Perforator-based Island Flap Research Articles

Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects.

This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm2. There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.

High-Pressure Paint Gun Injury of the Thumb: A Case of Reconstruction Using a Reverse Thenar Perforator-Based Island Flap

Hand injuries due to high-pressure paint gun devices are rare but may lead to serious outcomes. The authors describe a case of a high-pressure injury of the thumb that was managed promptly and later reconstructed successfully with minimal functional deficit. A 39-year-old man with a high-pressure paint gun injury of the right thumb was referred. Though the external wound was small, X-ray and computed tomography images showed extensive spread of paint inside. The paint was removed through a wide skin incision. After 6 weeks, the surgical wound had completely healed, except for a defect around the interphalangeal joint with bone exposure. A reverse thenar perforator-based island flap based on the princeps pollicis artery was elevated and moved to the defect. After defect reconstruction, the patient recovered pinch and grasp function through physiotherapy. High-pressure paint gun injuries of the thumb can lead to significant functional deficits of the hand. A small skin lesion may cause the actual extent of damage to be underestimated, as extensive penetration of paint can cause severe damage to the soft tissues. Thus, immediate surgical removal of the paint and coverage of the remnant wounds with an appropriate flap are necessary.

Supraclavicular Artery Perforator Based Flap in Reconstruction of Neck Soft Tissue Defects: Our Experience.

Neck reconstruction is challenging task as it requires achievement of both function and aesthetic form as it is exposed and visible part of body. Various reconstruction modalities like Skin graft to free flap has been described in literature (Achauer and Sood's Burns Surgery, edition 2006). We used Supraclavicular artery perforator based island Flap for resurfacing defect in Five patients. After localization of Supraclavicular artery perforator with hand held Doppler; flap was raised in subfascial plane and inset was given under anesthesia. Out of five patients, there were two males and three females. Three patients had Postburn neck contractures, one had post electrical burn defect, and one had post infective defect over neck region. All flaps survived well without any complications. Supraclavicular artery perforator based island Flap is a reliable soft tissue cover for neck defects from various etiologies.

A modified induced membrane 2-stage technique using a thoracodorsal artery perforator free flap followed by vascularized or non-vascularized free fibular transfer for the treatment of complex bone infection with concomitant severe soft tissue lesion–A case series of 9 cases

Treatment of post-traumatic complex bone infection is very challenging. The two principal bone reconstruction approaches are the single-stage vascularized bone graft technique and the two-stage induced membrane technique (IMT). Here we introduce a modified 2-stage induced membrane technique (MIMT) for complex long bone infection with a major bone defect and a concomitant severe soft tissue lesion. The 2-stage procedure consists of bone debridement, placement of a PMMA spacer and soft tissue reconstruction with a thoracodorsal artery perforator free flap (“Tdap”) at stage 1. At stage 2, the thoracodorsal artery perforator flap is elevated and a fibular strut graft (either vascularized of non-vascularized) is placed for bone reconstruction.We retrospectively analyzed the extents of lower extremity, long bone, post-traumatic bone infection treated via MIMT from 2008 to 2020. There were nine such cases (eight males) of mean age 59.8 (range 31 to 79) years. The osteomyelitis durations ranged from 3 to 360 months (mean 53 months). The cortical bone defect sizes was ranged from 9 to 14 cm (mean10.7 cm). All skin resurfacing employed Tdap. Vascularized fibular grafts were placed in six patients and non-vascularized grafts were placed in three. The fibular graft size ranged from 12.5 to 19 cm (mean 16.2 cm). Non-vascularized iliac bone grafts served as the fibula docking sites.Unfortunately, all patients suffered complications before bone union was achieved. One case of plate stress fracture and one case of screw fracture required plate and screw change. In three cases of cellulitis, one resolved by use of intravenous antibiotics, others required plate and screw removal. Wound disruption required re-suture and distal skin flap partial necrosis was covered by perforator-based island flap. One case of fibular stress fracture needed cast for 4 weeks. A peroneal nerve palsy patient recovered spontaneously. Bone union was achieved after 6 months in five patients and after 8 months in three (mean 6.9 months). All patients were able to walk unaided. The follow-up period ranged from 2 to 14 years (mean 6.2 years).MIMT saves the limbs in cases with difficult post-traumatic bone infection. It is valid treatment option for complex bone infections with severe soft tissue lesions. However, even with this technique potential complication must be considered.

Successful Reconstruction of a Defect Secondary to an Intersphincteric Abscess with Fournier’s Gangrene Using a Perforator-based Island Flap: A Case Report

Fournier’s gangrene, a soft tissue infection which is aggressive and sometimes lethal, often passes through deep fascial planes of the penis, scrotum, perineum, and lower abdomen; however, it rarely extends upward into the high intermuscular plane. We managed a rare case of Fournier’s gangrene with a high intersphincteric abscess from a perianal infection that resulted in a large defect in the anus and inferior aspect of the scrotum. A perforator-based island flap for the post-debridement defect was performed successfully. The perforator was selected near the defect along the lateral sacral border; the border of the flap design was adjacent to the defect, thus providing a sufficient angle of rotation near the pedicle with minimal dissection. Remnant undissected tissues around the pedicle prevented postoperative vascular complications. Additionally, the distal part of the flap design was elongated to the gluteal sulcus to be harvested as a very thin flap. This study suggests a perforator-based island flap as a secure and convenient option for covering a large defect involving the perianal region and inferior aspect of the scrotum.

Designing with relaxed skin tension line in perforator-based island flap for sacral sore reconstruction: A STROBE-compliant observational study.

Many various types of operative techniques have been performed used to treat make-up for sacral defects. Perforator-based flaps with flap transposition, but achieving an optimal flap design and tension-free flap closure without skeletonizing the perforator requires a great deal of clinical experience. In this study, we demonstrate perforator selection based on considerations of the relaxed skin tension line (RSTL), which has proven to be a suitable method of achieving an efficient flap design that enables primary closure.Twenty-five perforator-based flap procedures were performed on 25 patients at a single institution from February 2018 to January 2021. The medical records of patients were retrospectively reviewed.Twenty-three flaps survived completely. Two flaps developed partial tip necrosis but recovered after secondary healing, and 1 patient developed temporary congestion, which resolved spontaneously. No recipient or donor site recurrence or dehiscence was identified during follow-up.We report our clinical experiences of perforator-based flap use in the sacral region. When selecting an appropriate perforating vessel, 2 important points should be considered, that is, a flap long axis parallel to RSTLs and defect shape. According to the method presented in this paper, perforator-based flaps can be transposed safely and easily with few complications and serve as useful practice models to cover sacral defects.

Successful Perforator-Based Island Flap Placement Using the Push Technique

Background: Several surgical options are available for covering soft tissue defects. Perforator-based flaps can be utilized without skeletonization of the perforator, and surgery is usually straightforward, albeit with limited arcs of rotation. To overcome this limitation, we present our experience of the push technique, whereby the flap is manually pushed to release soft tissue attachments, allowing circumvention of the meticulous dissection required to enhance arc rotation. This technique allows faster flap elevation with minimal complications.Methods: The records of 37 patients that underwent perforator-based flap surgery using the push technique from September 2020 to June 2021 at our institution were retrospectively reviewed.Results: All 38 flaps survived completely though one flap developed congestion resulting in partial necrosis and revision. Mean operation time was less than 80 minutes. No dehiscence or recurrence was encountered at any donor or recipient site during follow-up.Conclusion: We present the “push technique” used during perforator-based flap surgery. This method allows for efficient, minimal, and rapid flap elevation without meticulous dissection and helps the operator determine which parts of soft tissue attachments require further release. The push technique can be performed safely and easily without jeopardizing flap survival due to venous ischemic or congestive change. It serves as a good practice model for inexperienced surgeons wishing to cover moderate-to large-sized defects.

Superficial temporal artery capillary perforator-based island flap for conchal bowl and external auditory canal reconstruction

Reconstruction of the auricle is challenging to surgeons as a result of its complex anatomy. Defects including the conchal bowl and the external auditory canal (EAC) do not accept imperfection as functional consequences may add to aesthetic ones. Local flaps that are relying mainly on posteriorly based auricle flaps do not represent ideal solutions. This study aims to report the perforator modification of an anteriorly based pre-auricular flap that matches all requires goals of reconstruction. From 2015 to 2019, three capillary perforator-based island flaps (c-PBIF), with the Superficial Temporal Artery (STA) as source pedicle, were performed to reconstruct a combined Conchal Bowl-External Auditory Canal (CB-EAC) defect, secondary to basal cell carcinoma resection. Free margins were obtained via the Tubigen micrographic approach. All three flaps were raised on the perforator originating from the superficial temporal pedicle. In 2 of the cases, the perforator was found at the level of the tragus while in the last case, it was found 1cm more distal. Capillary perforators were isolated and dissected down to their origin from the STA thereby increasing their arc of rotation and pliability. The median follow-up time was 4 years. All flaps survived. Aesthetic results were excellent leaving no distortion of the external ear and the hollow aspect of the conchal was well supported. The tragus mount was preserved, EAC lining was secured, and good audition was restored with no bulging of the flap into the canal in all the cases. Harvesting pre-auricular flaps as c-PBIFs are safe and acts as an excellent solution for the reconstruction of the challenging combined CB-EAC defect. It allows a one-stage reconstruction that does not need a secondary revision, it also gives excellent correction and functional results. We would recommend it as a useful option for the reconstruction of the conchal-EAC defects.

Pedicled vertical posteromedial thigh (vPMT) flap for the reconstruction of extensive perianal-genital defects

Perianal and genital defects occur because of a vast etiology making the reconstruction of function and esthetics remain challenging. Depending on the extent of the defect, different techniques have been employed for coverage including skin grafts, local skin flaps, musculocutaneous flaps, and pedicled perforator flaps. The pedicled vertical posteromedial thigh (vPMT) flap is a new perforator flap that has rarely been employed for this kind of reconstruction. The purpose of this article is to focus on the vPMT perforator flap, which is mainly used as a propeller flap, for reconstructing the perianal and genital region as a feasible option in this area. From July 2013 to December 2018, we treated twelve patients with extensive perianal and/or genital defects with 21 pedicled vPMT flaps. Three patients needed unilateral reconstruction, while 9 patients bilateral needed bilateral reconstruction. The location of the defects included the scrotal region (3 cases), the perianal region (8 cases), and the vulvar region (5 cases), whereby some cases had combined defects. The flap sizes varied from 5-9 cm in width to 18-35 cm in length and all flaps were harvested as perforator-based island flaps. The flap movements used for defect coverage included V-Y advancement in three cases and rotation in propeller fashion in eighteen cases. All flaps survived without any major complications and all donor sites were closed primarily. Our case series showed an exemplary model for the coverage of the perianal and genital region by using the pedicle vPMT flap and the achievement of a sustainable treatment with a minor morbidity of the donor site. We believe that the vPMT flap could be an alternative option for the reconstruction of the perianal and genital region and could be inserted in the armamentarium of the reconstructive microsurgeon.

Comparative Study between Perforator Based Island Flaps and Fasciocutaneous Flaps in Reconstruction of Lower Extremities

Background: Open wound of the lower limb is one of the common health problems that have a significant economic and social burden. It has a risk of osteomyelitis of the underlying bone and even necrosis can occur. Objective: To evaluate the difference between the perforator-based island flaps and fasciocutaneous flaps in reconstruction of lower extremities regarding; functional, aesthetic outcome, size of the flap, degree of rotation, technical difficulties, percentage of flaps survival, flap loss, operative time and donor site morbidity. Patients and Methods: The study was conducted on 40 patients with soft tissue defects in lower extremities which were equally distributed into two groups. Group 1 consisted of 20 patients that were treated by perforator based island flap and group 2 that consisted of 20 patients treated by fasciocutaneous flap. Results: The two techniques had similar results when evaluated by the Likert scale. The results of both procedures had no significant statistical differences as regards any of the Likert score components namely, color, texture, appearance, and shape. The main finding of the current study was the comparable postoperative outcome for both techniques. The number of patients that had necrosis was 7 in perforate based island flap and 4 in fasciocutaneous flap which represented 35% and 20% respectively of each studied group and this was statistically insignificant. Conclusion: Any flap can be used as a perforator-based island flap in which the source vessel is completely preserved. Perforator flaps have multiple advantages over Fasciocutaneous flaps as allowing increased diversity and versatility in the design and composition of flaps.

Comparative Study between Perforator Based Island Flaps and Fasciocutaneous Flaps in Reconstruction of Lower Extremities

Background: Open wound of the lower limb is one of the common health problems that have a significant economic and social burden. It has a risk of osteomyelitis of the underlying bone and even necrosis can occur. Objective: To evaluate the difference between the perforator-based island flaps and fasciocutaneous flaps in reconstruction of lower extremities regarding; functional, aesthetic outcome, size of the flap, degree of rotation, technical difficulties, percentage of flaps survival, flap loss, operative time and donor site morbidity. Patients and Methods: The study was conducted on 40 patients with soft tissue defects in lower extremities which were equally distributed into two groups. Group 1 consisted of 20 patients that were treated by perforator based island flap and group 2 that consisted of 20 patients treated by fasciocutaneous flap. Results: The two techniques had similar results when evaluated by the Likert scale. The results of both procedures had no significant statistical differences as regards any of the Likert score components namely, color, texture, appearance, and shape. The main finding of the current study was the comparable postoperative outcome for both techniques. The number of patients that had necrosis was 7 in perforate based island flap and 4 in fasciocutaneous flap which represented 35% and 20% respectively of each studied group and this was statistically insignificant. Conclusion: Any flap can be used as a perforator-based island flap in which the source vessel is completely preserved. Perforator flaps have multiple advantages over Fasciocutaneous flaps as allowing increased diversity and versatility in the design and composition of flaps.

Closure of excisional defects of pilonidal sinus surgery using a perforator-based island flap

Background and Aim of the Work: Pilonidal sinus disease is a common condition in the young adults, which carries significant patient discomfort. There is no consensus regarding the best surgical technique for the treatment of this disease. A controversy is present about the various options for closure of the wound following resection of the affected tissue. In this study, the perforator-based island flap was successfully used for closing the defect left after excising the pilonidal sinus. Methods: Twenty-three patients with a primary complex pilonidal sinus disease were operated upon and followed up in the period from October 2014 to October 2018 at the General Organization of Teaching Hospitals and Institutes hospitals. After wide excision of the pilonidal sinuses, the defects were reconstructed with perforator-based flaps, which were designed with an axis of 45°–90° angle to the vertical axis of the defects. Results: Of the 23 patients included in this study, only three patients developed minor complications (one case of mild seroma and two cases of minor wound infections), and they were treated conservatively. Mean time of hospital stay was <2 days. Mean time to return to normal daily activities was 5 days (range: 3–7). Mean time to complete healing of the wound was 12 days (range: 10–15). Mean time off-work days was14 days (range 12–17). All the patients did not show recurrences during the period of follow-up which continued for at least 9 months postoperatively with a mean time of 10 months (range: 9–15). Conclusions: This study shows that closure of postexcisional defect of pilonidal sinus using a perforator-based island flap is a reliable option for the treatment that fulfill the principles and criteria required to achieve complete cure of the condition in a short period of time.

Treatment of deep cavities using a perforator-based island flap with partial de-epithelization

BackgroundThe perforator-based island flap is a popular option for defect coverage. In cases with deep cavities, however, the classical island flap may not be a suitable option. By de-epithelization of the peripheral portion of a perforator-based island flap, the distal part of the flap can be used to fill deep spaces, as the flap can be folded and inserted into the spaces.MethodsFrom June 2015 to April 2017, 21 cases of deep internal defects were reconstructed with perforator-based island flaps with peripheral de-epithelization. A fasciocutaneous flap was elevated and rotated with the pivot point on the perforator. After performing de-epithelization on the periphery of the flap, the de-epithelized portion of the flap was inserted and anchored into the internal defect. Demographic information about the patients, the size of the defects, the perforators that were used, and complications were recorded.ResultsDuring the follow-up period (mean, 14.2 months) of total 21 cases, no major complications such as flap loss occurred. In 2 cases, a minor complication was observed. Temporary flap congestion was seen in 1 case, and was treated with a short period of leech therapy, and the other case was partial necrosis on the flap margin, which was cured with minimal debridement and conservative treatment. No major problems have occurred, especially on the de-epithelized part of the flap and in the occupied space.ConclusionsWith performing careful procedure, a perforator-based island flap with partial de-epithelization can be a useful option for the surgical treatment of deep cavities.Trial registrationThis study was retrospectively registered in the institutional review board on human subjects research and the ethics committee, Hanyang University Guri Hospital (Institutional Review Board File No. 2018–01–003-002 https://www.e-irb.com:3443/devlpg/nlpgS200.jsp).

Pedicled posteromedial thigh (pPMT) perforator flap and its application in loco-regional soft tissue reconstructions

The posteromedial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports. The purpose of this article is to describe various clinical applications of the pedicled posteromedial thigh (pPMT) flap for reconstruction of loco-regional soft tissue defects. From 2014 to 2016, 15 patients underwent reconstruction with 15 pPMT flaps. The locations of the defects included the inguinal region (4 cases), the perineal and genital region (3 cases), the proximal and distal medial thigh (3 and 2 cases, respectively), and the popliteal fossa (3 cases). The perforator selected was a branch of the profunda femoris artery (PFA) in 12 cases and the medial circumflex fermoral artery (MCFA) in 3 cases. In all cases, the flap was harvested as a perforator-based island flap, while the mechanism of flap transfer varied between V-Y advancement, interpolation, or different degrees of axial pivoting around the skeletonized perforator (propeller flap design). The flap sizes varied from 5 × 4 cm2 to 29 × 8 cm2, and the pedicle could be skeletonized for up to 13 cm. All the flaps survived after surgery without complication. The donor sites were all primarily closed with minimal morbidity. Follow-up observations were conducted for 6 to 14 months, and all patients had good functional recovery. The pPMT perforator flap is a reconstructive option that can be considered when dealing with soft tissue defects located in body regions ranging from the groin down to the popliteal fossa. It avoids the need for a microsurgical transfer and easily fulfills the dictum of replacing "like tissue with like tissue."

Abstract: “Please Turn Over (PTO) Perforator Flap”: A New Technique to Reconstruct Perineal Defects Following Extralevator Abdominoperineal Excision (ELAPE)

INTRODUCTION: Locally advanced low rectal cancer is now increasingly treated with an extralevator abdominoperineal excision (ELAPE) as ELAPE has been deemed to provide superior oncological clearance than traditional abdominoperineal excision (APE).1 However, the extended perineal dissection performed in ELAPE creates a perineal wound that is more demanding in terms of reconstruction. This is because a larger perineal cavity and potential dead space is created and less gluteal skin is excised when compared to standard APE.1 These two characteristics along with the neo-adjuvant chemo-radiation effects on wound healing have been associated with increased perineal wound morbidity, making uneventful perineal reconstruction post-ELAPE challenging to plastic surgeons whose assistance is sought in 67% of ELAPE cases. We present a new technique for perineal reconstruction post-ELAPE, using a perforator, islanded, turn over, de-epithelialized local flap (PTO – Perineal Turn Over perforator flap). METHODS: The PTO flap is raised based on perforators from internal pudendal artery. In the current literature perineal perforator based flaps have been described for vulva reconstruction but not for perineal reconstruction after ELAPE.2 The concept of the flap is based on two components: a) the thick gluteal dermis acts as an autologous dermal vascularised substitute for the excised pelvic floor muscles providing a tension free repair that prevents perineal hernia formation b) the gluteal subcutaneous fat obliterates the dead space reducing fluid collections and preventing infections. This was a retrospective review of patients undergoing reconstruction with the PTO flap following ELAPE. Data included patients’ demographics, neo-adjuvant chemo-radiotherapy, histopathology, duration of surgery, follow-up period and complications. RESULTS: Fourteen patients were identified. Median operating time for the PTO flap was 49 min. There were no cases of flap loss, donor site morbidity or major wound complications. Superficial skin dehiscence and perineal hernia formation were reported in 2 patients respectively. None of the patients developed chronic perineal pain. All patients reported excellent satisfaction with the aesthetic outcome. CONCLUSION: The PTO flap is a reliable option for perineal reconstruction after ELAPE that provides many advantages over other reconstructive techniques including primary closure, myocutaneous flaps, and biologic meshes. Reference Citations: 1. Holm T. Controversies in abdominoperineal excision Surg Oncol Clin N Am 23 (2014) 93–111 2. Kim JT, Ho SY, Hwang JH, Lee JH. Perineal perforator-based island flaps: the next frontier in perineal reconstruction. Plast Reconstr Surg. 2014 May; 133(5): 683e-687e.

Reconstruction of a Complex Scalp Defect after the Failure of Free Flaps: Changing Plans and Strategy.

The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neurosurgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.

Three-Directional Reconstruction of a Massive Perineal Defect after Wide Local Excision of Extramammary Paget's Disease

Extramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial malignancy that mainly involves the genital region, including the vulva, penis, scrotum, perianal, and periurethral areas. Although several treatment options exist, wide local excision with a safe margin is considered the treatment of choice. After resection of the lesion, it is often challenging to reconstruct the defect because defects in the perineal region require adequate volume for protection and are susceptible to infections, which is a particularly significant risk for large defects. We report a case of perivulvar EMPD that was reconstructed with three-directional local flaps after wide excision of the tumor. We covered the defect sequentially using the following 3 flaps: a gracilis myocutaneous flap from the left thigh, a bipedicled V-Y advancement flap from the lower abdomen, and an internal pudendal artery perforator-based island flap from the right buttock. To the best of our knowledge, this report is the first to describe a three-directional approach to extensive perivulvar reconstruction.

Saphenous artery-based flap models in rats: new flap designs for experimental studies

BackgroundExperimental research using laboratory animals provides substantial data about reconstructive surgery. However, the literature does not include any experimental studies that have used flap models on the hind limbs of rats. To gain an understanding of the physiology of lower-extremity flaps and of flap failures, this study assessed the cutaneous perforators of the saphenous artery, and new flap models were designed for the hind limbs of rats. Materials and methodsThe experiment was designed to include three stages and used 35 rats. The first stage involved mapping the perforators of the saphenous artery. In the second stage, the contents and structures of McFarlane, epigastric, and anterior hind limb flap tissues were compared histologically. The third stage of the study involved designing and comparing different flaps for the hind limbs of the rats and included random flaps, perforator-based peninsular flaps, perforator-based island flaps, and perforator-based flaps with rotated pedicles. Postoperative necrosis ratios were evaluated using computer-based software. ResultsMapping of the saphenous artery perforators revealed an average of 2.2 septocutaneous arteries in each hind limb. Histologic studies showed thick dermis and panniculus carnosus in the McFarlane flaps, thick dermis, and thin panniculus carnosus layers in the epigastric flaps, and thin subcutaneous tissue with no panniculus carnosus tissue in the skin of the hind limbs. The results of the flap studies that used random flaps showed a 52.4% necrosis, while there was no necrosis when perforator-based peninsular flaps, island flaps, and flaps with rotated pedicles were used. ConclusionsNew flap models used on the saphenous artery perforators of the hind limbs of rats can provide valuable information about the physiology of lower-extremity flaps. New studies can also be designed based on these flap models to acquire more knowledge about pathologic conditions such as ischemia and venous insufficiency.

Perforator-based island flap with a peripheral muscle patch for coverage of sacral sores

Despite numerous therapeutic advances, the treatment of pressure sores remains a challenge. The increased use of perforator flaps enables surgeons to minimize donor-site morbidity by sparing the underlying muscle. In the presence of focal deep spaces, however, the inclusion of muscle would be beneficial. The goal of this study was to introduce a method for including a muscle patch at the periphery of a perforator-based island flap for coverage of sacral pressure sores. Between March 2010 and February 2015, 26 patients with stage IV sacral sores underwent perforator-based island flap reconstruction with a peripheral muscle patch. Patient characteristics, including sex, age, defect size, and postoperative complications, were recorded. All flaps survived without major complications. No flap necrosis was noted. The present study shows that a muscle patch incorporated into the periphery of a perforator-based flap can be transferred safely. This can be a good surgical option in cases where infection control or more volume is needed.

Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application.

Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow. Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators. A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months. The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction. The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.