Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps

Qing, Liming; Li, Xiaoxiao; Wu, Panfeng; Zhou, Zhengbing; Yu, Fang; Tang, Juyu

doi:10.1016/j.bjps.2019.08.004

Cited by 15 publications

(14 citation statements)

References 37 publications

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“…Koshima et al first described a fabricated chimeric flap, which consisted of a flow‐through ALT flap used as a bridge flap, to reconstruct massive cervical defects (Koshima, 2001); it consists of at least two flaps that are simultaneously harvested, and the vascular pedicles of these flaps are fabricated together into a single vascular source by micro‐anastomosis (Song et al, 2016). Our previous publication used the chain‐linked bilateral ALT flaps for complex soft‐tissue defects in the hand and forearm (Qing, Li, et al, 2019). However, the area of reach of the sequential bilateral ALT flap was still insufficient in our case.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…To repair large wounds and salvage patients' lower extremities while reducing the donor site morbidity associated with such surgeries, we previously used bilateral ALT perforator flaps (Qing, Li, et al, 2019). However, if the sole, ankle, and tibial bone are exposed, no flap, not even the rectus abdominis, can cover it.…”

Section: Introductionmentioning

confidence: 99%

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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“…Tan et al introduced computed tomography angiography (CTA) for preoperative planning in complex toe-to-hand reconstruction 21 . In our team, CTA is also commonly used to map donor site and recipient vasculature 22 – 24 , and CT data were used to generate 3D models of complex soft tissue defect for individual design for perforator flap.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the accuracy of hand models obtained from two 3D scanning techniques

Yu¹,

Zeng²,

Ding³

et al. 2020

Sci Rep

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The aim of this study was to identify an efficient approach for 3D imaging of hand. The 3D photographs of hand were taken with Gemini structured-light scanning system (SL scanning) and CT scanning. The 3D photographs, average time of scanning and reconstruction were compared between these two indirect techniques. The reliability, reproducibility and accuracy were evaluated in these two indirect techniques and the direct measurement (DM). Statistical differences in the measurements were assessed by 99% probability, with clinical significance at > 0.5 mm. The Gemini structured-light scanning system established a complete and smooth 3D hand photograph with shorter scanning and reconstruction time. Reproducibility of CT scanning and SL scanning methods was better (P < 0.01, both) than the DM, but did not differ significantly from each other (P = 0.462). Of the 19 (31.58%) measurements obtained, 6 showed significant differences (P < 0.01). Significant differences were observed more often for circumference dimensions (5/9, 55.56%) than for length dimensions (1/10, 10%). Mean absolute error (AE) of the 10 subjects was very low for 3D CT (0.29 ± 0.10 mm) and SL scanning (0.30 ± 0.11 mm). Absolute percentage error (APE) was 4.69 ± 2.33% and 4.88 ± 2.22% for 3D CT and SL scanning, respectively. AE for the PIP circumference between the 3rd finger (0.58 mm) and 4th finger (0.53 mm) scan was > 0.5 mm, indicating significant difference between DM and CT scanning at the level of 99% probability. In this study, the Gemini structured-light scanning system not only successfully established a complete and smooth 3D hand photograph, but also shortened the scanning and reconstruction time. Compared to the DM, measurements obtained using the two indirect techniques did not show any statistically or clinically insignificant difference in the values of the remaining 17 of 19 measurements (89.47%). Therefore, either of the two alternative techniques could be used instead of the direct measurement method.

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“…To reduce the donor site morbidities, sequential chimeric aps were used to repair large soft-tissue defects [16][17][18] . Qing et al reported using the bilateral chain-linked ALT perforator aps for large defects [19] . All the patients have got a good result with limited donor site morbidities.…”

Section: Discussionmentioning

confidence: 99%

Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

Qing

et al. 2020

Preprint

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Background: Extended latissimus dorsi musculocutaneous (LDMC) flap increasing the size of the flap and most used for breast reconstruction. This report will share our experience in designing different extended LDMC flap for large wounds in extremities.Patients and methods: From January 2004 to December 2018, extended LDMC flaps were performed on 72 consecutive patients aged 2 to 68 years (37 men and 35 women). All the wounds were extensive, either in upper or lower limbs, the skin defect ranged from 18 ×10 cm2 to 37 × 21 cm2. Single wing and double wings extended LDMC flaps were designed and harvested based on the wounds.Results: Seventy-two patients included this series, 5 pedicle and 67 free flaps were successfully harvested. The mean flap harvest time was 56.2 min. The donor sites were closed primarily in all patients. The venous compromise was noticed on the first postoperative day in 4 cases. Two flaps were salvaged after emergency re-exploration, another two patient’s flaps were total necrosis. One of the patients was received lower extremity amputation, another patient was repaired by extended LDMC flap on the other side. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Five patients lost follow-up, the follow-up period ranged from 10 to 56 months (mean, 15.7 months). Patients didn’t occur significant donor site morbidities that influenced their daily activities during follow-up.Conclusion: The single wing and double wings extended latissimus dorsi musculocutaneous flaps are simple and reliable methods for large skin and soft-tissue defects in extremities.

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Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps

Cited by 15 publications

References 37 publications

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

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

Evaluating the accuracy of hand models obtained from two 3D scanning techniques

Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

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