect coverage using previous flap. METHODOLOGY This flap is harvested from previous flap and raised at sub-dermal level. The flap is flipped 180° on itself to cover the defect. The residual area is finally covered with split skin graft. RESULTS This is a prospective study conducted on 10 patients, with 9 flap survival and 1 flap failure. In 7 out of 10 cases partial graft failure was observed, but all the defects healed eventually. DISCUSSION AND CONCLUSION This flap is a less morbid and rapid option for coverage of small sized defects. It has no donor site morbidity as flap is raised from the previously harvested flap.
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The flip-flap puzzle flap: Another recycling option. Arch Plast Surg 2019; 46:176-180. [PMID: 30934184 PMCID: PMC6446029 DOI: 10.5999/aps.2018.00983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/08/2018] [Indexed: 11/08/2022] Open
Abstract
Post-traumatic soft tissue defects sometimes require sequential flap coverage to achieve complete healing. In the era of propeller flaps, which were developed to reduce donor site morbidity, Feng et al. introduced the concept of the free-style puzzle flap, in which a previously harvested flap becomes its own donor site by recycling the perforator. However, when a perforator cannot be found with a Doppler device, we suggest performing a new type of flap, the flip-flap puzzle flap, which combines two concepts: the free-style puzzle flap and the flip-flap flap described by Voche et al. in the 1990s. We present the cases of three patients who achieved complete healing through this procedure.
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Serror K, Chaouat M, Romano G, Schmidt M, Blet A, Mimoun M, Boccara D. Free-style puzzle flap as a cross-leg pedicled flap: the concept of re-using a flap in acute burns, a case report. BURNS & TRAUMA 2018; 6:2. [PMID: 30009190 PMCID: PMC6040606 DOI: 10.1186/s41038-018-0107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 11/23/2022]
Abstract
Background In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised. Case presentation We report the case of a patient with full thickness burns on both legs, leading to the exposure of joints of the right ankle and the right foot and left patellar tendon. The right lower extremity was covered with a free musculo-cutaneous latissimus dorsi flap. Then, a musculo-cutaneous cross-leg flap pedicled on the anterior branch and centered on a perforator was harvested from the previous redundant flap to cover the controlateral knee. Conclusion Sequential flap coverage can be considered in cases of extensive soft tissue defects and particularly in burns. This case illustrates that re-using a redundant part of a previous flap to cover another defect is a safe and interesting alternative in the event of a lack of donor sites or to save donor sites for later reconstruction of contracted burn scars.
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Affiliation(s)
- Kevin Serror
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marc Chaouat
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Golda Romano
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Magali Schmidt
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Alice Blet
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Maurice Mimoun
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - David Boccara
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
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10
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Repeated Use of Gluteal Fold Flaps for Post–Oncologic Vulvoperineal Reconstruction. Ann Plast Surg 2018; 80:648-652. [DOI: 10.1097/sap.0000000000001445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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A Systematic Review and Meta-analysis of Free-style Flaps: Risk Analysis of Complications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1651. [PMID: 29616165 PMCID: PMC5865937 DOI: 10.1097/gox.0000000000001651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/04/2017] [Indexed: 11/26/2022]
Abstract
Background: Free-style flaps allow surgeons to overcome anatomical variations and raise perforator flaps wherever a pulsatile signal can be detected. We performed a systematic review and meta-analysis to identify the risk factors for complications and indications for free-style flaps in soft-tissue defect reconstructions. Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The databases of MEDLINE, PubMed, ScienceDirect, and Cochrane Library were searched from January 1991 to January 2017 for original articles describing free-style flaps in soft-tissue defect reconstruction. Results: A total of 17 articles met the inclusion criteria, representing 453 free-style flaps. The percentage of free-style flaps conducted after primary oncologic resection was 54.4% (246/453). Free-style flaps were mostly used in the head and neck region (35.5%), and most of them were designed as pedicled perforator flaps (96.7%). Complete flap survival was accomplished in 91.8% of the free-style flaps. Complications were found in 13.5% of cases, and 2 risk factors were identified: extremity defects (risk ratio, 2.39; P = 0.006) and single perforator flaps (risk ratio, 4.93; P = 0.002). No significant differences were found among the criteria including patients aged greater than 60 years, female gender, chronic etiology, flap size over 100 cm2, flap rotation, or perforator skeletonization. Conclusions: Free-style flaps are both reliable and advanced forms of perforator flaps for use in soft-tissue defect reconstructions. Defects located on the extremities and flaps with single perforators are risk factors for flap failure and complications.
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13
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Kim JT, Kim YH, Ghanem AM. Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system. J Plast Reconstr Aesthet Surg 2015; 68:1556-67. [PMID: 26323993 DOI: 10.1016/j.bjps.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/09/2015] [Accepted: 07/06/2015] [Indexed: 11/25/2022]
Abstract
Complex defects present structural and functional challenges to reconstructive surgeons. When compared to multiple free flaps or staged reconstruction, the use of chimeric flaps to reconstruct such defects have many advantages such as reduced number of operative procedures and donor site morbidity as well as preservation of recipient vessels. With increased popularity of perforator flaps, chimeric flaps' harvest and design has benefited from 'perforator concept' towards more versatile and better reconstruction solutions. This article discusses perforator based chimeric flaps and presents a practice based classification system that incorporates the perforator flap concept into "Perforator Chimerism". The authors analyzed a variety of chimeric patterns used in 31 consecutive cases to present illustrative case series and their new classification system. Accordingly, chimeric flaps are classified into four types. Type I: Classical Chimerism, Type II: Anastomotic Chimerism, Type III: Perforator Chimerism and Type IV Mixed Chimerism. Types I on specific source vessel anatomy whilst Type II requires microvascular anastomosis to create the chimeric reconstructive solution. Type III chimeric flaps utilizes the perforator concept to raise two components of tissues without microvascular anastomosis between them. Type IV chimeric flaps are mixed type flaps comprising any combination of Types I to III. Incorporation of the perforator concept in planning and designing chimeric flaps has allowed safe, effective and aesthetically superior reconstruction of complex defects. The new classification system aids reconstructive surgeons and trainees to understand chimeric flaps design, facilitating effective incorporation of this important reconstructive technique into the armamentarium of the reconstruction toolbox.
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Affiliation(s)
- Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Centre, Seoul, Republic of Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Centre, Seoul, Republic of Korea
| | - Ali M Ghanem
- Barts and the London School of Medicine and Dentistry, London, UK.
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A "green" approach to secondary reconstruction: the concept of the recycle flap and a classification. Plast Reconstr Surg 2015; 135:401e-412e. [PMID: 25626825 DOI: 10.1097/prs.0000000000000996] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Harvesting soft tissue from a previously transferred flap allows for flap reshaping and simultaneously raising tissue for a secondary procedure. This is done without increasing the number of donor sites and is therefore a very attractive reconstructive option. METHODS Between March of 2011 and October of 2013, the authors performed 60 recycle flaps on 60 patients (three women and 57 men) who had undergone previous flap reconstruction (52 free and eight pedicled). The recycle flaps were raised as either random pattern or perforator flaps. Mean time between primary reconstruction and the recycle procedure was 28.3 months (range, 6 months to 20 years), and the mean age of our patients was 57 years (range, 21 to 78 years). RESULTS Of 60 recycle flaps raised for secondary reconstruction, 58 survived completely (97 percent). Two cases of total flap necrosis were encountered resulting from pedicle damage during attempted perforator dissection within a previously irradiated flap. Twenty-nine flaps were raised as random pattern flaps, 29 were raised as pedicled perforator flaps (20 with perforator skeletonization), and two were raised as free perforator flaps. CONCLUSIONS There are a number of ways to safely "recycle" the soft tissues used in a previous reconstruction. This provides new tissue for a secondary procedure while debulking and refining the primary flap. Raising perforator flaps from previously irradiated flaps is, however, technically challenging and carries a high risk of flap necrosis (40 percent in our series) and should be advised against. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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The trapezius perforator flap: an underused but versatile option in the reconstruction of local and distant soft-tissue defects. Plast Reconstr Surg 2014; 134:449e-456e. [PMID: 25158722 DOI: 10.1097/prs.0000000000000430] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The trapezius myocutaneous flap is an established reconstructive option in head and neck cases The authors present their experience with 10 trapezius perforator flaps, all raised using a freestyle technique of perforator dissection, to successfully reconstruct both local and distant soft-tissue defects. METHODS Ten patients underwent soft-tissue reconstruction using trapezius perforator flaps. After mapping the perforator with a handheld Doppler device at the intersection of a horizontal line drawn 6 to 8 cm inferior to the scapular spine and a vertical line drawn 8 to 9 cm lateral to the midline of the back, perforator flaps were raised in a freestyle fashion, with complete preservation of the trapezius muscle. The flap can be pedicled into local defects or transferred as a free flap. RESULTS Six flaps were elevated as pedicled flaps and four were transferred as free flaps. Flap size ranged from 6 × 4 cm to 25 × 15 cm. The pedicle length ranged from 4 to 14 cm. The pedicle originated from the dorsal scapular artery. In one case, the authors converted from a pedicled flap to a free flap secondary to insufficient pedicle length. All donor sites were closed directly. The follow-up period ranged from 4 months to 4 years. All of the flaps survived completely with no major complications, and no patients developed any shoulder dysfunction. CONCLUSIONS The trapezius perforator flap is a reliable and versatile reconstructive option that can be used to repair both local and distant soft-tissue defects. The donor-site morbidity is minimal. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Treatment of the Secondary Defect on the First Metatarsophalangeal Joint Using the Medial Plantar Hallucal Artery Dorsal Perforator Flap. Ann Plast Surg 2014; 76:536-40. [PMID: 25275474 DOI: 10.1097/sap.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Injuries or burns to the dorsum of the first metatarsophalangeal (MTP) joint may develop scar formation, resulting in hyperextension contracture. Surgical correction of the deformity often produces a secondary defect. The purpose of this study is to report on the use of the medial plantar hallucal artery dorsal perforator flap for the treatment of such defect. From February 2010 to June 2011, 16 patients were treated. The mean preoperative hyperextension of the first MTP joint was 48 degrees. The mean size of the defects was 3.6 × 6 cm. The mean flap size was 4 × 6.5 cm. The mean pedicle length was 4 cm. All flaps survived completely. Patient follow-up lasted a mean of 14 months. At the final follow-up, the mean hyperextension of the first MTP joint was 9 degrees. After surgery, the mean Foot Function Index improved from 62 to 7. Almost all patients were satisfied with the results. Transferring the medial plantar hallucal artery dorsal perforator flap is a useful and reliable technique for the reconstruction of the secondary defect on the first MTP joint.
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Han BL, Choi HJ. Free-Style Dual Plane Recycling Tensor Fascia Lata Musculocutaneous Perforator Flap for Reconstruction of Recurrent Trochanteric Defects. INT J LOW EXTR WOUND 2014; 13:72-5. [DOI: 10.1177/1534734613520324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sequential flap coverage might be required for recurrent defects, but reusing a flap as a donor site has seldom been reported. The concept of a “free-style flap” has been developed, and it allows reconstructive surgeons to raise flaps with various designs reliably, even at sites of previous flap surgery. This article presents the concept of free-style recycling of a tensor fascia lata flap into a perforator-based flap separated in 2 planes in a patient with a recurrent bilateral trochanteric defect. If a reliable perforator is preserved and identified within the tissues by computed tomography angiography or a Doppler device, a new perforator flap can be designed and raised at the previous flap site.
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18
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Chen YC, Huang EY, Lin PY. Comparison of gluteal perforator flaps and gluteal fasciocutaneous rotation flaps for reconstruction of sacral pressure sores. J Plast Reconstr Aesthet Surg 2014; 67:377-82. [PMID: 24476704 DOI: 10.1016/j.bjps.2013.12.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The gluteus maximus myocutaneous flap was considered the workhorse that reconstructed sacral pressure sores, but was gradually replaced by fasciocutaneous flap because of several disadvantages. With the advent of the perforator flap technique, gluteal perforator (GP) flap has gained popularity nowadays. The aim of this study was to compare the complications and outcomes between GP flaps and gluteal fasciocutaneous rotation (FR) flaps in the treatment of sacral pressure sores. METHODS Between April 2007 and June 2012, 63 patients underwent sacral pressure sore reconstructions, with a GP flap used in 31 cases and an FR flap used in 32 cases. Data collected on the patients included patient age, gender, co-morbidity for being bedridden and follow-up time. Surgical details collected included the defect size, operative time and estimated blood loss. Complications recorded included re-operation, dehiscence, flap necrosis, wound infection, sinus formation, donor-site morbidity and recurrence. The complications and clinical outcomes were compared between these two groups. RESULTS We found that there was no significant difference in patient demographics, surgical complications and recurrence between these two groups. In gluteal FR flap group, all recurrent cases (five) were treated by reuse of previous flaps. CONCLUSIONS Both methods are comparable, good and safe in treating sacral pressure sores. Gluteal FR flap can be performed without microsurgical dissection, and re-rotation is feasible in recurrent cases. The authors suggest using gluteal FR flaps in patients with a high risk of sore recurrence.
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Affiliation(s)
- Yen-Chou Chen
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yuan Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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