Artery Perforator Flap For Repair Research Articles

Internal mammary artery perforator flap for repair of an upper thoracic tracheo-oesophageal fistula

Tracheoesophageal fistulas (TOF) following esophagectomy for esophageal cancer are rare but potentially fatal. There is no consensus on treatment between stenting and surgical repair, although the latter is associated with better distant survival. In surgical repair, the interposition of a flap improves healing by providing well-vascularized tissue and reinforcing the repair zone. The flaps described are usually muscular and decaying. We present the case of a malnourished fifty-year-old man who underwent intrathoracic surgical repair of symptomatic recurrent TOF using a skin flap based on the perforators of the internal thoracic artery (IMAP). The perforator flap was completely de-epidermized and tunneled under the sternum by a proximal and limited resection of the 3rd costal cartilage and placed at the posterior aspect of the trachea, with the excess tissue rolled up on either side. At 9 months, the patient showed no recurrence and improved general condition. The de-epidermized IMAP tunneled under the sternum intrathoracically is a reliable alternative to the conventional muscle flaps described in TOF management and an attractive additional tool in the plastic surgeon's surgical arsenal.

Free lateral tarsal artery perforator flap for repair of volar skin defect of thumb.

To investigate the effect of free lateral tarsal artery perforator flap in the repair of the volar skin defect of the thumb. From January 2020 to December 2022, the free lateral tarsal artery perforator flap was used to repair the skin defect of the palmar side of the thumb in 11 cases. There were 9 males and 2 females with an average age of 45 years (range, 35-62 years). The causes of injury were mechanical injury in 8 cases, traffic accident in 3 cases, combined with different degrees of tendon and bone exposure and injury. The time from injury to operation was 1 to 4 hours, with an average of 2.5 hours. The size of the flap ranged from 3.0 cm × 3.0 cm to 5.5 cm × 5.0 cm, and the donor site was repaired with the skin graft. All the flaps and skin grafts survived successfully, and the wounds healed in the first stage. All patients were followed up for 6 to 24 months, with an average of 15 months. The appearance of the flap was good, with normal color, no pigmentation, and a soft texture. The 2-point discrimination of the flap was 6 to 11 mm, with an average of 8.5 mm at 6 months after operation. At the last follow-up, 8 cases were excellent and 3 cases were good according to the trial standard of upper limb function evaluation of the Chinese Society of Hand Surgery of the Chinese Medical Association, and the excellent and good rate was 100%. There was no significant effect on the sensation and function of the feet in the donor site, and the patient satisfaction was high. Free lateral tarsal artery perforator flap is a good choice to repair the skin defect of the palmar side of the thumb because of its simple operation, high survival rate and good sensory recovery of the recipient area.

Application of free wrist crease radial artery perforator flap for repair of finger skin defects

Objective To investigate the clinical efficacy of free wrist crease radial artery perforator flap for repair of finger skin defects. Methods From July 2015 to May 2018, 42 patients with finger skin defects were treated. All the wounds were combined with bone and tendon exposure and repaired with free wrist crease radial artery perforator flap. The area of skin defects ranged from 1.5 cm×1.2 cm to 3.9 cm×2.0 cm. The patients were followed up regularly after operation. The survival of the flaps and the functional recovery of the repair site were observed, and the clinical efficacy was evaluated. Results All the flaps survived without vascular crisis. The follow-up period was 5 to 28 months, with an average of 13.5 months. The flaps had good blood supply, soft texture and good elasticity. Among them, 2 flaps were slightly bulky and the appearance was improved after secondary plasty. The movement and sensory function of the affected fingers recovered well. Conclusion The application of free wrist crease radial artery perforator flap for repair of finger skin defects can achieve good clinical efficacy postoperatively. Key words: Finger injuries; Surgical flap; Radial artery; Microsurgery

Clinical application of free wrist crease radial artery perforator flap for repair of complex hand wounds

目的 探讨游离腕横纹穿支皮瓣修复手部复杂创面的临床疗效。 方法 自2014年2月至2018年8月，我们共收治手部中小面积软组织缺损患者11例，均为累及2指以上的复杂创面，采用游离腕横纹穿支皮瓣修复指端缺损4例、中远节皮肤缺损3例、近中远节皮肤缺损4例，其余创面联合采用其他皮瓣修复。 结果 术后10例皮瓣完全存活；1例因皮瓣过长，远端坏死，经换药后Ⅱ期愈合。所有患者均获得随访，时间为3~12个月，平均6个月，游离腕横纹穿支皮瓣均外观满意，皮瓣颜色、质地、厚度与手部皮肤近似，供区隐蔽。 结论 游离腕横纹穿支皮瓣对于手部复杂创面的修复具有良好的疗效，适合临床推广应用。

Clinical application of the thoracodorsal artery perforator flap for repair of hand skin defects

Objective To explore the clinical application of the thoracodorsal artery perforator flap in repair of hand skin defects. Methods From April 2013 to December 2016, 5 patients with hand skin defects being 3.5 cm×5.2 cm to 6.8 cm×9.5 cm were treated using free transplantation of the thoracodorsal artery perforator flap. The blood circulation was reconstructed by the trunk of thoracodorsal artery anastomosis with the branch of hand artery, and flap accompanied vein or subcutaneous vein anastomosis with dorsal hand vein. The wound of donor site at chest and back was closed by direct suture. Results All 5 cases of the thoracodorsal artery perforator flap survived after operation. Partial skin margin necrosis occurred in 1 case, which obtained direct suture after secondary surgical debridement. Flap debulking was performed in 2 cases 3 months after the operation. The postoperative follow-up ranged from 3 to 15 months with an average of 6 months. The flaps had good texture, satisfactory appearance and good hand functional recovery. The donor site of the thoracodorsal artery perforator flap was hidden only with linear scar. Conclusion The thoracodorsal artery perforator flap is an ideal method for the repair of hand skin defects. Key words: Surgical flaps; Hand injuries; Skin defects; Thoracodorsal artery

Application of free medial sural artery perforator flap for repair of severe thumb web scar contracture

Objective To explore the clinical effect of free medial sural artery perforator (MSAP) flap for repair of severe thumb web scar contracture. Methods From October 2012 to March 2015, 14 cases of severe thumb web scar contracture were repaired with free MSAP flap after scar excision. The flap areas ranged from 5 cm×4 cm to 9 cm×6 cm. The clinical outcomes were evaluated by the appearance of transplanted flaps, sensory recovery, opening angle and width of thumb web and donor site recovery at postoperative follow-up. Results All 14 flaps survived uneventfully. The thumb webs were well-stacked with satisfactory shapes. There was no secondary contracture. Primary healing was achieved at donor sites. Postoperative follow-up ranged from 12 to 18 months, with an average of 14 months. Postoperative angle of repaired thumb webs was enlarged to (80±6)° from preoperative angle of (15±5)°. And the width was enlarged to (45.0±5.6) mm from (20.0±3.5) mm. Thumb functions of abduction, adduction and opposition were all improved obviously. All flaps restored protective sensation. Six cases with anastomosis of medial sural cutaneous nerve recovered to S3. No functional damage was observed at donor sites. Conclusion MSAP flap is an effective way to repair severe thumb web contracture because of its constant perforator, satisfactory shape of repaired thumb webs and minor damages to donor sites. Key words: Surgical flaps; Transplantation; Medial sural artery perforator; Thumb web contracture

REPAIR OF ANKLE SKIN AND SOFT TISSUE DEFECT WITH FREE SUPERFICIAL ILIAC CIRCUMFLEX ARTERY PERFORATOR FLAP

To investigate the effectiveness of free superficial iliac circumflex artery perforator flap for repair of foot skin and soft tissue defect. Between January 2010 and December 2015, 16 patients with ankle skin and soft tissue defect were treated. There were 13 males and 3 females with an average age of 32 years (range, 5-56 years). The causes included traffic accident injury in 8 cases, machinery injury in 3 cases, falling injury in 3 cases, and electrically injury in 2 cases. The time from injury to hospital was 1 to 6 hours (mean, 3.5 hours). The wound sites included foot dorsum skin defect in 6 cases, ankle skin defect in 5 cases, the back foot and ankle skin defect in 5 cases. The skin defect size ranged 5 cm×4 cm to 16 cm×7 cm. All patients had tendon exposure, and 8 patients had fracture. An emergency repair was performed in 6 cases, and selective surgery in 10 cases. The free iliac circumflex artery perforators flap was used to repair defect; the flap size was 6 cm×5 cm to 17 cm×8 cm, and the flap thickness was 0.4 to 1.1 cm (mean, 0.8 cm). The flaps survived in the other 15 patients with primary healing of wounds except 1 patient because the iliac circumflex artery was too small to provide good blood supply, who underwent repair with local skin flap. Incision at donor site healed by first intention. The 15 cases were followed up 6-24 months (mean, 13 months). The appearance of the foot was satisfactory, and the flap had good texture without bulky flaps. Free iliac circumflex artery perforators flap is one of ideal flaps in repair of skin defect of the foot and ankle because of hidden donor site, reliable blood supply, less injury to donor site, and full use of the flap.

Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects. Methods From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group). The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6-38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group. Results After debridement, the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm × 13.5 cm). Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14 cm). Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3-21 (mean 5.9) and sutures were removed on postoperative Days 12-14. Each flap included 1-2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group (80%, 8/10) significantly increased than that of control group ((25%, 3/12), χ2=4.583, P=0.032). Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected. Conclusion The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.

Free or Pedicled Thoracodorsal Artery Perforator Flap for Repair of Soft Tissue Defect on the Upper Limb

Free or Pedicled Thoracodorsal Artery Perforator Flap for Repair of Soft Tissue Defect on the Upper Limb

Use of the Internal Mammary Artery Perforator Flap for Repair of Pharyngocutaneous Fistulas in the Vessel-Depleted Neck

Use of the Internal Mammary Artery Perforator Flap for Repair of Pharyngocutaneous Fistulas in the Vessel-Depleted Neck

Free medial plantar artery perforator flap for finger pulp reconstruction: Report of a series of 10 cases

Treatment of composite tissue loss in the finger pulp is often difficult. The purpose of this report is to present our experience on using medial plantar artery perforator flap for repair of finger pulp defects and to restore fingertip sensation after traumatic injury. The free medial plantar artery perforator (MPAP) flaps were performed for digital pulp reconstruction in ten patients (eight fingertips and two thumbtips) between June, 2006 and December, 2007. This flap blood supply was perforator vessel of medial plantar artery, which was through the intermuscular septum between the abductor hallucis muscle and the flexor digitorum muscle. The recipient vessels were digital artery and dorsal digital vein. The flap was not reinnervated during transfer procedures. The donor sites were closed primarily in all cases. Flap size ranged from 15 x 25 mm to 60 x 20 mm. All flaps were survival. Partial loss occurred in one flap, due to venous congestion caused by excessive stitch tension. The donor sites healed unevenfully in eight cases, but mild wound dehiscence occurred in two cases. The follow-ups ranged from 6 to 29 months with the mean of 18.1 months. The mean of s-2PD and m-2PD were 8.8 mm and 6.8 mm at patients' last visits, respectively. MPAP flaps are good in terms of general morbidity, cosmetic results, and durability. This flap is a valuable alternative method of repairing the glabrous finger pulp and tip defects.

Medial Sural Artery Perforator Flap for Repair of the Hand

We report our experience of using the medial sural artery perforator flap in the reconstruction of soft tissue defects in the hand in seven cases with 1 to 2 year follow-up. The flap is harvested from the posteromedial aspect of the leg, just below the knee and superficial to the medial head of the gastrocnemius muscle. It is based on the perforator arteries and veins supplied by the medial sural artery. The flaps ranged in size from 14 x 10 cm to 8 x 6 cm. The donor area was closed directly or by a skin graft. All but one flap survived. The cosmetic results were satisfactory and without apparent bulkiness. Similarity of colour and thickness of the donor and recipient sites are advantages. We feel that this new flap is a satisfactory option for use in the hand, particularly for extended soft tissue defects on the dorsal hand.