One-stage reconstruction of complex soft tissue defects in the hands using multidigit, chimeric, lateral arm, perforator flaps

Ye, Shuming; Yu, Yue; Jing, Juehua; Zhou, Yun; Zhang, Jisen; Teng, Xiaochun; Xu, Chungui; Cheng, Wendan; Li, Ziyu; Xu, Youjia

doi:10.1016/j.bjps.2018.12.034

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…Septocutaneous vessel-based flaps, commonly pursued before the perforator flap era, similarly allow for a straightforward harvest. For example, the lateral arm flap provides consistent septal perforators from the posterior radial collateral vessels (Figure 3) (Ye et al., 2019). Limitations of this flap include a modest size, relatively short pedicle and excessive bulk, making it unsuitable for distal forearm or hand resurfacing.…”

Section: Evolution and Nomenclature Of Flapsmentioning

confidence: 99%

Evolution of free flap reconstruction in the upper extremity: perspective from a tertiary plastic and reconstructive institution

Wu,

Lin,

Hsu

et al. 2023

J Hand Surg Eur Vol

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Soft tissue reconstruction of the upper extremity requires consideration of wound bed status, varied anatomic composition, future function and tissue match, whether in thickness, pliability or involvement of other tissue components. Of the options available, microvascular free tissue flaps allow maximal customizability with the avoidance of long-term donor site morbidity. Free tissue transfers have evolved, given increased surgical proficiency, from direct vessel-based flaps to septocutaneous vessel-based flaps, to musculocutaneous perforator flaps, and most recently to free-style free flaps. With increases in technical complexity come limitless alternatives. We documented the progression of free flap upper extremity reconstruction in recreating form and function of the upper extremity. The foundations laid should allow surgeons the freedom and versatility to choose the most faithful restoration of the defect and produce the best functional and aesthetic results.

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Section: Evolution and Nomenclature Of Flapsmentioning

confidence: 99%

Evolution of free flap reconstruction in the upper extremity: perspective from a tertiary plastic and reconstructive institution

Wu,

Lin,

Hsu

et al. 2023

J Hand Surg Eur Vol

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“…By carrying part of the medial gastrocnemius muscle, a chimeric MSAP (cMSAP) flap can be made to three-dimensionally reconstruct complex soft tissue defects of extremities with deep dead space. 11,12 At present, there are few literature reports on cMSAP flap. This article reports our 11 cases of complex extremity wounds with deep dead space repaired by cMSAP flap in our hospital from March 2016 to May 2022 were retrospectively analysed.…”

Section: Introductionmentioning

confidence: 99%

“…The medial sural artery perforator (MSAP) flap is known to be a typical flap for repairing soft tissue defects of extremities. By carrying part of the medial gastrocnemius muscle, a chimeric MSAP (cMSAP) flap can be made to three‐dimensionally reconstruct complex soft tissue defects of extremities with deep dead space 11,12 . At present, there are few literature reports on cMSAP flap.…”

Section: Introductionmentioning

confidence: 99%

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

Sui

Khan

Qing

et al. 2023

International Wound Journal

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Trauma or lesion resection often causes complex wounds with deep soft tissue defects in extremities. Simply covering with a skin flap will leave a deep dead space resulting in infection, non‐healing wounds, and poor long‐term outcomes. Thus, effectively reconstructing complex wounds with dead space leaves a clinical challenge. This manuscript presents our experience using chimeric medial sural artery perforator (cMSAP) flap, to reconstruct complex soft tissue defects of the extremities, thereby exploring broader analysis and indications for future reference. Between March 2016 and May 11, 2022, patients (8 males and 3 females) with a mean age of 41 years (range from 26 to 55 years) underwent reconstructive surgery with the cMSAP flap. The cMSAP flap consists of an MSAP skin paddle and a medial sural muscle paddle. The size of the MSAP skin paddle ranged between 9 × 5 cm and 20 × 6 cm, and the size of the medial sural muscle paddle ranged between 2 × 2 cm and 14 × 4 cm. Primary closure of the donor site was achieved in all cases. Of the 11 patients, the cMSAP flap survived in 10 cases. The vascular compromise occurred in one special case and was treated with surgical procedures. The mean follow‐up duration was 16.5 months (range of 5–25 months). Most patients present satisfactory cosmetic and functional results. The free cMSAP flap is a good option for reconstructing complex soft tissue defects with deep dead space in extremities. The skin flap can cover the skin defect, and the muscle flap can fill the dead space against infection. In addition, three types of cMSAP flaps can be used in a broader range of complex wounds. This procedure can achieve an individualised and three‐dimensional reconstruction of the defects and minimise the donor site morbidities.

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“…The lateral arm flap is suitable for soft tissue defect coverage of the hand and fingers because of its good colour match, similar texture, potential for sensory reconstruction and its thinness, due to minimal subcutaneous fat in the upper arm (Sauerbier et al., 2012; Ye et al., 2019). However, the flap width rarely exceeds 6 cm (Ye et al., 2019), and this remains one of its drawbacks if primary closure of the donor site is to be achieved. A split-thickness skin graft in the upper arm donor site produces an undesirable appearance (Graham et al., 1992).…”

mentioning

confidence: 99%

“…In this instance, we utilized the reliability of the multiple septocutaenous perforators to design a polyfoliate flap that allowed us to increase its width without an additional microsurgical procedure and allowed primary closure of the donor site. Ye et al. (2019) reported on a series of chimeric lateral arm flaps to cover multiple defects at different sites (or digits) and we further expanded on its indication with a bifoliate design for the dorsum of the hand and fingers.…”

mentioning

confidence: 99%

Reconstruction of the dorsum of the hand and fingers with a bifoliate lateral arm flap: a case report

Tang

Ding

2020

J Hand Surg Eur Vol

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One-stage reconstruction of complex soft tissue defects in the hands using multidigit, chimeric, lateral arm, perforator flaps

Cited by 7 publications

References 33 publications

Evolution of free flap reconstruction in the upper extremity: perspective from a tertiary plastic and reconstructive institution

Evolution of free flap reconstruction in the upper extremity: perspective from a tertiary plastic and reconstructive institution

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

Reconstruction of the dorsum of the hand and fingers with a bifoliate lateral arm flap: a case report

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