An Overview of Pre-expanded Perforator Flaps

Wang, Chunmei; Yang, Sifen; Zhang, Jing; Yan, Lun; Song, Ping; Pu, Lee Li-Qun

doi:10.1016/j.cps.2016.09.008

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…32 In our opinion, it is best to elevate flaps of the leg in the subfascial plane. The loose areolar tissue in this plane allows easier flap elevation and importantly, the suprafascial plexus 33 is preserved. In contrast, elevating the flap in the suprafascial plane is more challenging as there is no clear tissue plane and the flap is perfused only by the subdermal plexus.…”

Section: Approach To a Defectmentioning

confidence: 99%

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

Low

Sebastin

Cheah

2019

Indian J Plast Surg

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Lower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors’ experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.

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Section: Approach To a Defectmentioning

confidence: 99%

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

Low

Sebastin

Cheah

2019

Indian J Plast Surg

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“…Many varieties of new free style perforator flaps appear wherever on the body as well as growing applications of tissue expanders in pre-expanded super-thin skin flaps (8). In addition, another potential field represent trials carried-out in robotic assisted surgery in free flaps harvesting or mini-perforator flaps using an extracorporeal perfusion etc (13).…”

Section: Resultsmentioning

confidence: 99%

“…We can call them septocutaneous perforators and find them mostly on extremities, where the perforating vessels are long and go through the septum to the skin. The other group (around 60 %) contains the indirect perforators which first penetrate some tissue such as muscle, bone, tendon, cartilage, before reaching the skin (8). They are called musculocutaneous perforators and are anatomically predominantly localized on the trunk, dorsum and abdomen.…”

Section: Clinical Applicationmentioning

confidence: 99%

The Angiosomal Concept: an Overview And 3 illustrative Cases

Lovětínská¹,

Zálešák²,

Klein³

et al. 2019

Mil. Med. Sci. Lett.

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The angiosomal theory and its clinical application is not the latest science discovery. Nevertheless, its importance in plastic reconstructive surgery is still often underestimated when planning surgical procedures. Knowing and understanding the main problem can be useful not only for planning the flap design but also for survival of large flaps and also the wound healing process. Learning more about the complexity of skin and soft tissue anatomy and the vasculatory system can be beneficial for a variety of medical subspecialities. The article is divided into two parts. Part one is an introduction to the history, anatomy and physiology of angiosomes and perforator flaps. The second part describes practical applications in 3 various cases treated at the

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“…Tissue expansion was used by placing lateral to the ALT flap design mainly to close the donor site. 3 – 5 Tsai 6 first used a pre-expanded flap as an innovative reconstruction technique, precluding the advantages created by the expansion process, such as thinning the tissue and an increase in vascularity. Acarturk also used the subfascial expanded ALT free flap to reconstruct postburn cervical scar contracture.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors have used the superficial expansion placed lateral to the flap to primarily close the donor site. [3][4][5] In 1991, Tsai 6 proposed subfascial tissue expander as a solution to increase the surface area of the anterolateral thigh (ALT) flap. Until now, subfascial ALT expansion has not been frequently used among surgeons in large defect reconstruction of the neck.…”

Section: Introductionmentioning

confidence: 99%

Reconstructing Skin Defects of the Neck with Subfascial Expanded Anterolateral Thigh Flap: Report of Two Cases

Sơn

Dung

Nghia

2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Reconstruction of functional and aesthetic deformities of the neck after severe burn contracture is challenging. A free anterolateral thigh (ALT) perforator flap may be required, especially if local tissue is affected. To enlarge the surface area of this flap, donor site pre-expansion can be combined with flap transfer. Two patients with large neck defects were treated using pre-expanded free ALT perforator flaps. A rectangular expander was placed under the deep fascia after dissection of the perforator of the descending branch of the lateral circumflex femoral artery. The expansion time was from 3 to 4 months and the final expanded volume was 900–1500 ml. Defect sizes ranged from 14 × 18 to 18 × 27 cm and the expanded ALT flap was measured from 12 × 18 to 27 × 18 cm with one perforator in the flap. After immediate thinning, flap thickness was reduced, ranging from 5 to 11 mm. All flaps survived completely. Two patients were followed for 40 months. The skin color and textures of the flap were good. There was also a clear improvement in appearance and function. In summary, the subfascial expanded ALT perforator flap can be an excellent option for repairing severe neck defects due to its safe harvesting even with the large flaps. The donor area is closed primarily, and the thinned expanded skin is more aesthetically pleasing. The drawbacks are that it is a two-stage procedure, and the expander may be displaced during the expansion period.

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An Overview of Pre-expanded Perforator Flaps

Cited by 12 publications

References 23 publications

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

The Angiosomal Concept: an Overview And 3 illustrative Cases

Reconstructing Skin Defects of the Neck with Subfascial Expanded Anterolateral Thigh Flap: Report of Two Cases

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