Paraumbilical Perforator Flap Research Articles

Extended paraumbilical perforator flap pedicled with the inferior epigastric artery for coverage of type III circumferential electrical burns of the wrist.

Type III electrical burns on the wrist are characterized by circumferential wounds, three dimensional with sandwich-like necrosis, and progressive blood circulation disturbances. Limb salvage is challenging, and success in meeting this challenge depends on vascular reconstruction and wound coverage. This paper is intended for the following purposes: to investigate the principles of wound debridement, the management of involved blood vessels, and the clinical effects of the extended paraumbilical perforator flap pedicled with the inferior epigastric artery for coverage of type III circumferential electrical burns of the wrist. Thirteen male patients (age, 20-43 years; average, 29 years) were enrolled in the study. After early escharotomy, debridement, and vascular reconstruction, all wounds were repaired with the extended paraumbilical perforator flap pedicled with the inferior epigastric artery. Flap survival was achived in all 13 patients. Subcutaneous liquefaction necrosis and infection beneath the flap occurred in 3 patients. Radial or ulnar artery reconstruction via the great saphenous vein graft was performed in 12 cases. All patients had a mean follow-up of 6-36 months, the flaps demonstrated satisfactory flexibility and texture. Hand function was preserved in 8 patients, and no patients developed abdominal hernia. Thorough debridement, early vascular re-establishment, and wound coverage are essential for the overall limb salvage effort for type III circumferential electrical burns of the wrist. The extended paraumbilical perforator flap may provide a new and appropriate option for the primary repair of extensive soft tissue defects.

The Versatility of Paraumbilical Perforator Flap in the Coverage of Large Posttraumatic Hand Defects

The Versatility of Paraumbilical Perforator Flap in the Coverage of Large Posttraumatic Hand Defects

The Versatility of Paraumbilical Perforator Flap in The Coverage of Large Posttraumatic Hand Defects

The Versatility of Paraumbilical Perforator Flap in The Coverage of Large Posttraumatic Hand Defects

Clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture deformity after extensive burns

Objective: To investigate the clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture after extensive burns. Methods: A retrospective observational study was conducted. From August 2017 to October 2021, 7 patients with severe scar contracture deformity caused by extensive burns were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 5 males and 2 females, aged 26-65 years, with scar area of 20 cm×4 cm-34 cm×14 cm. In the first stage, the rectangular skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 500-600 mL were embedded above the inguinal ligament, and then normal saline was injected after stitch removal for expansion to meet the needs of repair surgery. In the second stage, the scar was removed by surgical excision to correct the deformity and release the adhesion and contracture; after the removal of the expanders, the expanded ilioinguinal free flaps were harvested. When a larger flap was needed, the paraumbilical perforator flap was harvested at the same time, and the flaps were transplanted to the secondary wound after scar resection. The number of embedded expanders, the total amount of injected normal saline, the expansion time, the complications of skin and soft tissue expansion, the number, area, thickness, and anastomotic vascular pedicles of the expanded ilioinguinal flaps being resected, the type of flaps used, the repair method of flap donor sites, and the survival of flaps after operation were observed and recorded. The long-term repair effect and donor site condition were followed up. At the last follow-up, the patients' satisfaction with the curative effect of each surgical site was investigated according to the grade 5 score of Likert scale. Results: A total of 10 expanders were embedded in 7 patients, of which 4 patients had 1 each and 3 patients had 2 each. The total volume of normal saline injected was 800-1 800 (1 342±385) mL, and the expansion time was 4-24 (11±5) months. One patient had the expander exposed due to infection after the expander being inserted, while the other patients had no complications of skin and soft tissue expansion. Totally 10 expanded ilioinguinal flaps with the area of 22 cm×6 cm-36 cm×16 cm ((326±132) cm2) and the thickness of 0.6-1.1 (0.77±0.16) cm were harvested. Among the 10 expanded ilioinguinal flaps, 5 were pedicled with the superficial circumflex iliac artery, 3 with the superficial abdominal artery with relatively large caliber, 1 with the common trunk of the superficial circumflex iliac artery and the superficial abdominal artery, and 1 flap was anastomosed with the superficial circumflex iliac artery and bridged the superficial abdominal artery for intra-arterial supercharge. Unilateral expanded ilioinguinal flap combined with ipsilateral paraumbilical perforator flap were harvested in 4 cases, bilateral expanded ilioinguinal flaps were harvested in 1 case, and unilateral expanded ilioinguinal flap was harvested in 2 cases. Except for 1 case being transplanted with autologous split-thickness scalp to repair the flap donor site after combined resection of bilateral expanded ilioinguinal flaps, the donor sites of the other patients were sutured directly. All the flaps survived after operation without tip necrosis or wound residue. Follow-up for 3-30 (15±10) months showed that the flap was soft and not bloated, the function and appearance of the recipient area were significantly improved compared with those before operation, and the appearance of the donor sites was good. At the last follow-up, the patients' satisfaction with the treatment effect of the surgical site scored 4-5 (4.5±0.4). Conclusions: The expanded ilioinguinal flap can be obtained in a large area. It has the advantages of rich blood supply, less damage to the donor site, concealed location, and being convenient to be resected and transplanted in combination with the paraumbilical perforator flap. It is suitable for the clinical reconstruction and treatment of severe scar contracture deformity after extensive burns.

Clinical applications of paraumbilical perforator flaps in multiple angiosomes for the reconstruction of the upper limbs

BackgroundRepair of extensive deep wounds in the forelimb remains challenging for surgeons. The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator (PUP) flaps in patients with massive soft tissue defects in the upper limbs. MethodsBetween January 2017 and September 2021, 16 patients (6 women and 10 men) aged 24–54 years (average, 41.4 years) who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated. Their injuries included damage to the fingers, dorsal skin of the hands, wrist, or forearm. Their tendons or bones were exposed after debridement. In some patients, multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects. ResultsAll flaps survived and healed well. After a follow-up of 2–54 months, all patients recovered satisfactorily in terms of characteristic and functional review. ConclusionsThe application of PUP flaps, especially those encompassing multiple angiosomes (multiple-territory PUP flaps), can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.

Application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing destructive wounds

Objective: To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds. Methods: The retrospective observational study method was applied. From January 2015 to December 2020, 28 patients (21 males and 7 females, aged 25 to 66 years) with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital. The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement. Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively. The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm, and the lengths of vascular pedicles were 13.0-17.0 (15.1±2.3) cm. For type Ⅲ high-voltage electric burn wounds of wrist, two methods were used to reconstruct the blood flow of hand, one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap. The strength of abdominal wall in the donor site was strengthened by polypropylene patch, and then the wounds were directly sutured. If the wounds could not be sutured directly, then allogenic acellular dermal matrix (ADM) was applied to strengthen the abdominal wall first, and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds. The flap transplantation, hand blood flow reconstruction, the repair of donor site, the flap survival, the wound and donor site healing after operation, the appearance of flaps, and the wound and donor site recovery during follow-up were observed. Results: Among the patients in this group, 13 patients were treated with pedicled flap grafting, while 15 patients were treated with free flap grafting. The hand blood flow of 7 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting. The hand blood flow of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap. In 16 patients, the strength of abdominal wall was strengthened using patch in the donor site,and then the donor sites were sutured directly. In 12 patients, the strength of abdominal wall was strengthened using allogenic ADM, and then the donor sites were covered by skin grafting. All the transplanted flaps survived completely. The wounds of 24 patients were healed, while the wounds of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist and 1 patient with chronic radiation ulcer of ilium failed to heal because of there were still some necrotic tissue and purulent secretion under the flaps. The wounds were healed eventually after debridement and dressing changes. During the follow-up of 6 months to 3 years, the flap survived well with good appearance in all patients, and there was no recurrence, or no abdominal wall hernia occurred in the donor site. Conclusions: Paraumbilical perforator flap with inferior epigastric vessels has flexible design, long vascular pedicle, large area for cut. It can be pedicled or freely transplanted, which is a good choice for repairing destructive wounds in various areas.

Paraumbilical perforator flap for one-stage reconstruction of a large oncologic vulvar defect: a single case report

Paraumbilical perforator flap for one-stage reconstruction of a large oncologic vulvar defect: a single case report

VERSATILITY OF PARAUMBILICAL PERFORATOR FLAP FOR UPPER LIMB RECONSTRUCTION

Background Microvascular flap and groin flap are the most commonly used flaps for upper limb reconstruction. Microvascular flap can not be done in certain situations and groin flap is not convenient for coverage of forearm defect and elbow defect. Paraumbilical perforator (pup) flaps can provide a large amount of tissue for coverage of forearm , elbow defects and mitigates the side effects of groin flap. Material and method A retrospective study was conducted for reconstruction of soft tissue defects from finger tip to elbow between January 2016 to December 2019 with PUP flaps .Demographic data, size of the defect, etiology ,flap design and flap complication were analysed . Result The age of the patients ranged from 12 years to 56 year with mean age of 29.85 years and SD = 11.073. Male to female ratio was 1.5 : 1 (M=12 , F= 8). Size of the defect varied between 20 cm2 to 288cm2 with mean of 88.1 cm 2 and SD = 29.69 .No of cases with flap dimension < 100 cm 2 (n= 13), and > 100 cm2 (n= 7) . Aetiology of injury included vehicular accidents in 10 patients, machine injury in 2 patients, electrical burns in 6 patients post snake bite ulcer 2 patients. The location of the defect included hands, forearm and the elbow, and fingers.Flap was directed Superolaterally in 18 patients , inferolaterally in one case , and combined medially and laterally in one case. There was no case of complete flap failure. Conclusion Paraumbilical perforator flap can be a safe and reliable option for soft tissue reconstruction in varied areas of upper limb.

Two Perforators Improve the Extent and Reliability of Paraumbilical Flaps for Upper Limb Reconstruction.

BACKGROUNDComplex defects of the forearm and arm are best reconstructed with free flaps. Free flaps are however not universally available. They require long operative time and may be contraindicated in patients with extensive injuries due to a lack of good recipient vessels. The alternatives to free flaps are distant flaps such as groin flaps, random abdominal flaps, thoracoepigastric flaps and paraumbilical perforator flaps. These are axial flaps that are limited by the angiosomes supplied by a given perforator or blood vessel. To improve the extent and reliabilities of the paraumbilical flaps, we incorporated two perforators in the flap.METHODSA total of 17 patients with extensive forearm defects were managed by two vessel paraumbilical perforator flaps between January 2013 and December 2018. The perforators were identified by a hand-held Doppler and the flap was fashioned with the perforators at the base. RESULTSThe mean length of the flap raised was 19.5 cm and width was 8.3 cm. The median age was 39 years. All the flaps were successful with no incidence of flap necrosis and no dehiscence.CONCLUSIONTwo vessel perforator flaps improved the reliability of the paraumbilical perforator flap, allowing for a bigger flap to be harvested and thus ensuring a cover of larger defects. The flaps were easy to raise and were easily tolerated by the patients.

Current indications for abdominal-based flaps in hand and forearm reconstruction

Extensive soft tissue loss or injury of the hand and upper extremity is a challenging reconstructive problem traditionally treated with abdominal-based pedicled flaps. Options for coverage included the groin flap based on the superficial circumflex iliac artery, the Scarpa's fascia flap based on the superficial inferior epigastric artery, and the paraumbilical perforator flap from the deep inferior epigastric artery perforators. Despite the ability to provide consistent and pliable soft tissue coverage with ease of elevation, these flaps have several disadvantages including restriction of mobility, requirement for multiple procedures, bulkiness and patient discomfort. With the advent of microsurgery, pedicled regional flaps, and off-the-shelf skin substitutes, the applications for these flaps have narrowed. However several indications still remain. These include: patient and facility factors which deter microsurgery, the absence of recipient vessels after injury, prior surgical use of recipient vessels, the need to preserve major vessels for future reconstruction, and large multi-surface wounds requiring coverage. In this review we detail these indications and provide case examples for each.

Oblique Paraumbilical Perforator (OPUP) Flap: A Reliable Reconstructive Option in Massive Soft Tissue Defect of the Elbow

ABSTRACT Objectives: The upper extremity is an important functional unit and is frequently exposed to trauma. Large soft tissue defects in the upper extremities require reconstruction with reliable tissues with maximum functional and aesthetic results.We aimed to present a reconstruction a massive soft tissue defect of elbow with oblique paraumbilical perforator flap in a multitrauma patient. Methods: A 26 year-old female patient was admitted as a result of an in-vehicle traffic accident. The patient had cerebral contusion, lung contusion, humerus fracture, tibia fracture, large dermal abrasions in the trunk,extensive tissue defect including scalp, wrist, elbow and proximal forearm. After reduction of fractures,ulnar nerve was reconstructed with sural nerve graft. 22 x 17 cm sized massive soft tissue defect of the elbow was. Results: Based on two deep inferior epigastric artery perforators the OPUP flap was raised in suprafascial fashion. The flap was divided on the 22nd day. No complications observed postoperatively. Conclusion:The OPUP flap is a versatile and reliable flap; hence it can be used as a salvage option for massive upper extremity defects around the elbow especially when other reconstructive methods are not possible. Keywords: elbow; perforator flap; upper extremity

Evaluation paraumbilical flap for coverage of forearm and hand defects

Background: To find out the reliability and dimensions of the pedicled paraumbilical perforator flaps to cover the compound defects of the forearm and hand.Methods: Twelve (12) patients with defects of hand, wrist, forearm and elbow are included in this study. The study period extends from August 2012 to February 2015. Patients were aged between 12-45 years. The detailed systemic examination of the patient and the local examination of the wound was carried out in all the patients. For the patients with burns, hemodynamic stabilization was done with appropriate fluid management and blood transfusions. The routine laboratory investigations were done.Results: It was a prospective study of twelve (12) cases was carried out in this study. Six men (50%) aged between 25-45 years were the commonly affected group, followed by three women (25%) aged between 35 - 40 years and three children (25%), two males and one female aged between 12-17 years. Most common cause of the defect was electrical burns in seven cases (58.33%) due to accidental contact with high tension live electrical wire while at work in adults. In children it was due to accidental contact with live electric wire while they were playing. Most common site of injury was found on forearm in seven cases (58.33%), out of which left forearm was injured in five cases (41.66%) and right forearm in two cases (16.66%), followed by wrist in 2 cases (16.66%), dorsum of hand in one case (8.33%) and elbow in two cases (16.66%). All the defects were compound in nature with exposure of the tendons and bones and they were devoid of paratenon and periosteum.Conclusions: This study conclude that the paraumbilical flap is useful flap for coverage of the upper limb defects involving the hand, wrist, forearm and elbow. A fairly large flap with dimensions as large as 18 x 13 cm can be harvested. The flap is reliable with flap survival rate of 91.66%, (11 cases). There is no need to isolate the vascular pedicle, and the dissection is quick and easy. The flap and the limb remain in an elevated position and there is minimal edema and congestion postoperatively. Although the donor site scar is not concealed, as in groin flap, majority of the patients accepted the donor scar as it got concealed under the traditional dress. Thus, this flap can become workhorse for the defects of hand, wrist, proximal forearm and defects around the elbow.

Paraumbilical Perforator Flap: A Good Choice for the Repair of the Deep Soft Tissue Defects in the Hand and Forearm

Objective: Severe trauma to the hand or forearm often results in the deep soft tissue defect with the exposure of tendon or bone, which needs to be repaired by skin flaps. In this study, we introduced the use of paraumbilical perforator flap in the repair of such defects, and discussed its advantages and disadvantages. Methods: From Jan. 2006 to Dec. 2016, 14 patients with deep soft tissue defects in the hand and forearm were admitted into our clinic. The defects were caused by hot-crush injury (n=2), electrical injury (n=4), severe burn (n=2), crush injury (n=3), and avulsion injury (n=3). After admission, the patients underwent the debridement, vacuum suction, and skin graft to repair partial wound. The deep defects with the exposure of tendon and bone were repaired by paraumbilical perforator flap finally. Methods: From Jan. 2006 to Dec. 2016, 14 patients with deep soft tissue defects in the hand and forearm were admitted into our clinic. The defects were caused by hot-crush injury (n=2), electrical injury (n=4), severe burn (n=2), crush injury (n=3), and avulsion injury (n=3). After admission, the patients underwent the debridement, vacuum suction, and skin graft to repair partial wound. The deep defects with the exposure of tendon and bone were repaired by paraumbilical perforator flap finally. Conclusions: The paraumbilical perforator flap has reliable blood supply, good texture, sufficient area, and is convenient to transfer. It's an ideal choice for the repair of the deep soft tissue defect in the hand and forearm.

Paraumbilical Perforator Flap: A Good Choice for the Repair of the Deep Soft Tissue Defects in the Hand and Forearm

Paraumbilical Perforator Flap: A Good Choice for the Repair of the Deep Soft Tissue Defects in the Hand and Forearm

Pedicled Oblique Para-Umbilical Perforator (OPUP) Flap for Upper Limb Reconstruction.

Groin flap has been considered the workhorse flap for hand reconstruction. However it has certain drawbacks when covering defects over elbow or proximal forearm. Pedicled oblique paraumbilical perforator (OPUP) based flaps provide a good alternative in such cases. We performed OPUP flap in 11 cases of complex upper limb reconstructions over the past one year. We report our experience with this flap. All flaps survived. One patient had marginal necrosis of 1 cm in the proximal end after flap division. Three patients had donor site scar hypertrophy. OPUP flap is superior to groin flap for larger defects or defects around the elbow. The major disadvantage is the donor site scar which is prone to hypertrophy.

The pedicled inferior paraumbilical perforator (I-PUP) flap for a volar wrist defect: A reconstructive solution across the ages

Full-thickness soft-tissue defects overlying vital forearm or wrist structures frequently result from acute trauma or tumor ablation. These defects present reconstructive challenges, due to the thin pliable skin to be replaced and the non-graftable bed beneath. The authors discuss a case of a renal-transplant patient with a volar wrist SCC, in whom local vascular anatomy deemed microvascular free tissue transfer inappropriate. The authors present a successful novel reconstructive solution; the pedicled inferior paraumbilical perforator flap (I-PUP), a two-staged procedure that incorporates principles of distant flaps--which pre-date microsurgery--combined with techniques and lessons learned in the era of perforator flap surgery.

“Wing Flaps”

Single large-area or 2 small- to moderate-sized raw areas in the hand and forearm are difficult to cover with conventional groin or superficial inferior epigastric artery (SIEA) flaps. Though abdomen is a favorable donor site for a pedicled distant flap for soft tissue coverage of the hand and forearm, pedicle flaps based on paraumbilical perforators are not commonly used. We herein describe a method of soft tissue coverage using 2 flaps based on 1 paraumbilical perforator in certain difficult clinical situations, unsuitable to be covered with groin or SIEA flaps. By virtue of having a very narrow common pedicle for 2 substantially large flaps close to the chosen paraumbilical perforator, the configuration of it prompted us to call these twin flaps "wing flaps," or a winged version of paraumbilical pedicle flaps. The wing flap described was used to cover twin raw areas (in 6 cases) and a large area (in 1 case) in the hand and forearm. All 7 flaps went on to heal very well and served the purpose. The only complication observed was a minor thumb web contracture in one case, which improved with physiotherapy. The winged version of pedicled paraumbilical perforator flaps should find a place in the surgical armamentarium for soft tissue coverage in the hand and forearm in difficult situations. The advantages and simplicity of these flaps have been described, based on our experience in a small series of 7 cases.

Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the ventral thoracic wall

The purpose of this paper is to present a new method of ventral chest wall reconstruction utilizing skin and fat from the abdominal wall pedicled on the superior epigastric artery and its comitant veins without sacrificing the rectus abdominis muscle. In a patient with a 13 × 15 cm left parasternal soft tissue defect of the thoracic wall, a paraumbilical perforator flap of skin and subcutaneous tissue was elevated with meticulous preparation of the perforators to the right superior epigastric vessels without sacrificing any muscle. The skin and fat island with its vascular pedicle was drawn through an epigastric subcutaneous tunnel to the ventral thorax and placed into the defect. Postoperative flap perfusion measured by laser Doppler flowmetry was excellent, abdominal wall reconstruction was easy, and 3 months after operation, the ability to perform sit-ups was as good as before the operation. In two further patients, we found the vascular anatomy to be unsuitable for this flap. The pedicled superior epigastric perforator (SEP) flap is suitable in certain cases but unreliable for reconstruction of soft tissue defects at the chest wall. Further investigations and operating experience may provide additional knowledge to allow wider and more secure use of the SEP flap.

P‐I‐05 Flap Repairs for Incurable Lower Leg Ulcers

Incurable ulcer in the lower legs means avascular skin defects exposing bone and osteomyelitis which cannot be repaired even with skin grafting. A total of 151 patients with incurable ulcers were operated with flaps; 60 cases of traumatized avascular defects, 20 diabetic ulcers, 17 osteomyelitis, 14 malignant tumors, 5 arterial obstructions, and 5 arteriovenous malformations, and others. A total of 61 island flaps were used; 20 posterior tibial perforator flaps, 7 saphenous flaps, 7 peroneal flaps, 4 anterior tibial flaps, 4 malleolar perforator flaps, 4 medialis pedis flaps, and others. In addition, a total of 82 free flaps using microvascualr anastomosis were sued; 24 flow‐through anterior thigh flaps, 13 flow‐throuh thoracodorsal artery perforator flaps (or latissimus dorsi MC flap), 8 paraumbilical (or deep inferior epigastric artery ) perforator flap, 6 saphenous venous flaps, 7 combined flaps, and 24 others. In conclusions, small ulcers could be repaired with minimal invasive methods including local perforator flaps and small muscle flaps under local anesthesia. Free flow‐through flaps and free bypass flaps (for diabetic gangrene with ASO), and combined osteocutaneous flaps (for massive segmental defects after resecting advanced carcinoma) are indicated for large ischemic defects.

Modified free paraumbilical perforator flap: the next logical step in breast reconstruction.

The free paraumbilical perforator flap that was developed with only the perforator penetrating the rectus abdominis muscle seems nearly ideal from the donor-site perspective, because it reduces morbidity virtually to that of an abdominoplasty. However, it requires "supermicrosurgery" skills for suturing of vessels with diameters of 0.7 mm or less, making the procedure technically demanding and risky. Another significant disadvantage of that technique is that the flap has very short vascular pedicles. To overcome the disadvantages of the free paraumbilical perforator flap, a minor modification in flap harvesting that improves the vessel size and length is described. Results for a total of 15 patients who underwent breast reconstruction with modified free paraumbilical perforator flaps are presented, and the advantages and disadvantages of this flap are discussed.