Radial Collateral Artery Perforator Research Articles

Special-form radial collateral artery perforator flaps for the reconstruction of complex hand defects

BackgroundThe reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications.MethodsFrom June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases.ResultsAltogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps.ConclusionsThe free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.

Different forms of free radial collateral artery perforator flaps for reconstruction after removal of oral tumors

Objective: To investigate the efficacies of different forms of free radial collateral artery perforator flaps in repairing the defects after oral tumor surgeries. Methods: From May 2016 to March 2021, 28 patients (22 males, 6 females, aged 35-62 years) with oral tumors admitted by Hunan Cancer Hospital received the reconstructive surgeries with the free radial collateral artery perforator flaps after removal of oral tumors, including 24 cases of tongue cancer (11 cases of tongue marginal cancer, 9 cases of tongue belly cancer and 4 cases of tongue cancer involved in the floor of the mouth) and 4 cases of buccal and oral cancer. Four forms of radial collateral artery perforator flaps were used: single perforator flaps for 6 cases, double perforators flaps for 7 cases, flaps without perforator visualization for 10 cases and chimeric perforator myocutaneous flaps for 5 cases. The recipient vessels were the superior thyroid artery and superior thyroid vein, and if second concomitant vein available, it was anastomosed with internal jugular vein in end-to-side fashion. SPSS 20.0 statistical software was used to analyze the data. Results: The mean length of flaps was (9.7±0.4) cm, mean width (4.4±0.3) cm and mean thickness (1.1±0.4) cm. The mean length of the vascular pedicles was (7.1±0.6)cm (6.0-8.0 cm), the mean diameter of the radial accessory arteries was (1.1±0.3)mm (0.8-1.3 mm). Eleven cases(39.3%) had respectively one accompanying vein and 17 cases(60.7%) had respectively two accompanying veins, with the mean diameter of (1.1±0.3) mm (0.8-1.3 mm). All the 28 flaps survived, the donor and recipient wounds healed in one stage, the appearances of the flaps were satisfactory, only linear scars remained in the donor sites, and the upper arm functions were not significantly affected. Follow up for 12-43 months showed that the flaps were soft with partially mucosalization, the reconstructed tongue and buccal cavity were in good shape, and the swallowing and language functions were satisfactory. The swallowing and language functions were retained to the greatest extent in 3 cases with near total tongue resection, although the functions were still significantly affected. There was no local recurrence of the tumor during follow-up. One case had regional lymph node metastasis, and further lymph node dissection and comprehensive treatment were performed, with satisfactory outcomes. Conclusions: The vascular pedicle of the radial collateral artery perforator flap has a constant anatomy, which can be prepared in different forms to improve the safety of the operation and minimize the donor site damage. It is an ideal choice for the repair of small and medium-sized defects after oral tumor surgery.

Reverse-Flow Versus Perforator Propeller Lateral Arm Flap for Elbow Reconstruction.

The lateral arm flap (LAF) represents an attractive option for elbow reconstruction, due to low donor site morbidity and a consistent surgical anatomy. It has been described as reverse-flow and as perforator propeller flap (radial collateral artery perforator [RCAP]). We compared the 2 techniques in terms of immediate- and long-term outcomes, together with functional and aesthetic evaluation. We retrospectively reviewed 15 patients, 9 males and 6 females, according to the department prospectively maintained database. Ethiology of the defects and patient comorbidities were listed together with flap and clinical data (operative time, time to healing, hospital stay, etc). Functional outcomes were measured according to Quick Disability of Arm Shoulder and Hand score at the time of the last follow-up. Seven LAF flaps were raised in a reverse-flow fashion, whereas 8 were RCAP flaps. No patients described any major elbow functional limitations, and they were generally satisfied with the aesthetic appearance. When comparing the 2 groups of reconstruction, harvest of RCAP flap resulted significantly faster and patients needed less hospitalization days (*P < 0.05). Aesthetic scores were lower where a cutaneous bridge was left intact during rotation (leading to a dogear), which was always the case in reverse-flow flap. Among complications, a partial RCAP flap necrosis occurred in a highly comorbid patient and required a skin graft coverage, whereas 4 reverse-flow flaps presented distal venous congestion which, in 1 patient, led to a secondary flap procedure. In our practice, elbow reconstruction using the RCAP flap required less hospital stay and operative time. Being less prone to venous congestion, in presence of sizeable perforators, it should be preferred to the reverse-flow LAF flap.

Use of propeller flaps for reconstruction of extensor side elbow defects

Introduction: Extensor side elbow defects are difficult to repair among upper extremity injuries. The bulk of surrounding soft tissue is limited and often affected by the trauma, although seems to be ideal, propeller flaps are not being widely adopted for upper extremity soft-tissue reconstructions. In the present study, we set out to share the results of the perforator propeller flaps that are based on either the arm or the forearm, which we thought the perforator vessel anatomy is relatively constant. Patients and Methods: All patients who underwent elbow defect repair between June 2016 and June 2018 were evaluated retrospectively. Patients were evaluated in terms of the etiology and demographic parameters. Flaps were assessed by the artery system, on which they were based on the dimensions of skin island, the rotation angle of the skin paddle, and closure method of the donor site. Outcomes were noted during bimonthly follow-up visits. Results: In 11 patients, the dominant etiology was chronic bursitis. The mean flap skin paddle size was 48.8 ± 16.9 cm2. For defect repair, radial collateral artery (RCA) perforator flaps were used in six patients. Posterior interosseous artery (PIA) perforator flaps were used in remaining five patients. All the flaps were based on a single perforator artery. The mean rotation degree was measured as 165° ±11.6°. In nine cases, the flap donor site was closed primarily, whereas split-thickness skin grafts were used in two cases. The average follow-up period was 13 ± 5 months. No limitation in the range of motion of the elbow joint was noted. Distal marginal necrosis was observed in two flaps. Conclusion: We advocate that both PIA and RCA perforator flaps are very useful options for soft-tissue reconstruction of extensor side elbow defects.

Hybrid perforator flaps: Introducing a new concept in perforator flap surgery

Although perforator propeller flaps provide a safe and reliable reconstructive option, they are often limited in size, reach and degrees of freedom due to venous insufficiency. As a result, partial flap necrosis, particularly at the tip of the flap, may occur in some cases causing the loss of substance. To overcome this problem, we present a new concept of hybrid perforator flaps. From May 2014 to October 2017, 25 Hybrid perforator flaps were performed to reconstruct a variety of defects in upper and lower extremities following the removal of soft-tissue malignancies. Hybrid flaps included 14 hybrid radial collateral artery perforator propeller (RCAP) flaps, 7 hybrid propeller anterolateral thigh perforators (ALTs), 3 hybrid medial sural perforator flaps and one hybrid saphenous perforator flap. Following the excision of malignancy, several superficial skin veins were dissected on the edge of defect to be used as potential recipient vessels for venous supercharging. Hybrid flap design included the dissection of one or two superficial veins on the edge of the flap, which was used for prophylactic supercharging. The perforator flap was then raised in a usual fashion and rotated into the defect. Microsurgical venous anastomosis was performed between the previously prepared superficial flap vein and vein on the edge of defect. Venous stasis was encountered following flap rotation in 12 out of 25 flaps and was immediately resolved following venous anastomosis. No venous congestion was encountered perioperatively in the remaining 13 flaps. Healing was uneventful in 24 flaps with 100% flap surface area healed primarily and excellent functional/aesthetic outcome. Partial loss was found in only one single flap, with overall 96% success rate and 4% complication rate. Hybrid perforator flaps have the advantage of improved reliability, versatility and safety. In the author's experience, technique is reliable and obviates the need for flap monitoring. By including a superficial vein in the initial flap design and resectional defect, larger flaps can be harvested more reliably. The hybrid flap concept could potentially improve outcomes of propeller flaps. Our experience shows reduced complications when this technique is utilised with success rates comparable to free flaps.

Reconstruction of elbow skin and soft tissue defects using perforator-pedicled propeller flaps.

The elbow is a challenging region to reconstruct functionally. Several closure methods for elbow wounds have been reported, including flap surgery. Here, we present the results obtained using a propeller flap pedicled by a posterior ulnar recurrence artery perforator (PURAP) or a radial collateral artery perforator (RCAP) for functional reconstruction of soft tissue defects in elbows. Twenty-four patients with an average age of 27.0years (range, 9-52years) underwent elbow soft tissue reconstructions between 2005 and 2015. Twenty-one patients were male and three were female. Among them, 18 patients received a PURAP flap transfer and six received a RCAP flap transfer. The frequent soft tissue defects were due to release of a postburn scar contracture in 12 patients, trauma in ten patients. Functional results were obtained by measuring range of motion (ROM). The mean follow up time was 10.1months (range, 4-22months). The flaps ranged in size from 3×5cm to 16×6cm. Nearly all flaps survived with only one showing partial necrosis. 16 and 8 patients achieved ranges of motions of 0-5 and 6-15 degree extension and 130-145 degree flexion. With the aims of easy flap harvest, primary donor site closure, skin texture match, and avoiding vascular anastomosis, both PURAP and RCAP were employed. Both flap transfer techniques were safe and effective for elbow soft tissue reconstruction. It is important to ensure that the skin defect and flap design are closely matched.

Use of the free lobulated and chimeric radial collateral artery perforator flaps to repair soft tissue defects of oral and maxillofacial

Use of the free lobulated and chimeric radial collateral artery perforator flaps to repair soft tissue defects of oral and maxillofacial

Reconstruction of elbow defect with radial collateral artery perforator flap

Elbow defects form a challanging subgroup to reconstruct among upper extremity defects. We aimed to present a succesful case of elbow defect reconstructed by a Radial Collateral Artery Perforator Flap (RCAPF), also to discuss the advantages and applicability of this flap in light of current literature

Prophylactic Venous Supercharged Radial Collateral Artery Perforator Propeller Flap: Improved Outcome in Perforator Propeller Flaps

Propeller flaps provide a safe and reliable reconstructive option. Following flap rotation intraoperatively, a degree of venous stasis occurs. Difficulty lies in predicting whether this is likely to be transient or not. These flaps are therefore frequently at risk of venous congestion which can result in partial or total flap necrosis.1 This results in delayedwound healing and often necessitates further surgical procedures to achieve the final outcome. This defeats the original intention of performing a reliable, one-stage, and aesthetically pleasing reconstructive technique. Subsequent management of flap necrosis can include conservative and surgical management. Long-term dressings and negative pressure therapy, with or without eventual skin grafting, will result in wound healing, but can take time and are incapacitating for patients. The final result, by these means, can potentially negatively impact upper limb function in terms of scar contracture and appear less aesthetically pleasing. We present two prophylactically venous supercharged radial collateral artery perforator (RCAP) propeller flaps in the upper limb and suggest this is a more reliable approach than the standard RCAP flap technique.

Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction.

Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory. Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm(2) on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm(2)), and flap size was 9.0 × 5.5 cm(2) on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm(2)), whereas the humeral fragments were 2.0 × 1.0 cm(2) on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm(2)). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit. Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients. Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for reconstructing complex bone and soft tissue defects in thumb.

Modified Innervated Radial Collateral Artery Perforator Flap for Repairing Digital Defects.

The authors presented their clinical experience and demonstrated surgical methods to reconstruct soft-tissue defects in the digit by using modified innervated radial collateral artery perforator flap. Surgical procedures that involved 12 modified innervated radial collateral artery perforator flaps were performed in 12 patients. Among the patients, two had defects in the thumbs, six had defects in the index fingers, whereas two had defects in the middle fingers, two had defects in the little fingers. The flaps ranged in size from 5.0 × 2.0 to 7.5 × 4.0cm. The pedicle of the flap was divided and ligated below the level at which the radial collateral artery was divided into anterior and posterior branches. The recipient vessels were the proper digital artery and the palmar subcutaneous vein (n = 8), the deep branch of the ulnar palm artery (n = 4), and the venae comitantes. Nerve suture was done between the posterior cutaneous nerve of the arm and the proper digital nerve of the digital. The cosmetic appearance of the donor and recipient sites and static two-point discrimination of the operated finger were evaluated in a follow-up visit. Postoperative venous congestion happened in two cases, and both succeeded after exploration. All flaps survived, and all donor sites were closed directly, leaving a linear scar. Follow-up time ranged from 12 to 28months. Defatting of the flap was performed in two cases during the late postoperative period. Cosmetically acceptable results were achieved for the rest of the patients. The modified innervated radial collateral artery perforator flap is a good option for reconstructing soft-tissue defects in digits.

Reconstruction of elbow region defects using radial collateral artery perforator (RCAP)-based propeller flaps

Perforator-based propeller flaps permit flap rotation up to 180°. This ability to transfer skin from one longitudinal axis to another has led to the increasing use of perforator-based propeller flaps in extremity reconstruction, especially lower-extremity reconstruction. However, the application of perforator-based propeller flaps to upper-extremity reconstruction is still limited. This article reports two cases of successful reconstruction of elbow region defects with radial collateral artery perforator (RCAP)-based propeller flaps. The elbow region has a variety of perforators available for perforator-based propeller flap reconstruction. Among them, the RCAP seems to be one of the most reliable options. This is because there are less anatomical variations of perforators' location on the lateral upper arm than on the medial upper arm. By using an RCAP perforator as a flap pedicle, the small-to-medium sized defects (<6cm in diameter) around elbow regions can be closed primarily without skin grafts.