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Yoshimatsu H, Karakawa R, Fuse Y, Yano T, Muro S, Akita K. The Use of the Deep Brachial Artery as the Recipient Artery for Free Perforator Flap Transfer: An Anatomic Study and Clinical Applications. Medicina (Kaunas) 2023; 59:1087. [PMID: 37374291 DOI: 10.3390/medicina59061087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Soft tissue reconstruction after sarcoma ablation in the posterior aspect of the upper arm has been commonly addressed using the pedicled latissimus dorsi musculo-cutaneous flap. The use of a free flap for coverage of this region has not been reported in detail. The goal of this study was to characterize the anatomical configuration of the deep brachial artery in the posterior upper arm and assess its clinical utility as a recipient artery for free-flap transfers. Materials and Methods: In total, 18 upper arms from 9 cadavers were used for anatomical study to identify the deep brachial artery's origin and point of crossing the x-axis, which was set from the acromion to the medial epicondyle of the humerus. Measurements of the diameter were taken at each point. The anatomic findings of the deep brachial artery were employed clinically in the reconstruction of the posterior upper arm after sarcoma resection using free flaps in 6 patients. Results: The deep brachial artery was found in all specimens between the long head and the lateral head of the triceps brachii muscle, and it crossed the x-axis at an average distance of 13.2 ± 2.9 cm from the acromion, with an average diameter of 1.9 ± 0.49 mm. In all 6 clinical cases, the superficial circumflex iliac perforator flap was transferred to cover the defect. The average size of the recipient artery, the deep brachial artery, was 1.8 mm (range, from 1.2 to 2.0 mm). The average diameter of the pedicle artery, the superficial circumflex iliac artery, was 1.5 mm (range, from 1.2 to 1.8 mm). All flaps survived completely with no postoperative complications. Conclusions: The deep brachial artery can be a reliable recipient artery in free-flap transfers for posterior upper arm reconstruction, given its anatomical consistency and sufficient diameter.
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Affiliation(s)
- Hidehiko Yoshimatsu
- Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Ryo Karakawa
- Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Yuma Fuse
- Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Tomoyuki Yano
- Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Plastic and Reconstructive Surgery, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Fuse Y, Yoshimatsu H, Karakawa R, Yano T. Deep Fat Saving Elevation of the Superficial Circumflex Iliac Artery Perforator Flap. Medicina (Kaunas) 2022; 58:670. [PMID: 35630087 PMCID: PMC9145857 DOI: 10.3390/medicina58050670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Prolonged drain stay and lymphorrhea are often problems at the donor site of the superficial circumflex iliac artery perforator (SCIP) flap. This study aimed to introduce a novel technique of the SCIP flap elevation: Deep Fat Saving (DFS) technique. Materials and Methods: Thirty-two patients who underwent the SCIP flap transfer were divided based on the flap-elevated layer: above the deep fascia or the Camper fascia saving the deep fat. The duration of drain stay and the rates of flap survival and donor-site complications were compared between the groups. The inverse probability weighting (IPW) method was conducted to balance confounders. Results: By IPW, two balanced pseudo-populations were created: DFS = 33.9 and Conventional = 31.3. There were no significant differences in the rate of flap survival (DFS: 100% verses Conventional: 95.8%, p = 0.32) and donor site complications (DFS: 2.4% versus Conventional: 1.3%, p = 0.68, respectively). The duration of drain stay was shorter in the DFS group (weighted median: 6 versus 8 days; weighted difference: -1.6 days (95% confidence interval: -2.8 to -0.4), p = 0.01). Conclusions: An SCIP flap can be reliably harvested using the Deep Fat Saving technique.
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Affiliation(s)
- Yuma Fuse
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (H.Y.); (R.K.); (T.Y.)
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Yoshimatsu H, Karakawa R, Fuse Y, Yano T. Simultaneous Lymphatic Superficial Circumflex Iliac Artery Perforator Flap Transfer from the Zone 4 Region in Autologous Breast Reconstruction Using the Deep Inferior Epigastric Artery Perforator Flap: A Proof-of-Concept Study. J Clin Med 2022; 11:jcm11030534. [PMID: 35159986 PMCID: PMC8836945 DOI: 10.3390/jcm11030534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
The incidence of upper extremity lymphedema after breast cancer treatment is reported to be 14% after axillary lymph node dissection (ALND) and 33% after ALND and regional lymph node dissection. The present report describes a novel method in which the afferent lymphatic vessels are harvested with their lymph nodes from the Zone 4 region as a separate flap, the superficial circumflex iliac artery perforator (SCIP) flap, in the setting of autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap. From September 2017 to September 2020, seven female patients with an average age of 46.9 years (range: 39 to 54 years) underwent autologous breast reconstruction using the DIEP flap and the lymphatic SCIP flap procured separately from the Zone 4 region. All patients had undergone ALND, four patients had undergone radiation therapy, and three patients had established lymphedema at the time of reconstruction. All lymphatic SCIP flaps survived completely. Lymphedema did not occur in any of the four patients to whom the lymphatic flap was transferred for a preventive purpose (average follow-up: 37.5 months). In three patients with established lymphedema at the time of reconstruction, the average rate of estimated volume decrease at the last follow-up (average: 29.0 months) was 12.6%. A lymphatic SCIP flap procured from the Zone 4 region in DIEP flap breast reconstruction can contribute to improvement or prevention of lymphedema with no additional donor site.
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Fang Y, Ouyang Q, Zheng Z, Wang J. Case Report: Superficial Circumflex Iliac Artery Perforator Flap for Tongue Reconstruction Following the Hemiglossectomy. Front Surg 2021; 8:692331. [PMID: 34805255 PMCID: PMC8599122 DOI: 10.3389/fsurg.2021.692331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Therapeutic evaluation of applying superficial circumflex iliac artery perforator (SCIP) flap in tongue reconstruction after hemiglossectomy. Methods: We retrospectively collected a total number of 14 patients who received SCIP flap reconstruction for tongue defects at the Fujian Medical University affiliated Union Hospital, between November 2016 and November 2020. We evaluated the clinical features of the flap, analyzed the postoperative functions and esthetic effects after 6 months of the tongue reconstruction. Results: All the SCIP flaps survived successfully after the operation, the recipient site tongue bodies were well reconstructed 6 months after the surgery. Patient speech and swallowing functions were well recovered during the follow-up. The scars in the donor site were concealed with limited numbness. Conclusions: With the advantages of the hidden donor site and aesthetic benefits, the SCIP flap is a reliable option for the reconstruction of the tongue defect after hemiglossectomy.
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Affiliation(s)
- Yihong Fang
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qiming Ouyang
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhi Zheng
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jin Wang
- Department of Oral Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Schiltz D, Lenhard J, Klein S, Anker A, Lonic D, Heidekrueger PI, Prantl L, Jung EM, Platz Batista Da Silva N, Kehrer A. Do-It-Yourself Preoperative High-Resolution Ultrasound-Guided Flap Design of the Superficial Circumflex Iliac Artery Perforator Flap (SCIP). J Clin Med 2021; 10:jcm10112427. [PMID: 34070779 PMCID: PMC8198546 DOI: 10.3390/jcm10112427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 11/21/2022] Open
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe an easy, reliable, systematic, and standardized approach for preoperative SCIP flap design and perforator characterization, using color-coded duplex sonography (CCDS). A list of customized settings and a straightforward algorithm are presented, which are easily applied by an operator with minimal experience. Specific settings for SCIP flap perforator evaluation were investigated and tested on 12 patients. Deep and superficial superficial circumflex iliac artery (SCIA) branches, along with their corresponding perforators and cutaneous veins, were marked individually with a permanent marker and the anatomy was verified intraoperatively. From this, a simplified procedure for preoperative flap design of the SCIP flap was developed. Branches could be localized and evaluated in all patients. A preoperative structured procedure for ultrasonically guided flap design of the SCIP flap is described. A 100% correlation between the number and emergence points of the branches detected by preoperative CCDS mapping and the intraoperative anatomy was found.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany;
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Jasmin Lenhard
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Silvan Klein
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Alexandra Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Daniel Lonic
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Paul I. Heidekrueger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (E.-M.J.); (N.P.B.D.S.)
| | | | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
- Correspondence: ; Tel.: +49-941-9446763
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Yoshimatsu H, Karakawa R, Fuse Y, Tanakura K, Yamamoto T, Okada A, Daniel BW, Yano T. Use of the superficial circumflex iliac artery perforator flap for reconstruction after sarcoma resection. J Surg Oncol 2021; 123:1067-1080. [PMID: 33428783 DOI: 10.1002/jso.26364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/05/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative complications after flap-coverage in sarcoma treatment can postpone postoperative adjunct treatments. Here, we present our experience with the use of the superficial circumflex iliac artery perforator (SCIP) flap after sarcoma resection. PATIENTS AND METHODS Patients undergoing immediate reconstruction surgery with a flap after sarcoma resection at a single institution from February 2017 to April 2020 were identified. Patient demographics, tumor characteristics, surgical characteristics, and complications were examined. RESULTS Thirty-five consecutive patients underwent reconstructions using a SCIP flap (34 free and one pedicled SCIP flaps). We also identified 47 consecutive patients who underwent reconstruction with other pedicled or free flaps over the same time period. No significant differences were found in patient age, gender, defect size, or operative time between these two groups. The incidences of overall complications (20/47 [42.6%] vs. 3/35 [8.5%], p < .001), flap dehiscence (7/47 [14.8%] vs. 0/35 [0%], p = .018), and total flap complications (15/47 [31.9%] vs. 2/35 [5.7%], p = .005) were statistically greater in the control group than in the SCIP group. CONCLUSION With its minimal postoperative complication rate both in the reconstruction site and the donor site, the SCIP flap can be considered an optimal reconstruction option after sarcoma resection.
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Affiliation(s)
- Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuma Fuse
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenta Tanakura
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine Plastic and Reconstructive Surgery, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Bassem W Daniel
- Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine Plastic and Reconstructive Surgery, Tokyo, Japan
| | - Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Riesel JN, Giladi AM, Iorio ML. Volar Resurfacing of the Thumb with a Superficial Circumflex Iliac Artery Perforator Flap after Hydrofluoric Acid Burn. J Hand Microsurg 2018; 10:162-165. [PMID: 30483026 DOI: 10.1055/s-0038-1630146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/02/2018] [Indexed: 10/17/2022] Open
Abstract
A right-hand-dominant 55-year-old male automotive mechanic presented 24 hours following a hydrofluoric acid burn to the volar left thumb. Despite the severity of soft tissue injury, the neurovascular bundles were intact. Although a free toe-pulp flap is often described to cover volar digit defects, the resultant 6- × 4-cm full-thickness injury of the thumb was too large to be adequately covered by a toe-pulp flap or other commonly used local flaps from the ipsilateral hand. The authors used a superficial circumflex iliac artery perforator (SCIP) flap to reconstruct the volar surface of the thumb from the tip to the metacarpophalangeal joint. They used an arterial anastomosis with the princeps pollicis artery so that the anastomosis was well outside the zone of injury. The patient recovered from the procedure without event and was discharged home on postoperative day 5. At his 2-week postoperative visit, protective sensation with diminished light touch was intact. The authors conclude that the SCIP flap is a technically challenging but versatile, thin flap with minimal donor site morbidity that can be used to resurface the volar aspect of the thumb. The SCIP flap is a valuable resource for the hand surgeon confronted with larger soft tissue defects of the hand.
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Affiliation(s)
- Johanna N Riesel
- Harvard Combined Plastic Surgery Residency Training Program, Boston, Massachusetts, United States
| | - Aviram M Giladi
- The Curtis National Hand Center, Baltimore, Maryland, United States
| | - Matthew L Iorio
- Division of Plastic Surgery, University of Colorado, Aurora, Colorado, United States
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