Microdissected Prefabricated Flap: An Evolution in Flap Prefabrication

Taş, Süleyman

doi:10.5999/aps.2016.43.6.599

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…Recently, the innovation of microdissection techniques and the advanced perforasome concept have resulted in much thinner flap harvesting (super‐thin flaps), which contain minimal thickness of superficial fat tissue without any deep fat layer. Defatting without damage to the subdermal plexus enables super‐thin flap harvest (Adani et al, 2005; Altiparmak et al, 2020; Hong, 2021; Innocenti et al, 2021; Kim et al, 2014; Lee et al, 2017; Narushima et al, 2018; Taş, 2016).…”

Section: Discussionmentioning

confidence: 99%

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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PurposeThe conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics.MethodsThis article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two‐stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named “pushing with pressure and cutting” was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super‐thin TDAp flap only. In two cases (18%), non‐vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series.ResultsAll 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split‐thickness skin graft (STSG) (55%), and three cases of Z‐plasty performed on the first web space (27%). The mean follow‐up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76.ConclusionsWe resurfaced severe soft tissue defects of multiple fingers with thin to super‐thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two‐stage reconstructive strategy of mitten hand creation and proper division timing to create a 3‐dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.

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Section: Discussionmentioning

confidence: 99%

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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“…Some surgeons have tried to do the microdissection around the perforators. 11 The branches of the perforators in the superficial fat layer could be dissected despite some added risk of the flap survival. A safer way to get the thinner perforator flaps is to preserve the 1 or 2 m subcutaneous cuff around the perforator itself.…”

Section: Discussionmentioning

confidence: 99%

Extensive Facial Reconstruction Using Thickness-controlled Perforator Free Flaps

Choi

Park

Kim

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Although small and medium facial defects can be reconstructed with local flaps to ensure skin color and texture matching, extensive facial defects require the application of free flaps, including perforator free flaps. We hereby propose a personalized strategy for facial reconstruction to overcome these limitations, based on the use of free flaps accompanied by local flaps and thickness-controlled perforator flap concept, for extensive facial defects. Methods: A series of consecutive facial reconstructions were performed from 2006 to 2016 in the Plastic and Reconstructive Surgery Department of our institution. Only extensive facial defects greater than 40 cm2 were included in this study. Results: A total of 323 patients underwent reconstruction using free flaps with or without local flaps, from November 2005 to March 2019. Of these, 79 extensive facial surface reconstruction cases were analyzed retrospectively. The size of the defects, their areas (upper, middle, or lower third of the face), and the method of reconstruction were analyzed. This led to the development of a personalized reconstruction procedure for extensive facial defects. These extensive facial reconstruction cases included 24 defects of the upper third of the face, 43 cases of the middle third, and 12 of the lower third. Four cases addressed the middle and lower thirds simultaneously. Conclusions: The facial surface reconstruction strategy I suggest in this study is based on the flap selection, thickness-controlled perforator flap elevation, and combination of local and free flaps. We expect this procedure will improve the treatment and resolution of extensive facial defects.

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