A Novel Endoscopic-Assisted Harvesting of Pedicled Freestyle Fasciocutaneous Flaps

Abstract

The endoscopy-assisted technique has been demonstrated in harvesting muscle flaps; however, for pedicled freestyle fasciocutaneous flaps, few studies have applied this technique. We present a surgical procedure utilizing endoscopic-assisted method to identify the perforators of pedicled freestyle fasciocutaneous flaps for the reconstruction of soft tissue defects.From August to December 2012, 9 consecutive patients underwent endoscopic-assisted harvesting of fasciocutaneous flaps for the reconstruction of soft tissue defects. All of the defects were caused by trauma with tendon or bone exposure. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months.The age of the 9 patients (8 men and 1 woman) ranged from 20 to 79 years (median 59 years). The defects ranged in size from 2 × 2 to 6 × 8 cm2. Two patients received anterolateral thigh transmuscular perforator flaps, 5 patients received fibular septocutaneous perforator flaps, and 2 patients received medial gastrocnemius transmuscular perforator flaps. The median incision length was 10 cm, and the median operative time was 120 minutes. None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL). At the end of the 3-month follow-up period, none of the patients had any complications on either recipient or donor site, including total or partial necrosis of the flaps, flap dehiscence, hematomas, seromas, wound infections, or any conditions that indicated additional unplanned operative procedures. All of the patients had surviving flaps.Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps.

A comparison study between endoscope‐assisted and the standard approach in the harvesting of the free rectus femoris muscle flap

“…If the skin graft was harvested from the upper lateral thigh, both scars would be out of sight even when wearing short pants precise designs of flaps based on the location of the perforator vessels once located by the endoscope (Katsuragi-Tomioka, Nakagawa, Yamamoto, Kayano, & Matsui, 2012). It has also allowed for accurate identification of perforators to facilitate perforator-based pedicled free style fasciocutaneous flaps (Huang, Lin, Wu, & Yen, 2015). CO 2 insufflation to create a better optic cavity and using standard laparoscopic equipment has also been described for latissimus dorsi muscle flap harvest (Kiiski, Kaartinen, Kotaluoto, & Kuokkanen, 2017), as well as description of endoscope-assisted harvest of latissimus dorsi muscle free flap in the supine position to facilitate a two-team approach for oral cavity reconstruction (Cha, Jeong, & Ahn, 2013).…”

Comparison of perioperative outcomes between endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps

“…Details of the endoscopic technique have been described in the previous report. [5] Briefly, in the beginning, the temporary designed flap was marked on the skin. One 5-mm trocar was then inserted through a 1-cm endoscopic incision (Fig.…”

“…[1–3] In a case report in 2012, Katsuragi-Tomioka et al [4] was the first to apply the endoscopic technique to assist in harvesting fasciocutaneous flaps. Subsequently, Huang et al [5] demonstrated the feasibility of the endoscope-assisted method in identifying perforators of fasciocutaneous flaps for 9 consecutive patients. Both Katsuragi-Tomioka et al [4] and Huang et al [5] commented that the endoscope-assisted method could provide a precise flap design and reduce the sacrifice of donor sites because the perforator was directly localized by endoscopic vision.…”