Combined multi-lobed flaps: A series of 39 extensive hand and multi-digit injuries one-staged reconstructions using modified designs of ALT, DPA and chimeric linking flaps

Tang, Liang; Pafitanis, Georgios; Yang, Peng; Li, Zan; Jia, Ming; Koshima, Isao; Song, Dajiang; Chi, Zhenglin

doi:10.1016/j.injury.2017.03.049

Cited by 20 publications

(28 citation statements)

References 24 publications

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“…As a result of technical advancements and increasing microsurgical experience, chimeric perforator flaps have become the mainstream treatment for reconstruction of complex soft tissue defects (Koshima et al, 1993;Tang et al, 2017;Wang, Chai, Wen, & Han, 2013). However, conventional chimeric flaps lack the skin paddle size to reconstruct very large tissue defects with primary closure of the donor site (Tang et al, 2013a). Several modified approaches have (Yang et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…The DIEP flap is a popular option used by reconstructive surgeons because of its larger cutaneous area, reliable blood supply, and hidden donor-site. However, our previous experience showed that a secondary debulking procedure is often required for the DIEP flap (Tang et al, 2013a). Therefore, we do not commonly recommend this flap to reconstruct soft tissue defects of a limb when the ALTP flap is available.…”

Section: Discussionmentioning

confidence: 99%

“…One‐stage reconstruction of complex soft tissue defects is essential to salvage the extremities and restore function (Song et al, ; Zhang et al, ). However, it is always challenging for microsurgeons to successfully reconstruct a complex soft tissue defect, especially those involving deep structural damage and large surface soft tissue loss (Tang et al, ; Zheng et al, ). The challenge in these types of reconstructions is the three‐dimensional requirement of the flap, which not only eliminates the dead space but also covers the very large surface soft‐tissue defect in a single procedure with primary closure of the donor site.…”

Section: Discussionmentioning

confidence: 99%

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Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

Qing

et al. 2019

Microsurgery

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Background One‐stage reconstruction of complex soft tissue defects of the extremities is a challenging problem. Repair of complex soft tissue defects requires adequate skin tissues to cover the large surface wound and special tissues for obliterating the dead space. The chimeric flap is one of the most popular approaches for reconstruction of complex soft tissue defects. However, the problems of donor‐site morbidity and inability to repair very large defects at one‐stage remain. The purpose of this study was to present our clinical experience using sequential chimeric perforator flaps for reconstruction of complex extremity defects with primary closure of the donor site. Methods From August 2013 to March 2017, 12 patients with complex soft tissue defects underwent extremity reconstruction using sequential chimeric perforator flaps, which were composed of a chimeric anterolateral thigh perforator (ALTP) flap and an additional free perforator flap. The skin paddles were placed side‐by‐side to cover the large surface soft tissue defects, and the muscle component was used to obliterate the dead space. Of these patients, one was injured by a crushing accident, while the other 11 patients were injured in traffic accidents. Results The size of the skin paddles ranged from 26 cm × 8 cm–10 cm × 6 cm to 30 cm × 8.5 cm–29 cm × 9 cm. The muscle paddle size ranged from 2 cm × 3 cm × 4 cm to 22 cm × 4 cm × 2 cm. All‐components of the sequential chimeric flaps survived in all‐patients. Vascular compromise was observed in one case. One case suffered minor wound‐edge necrosis and was treated conservatively. Primary closure of donor‐site was successfully achieved in all‐patients, and all‐donor‐site wounds healed uneventfully. The mean follow‐up time was 15.25 months. Most of the cases showed a satisfactory contour, and only two patients presented with mildly bulky appearance that treated with a debulking procedure. Conclusions The sequential chimeric perforator flap is an alternative procedure for reconstruct complex soft tissue defects of the extremities. This approach allows for flexible design, a larger cutaneous area, and low donor site morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

Qing

et al. 2019

Microsurgery

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“…Usage of a flow‐through single ALT flap is not a new method. Koshima et al used flow‐through ALT flap in reconstruction of ischemic and traumatic extremity defects and Wells et al described applications on head and neck reconstructions (Koshima, Etoh, Kawamura, Moriguchi, & Sonoh, ; Tang et al, ; Wells et al, ). But, to the best of our knowledge, abdominal wall reconstruction with a flow‐through‐based ALT free flap using 2 free ALT flaps has not been described earlier.…”

Section: Discussionmentioning

confidence: 99%

“…Usage of a flow-through single ALT flap is not a new method. (Koshima, Etoh, Kawamura, Moriguchi, & Sonoh, 1995;Tang et al, 2017;Wells et al, 2014). But, to the best of our knowledge, abdominal wall reconstruction with a flow-through-based ALT free flap using 2 free ALT flaps has not been described earlier.…”

Section: Ca S E Re P O Rtmentioning

confidence: 98%

Reconstruction of a large full‐thickness abdominal wall defect with flow‐through‐based alt flaps: A case report

et al. 2017

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An extensive 35 × 20 cm sized full-thickness abdominal wall defect was created after resection of aggressive abdominal fibromatosis in a 19-year-old male patient. Immediate reconstruction was not possible due to prolonged operation time and resulting severe bowel edema. A silicone sheet with NPWT was applied over the exposed viscera. After 1 week, silicone sheet was substituted with a composite mesh. Then, abdominal wall reconstruction with bilateral free anterolateral thigh (ALT) flaps (30 × 12 cm and 25 × 12 cm sized) was performed. Since there was only a single reliable recipient vessel available, we linked 2 ALT free flaps sequentially in a flow-through fashion to the left inferior epigastric artery and vein. Two donor sites were closed primarily. The flap fully survived and the defect was covered successfully without any complication for 11 months of follow up. Multiple flaps may be needed for large full-thickness abdominal wall defect coverage. Linked fasciocutaneous free flaps could be a solution with a less donor site morbidity even in the case of limited available recipient vessels. The purpose of this study is to introduce our experience of extensive full-thickness abdominal wall reconstruction using only ipsilateral deep inferior epigastric vessels.

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Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

Qing

et al. 2021

Microsurgery

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Background: Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow-through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft-tissue defects is described. Methods: From January 2012 to September 2018, 12 patients (six men and six women) aged 6-37 years, sustained injuries in road traffic accidents with large softtissue defects in the lower extremities. Seven cases were Gustillo Anderson type IIIB open fractures and two cases were Gustillo Anderson type IIIC open fractures. Two wounds were located in the knee joint, four in the calf, and six in the ankle and foot. The skin defect size ranged from 25 Â 20 cm 2 to 36 Â 25 cm 2 . All patients in this series underwent reconstruction using combined transfer of the LD musculocutaneous flap and flow-through ALT perforator flap, wherein the LD was attached through its pedicle to the distal continuation of the ALT flap.Results: The size of the flow-through ALT perforator flaps ranged from 13.5 Â 6.5 cm 2 to 31 Â 8.5 cm 2 . The size of the LD musculocutaneous skin paddle ranged from 25 Â 6 cm 2 to 34 Â 7 cm 2 , and that of the muscle paddle ranged from 13 Â 3.5 cm 2 to 30 Â 11 cm 2 . One patient experienced postoperative thrombosis of the venous pedicle, and the flap was salvaged after emergency re-exploration and thrombectomy.No other complications were observed postoperatively. The mean follow-up period was 26.8 months. All patients were able to ambulate independently at the end of the follow-up period. Conclusions:The combined transfer of the LD musculocutaneous flap and flowthrough ALT perforator flap ensured adequate surface coverage, making it a feasible procedure for large soft-tissue defects. | INTRODUCTIONHigh-energy traumatic injury often causes significant soft-tissue loss.Early reconstruction of extensive soft-tissue defects is essential to salvage an extremity and restore its functionality (Soni et al., 2012;Zeltzer & Van Landuyt, 2012;Zhu et al., 2013). Fabricated chimeric flaps or sequential chimeric flaps based on the flow-through anterolateral thigh (ALT) perforator flap were commonly used to restore complex lower extremity defects. However, several reports have focused on the simultaneous transfer of microsurgically

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Combined multi-lobed flaps: A series of 39 extensive hand and multi-digit injuries one-staged reconstructions using modified designs of ALT, DPA and chimeric linking flaps

Cited by 20 publications

References 24 publications

Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

Reconstruction of a large full‐thickness abdominal wall defect with flow‐through‐based alt flaps: A case report

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

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