Peroneal artery perforator flap for the treatment of chronic lower extremity wounds

Cheng, Liang; Yang, Xiaohong; Chen, Tingxiang; Li, Zhijie

doi:10.1186/s13018-017-0675-z

Cited by 24 publications

(15 citation statements)

References 23 publications

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“…Septocutaneous perforators anastomose with each other forming a microvascular suprafascial axis that stretches from the head of fibula to the tip of LM (11). Schaverein et al, after studying 30 specimens identified that the perforators from PA are not in clusters as reported by some studies, but they are distributed at different levels (13). Among the perforator flaps, the distal flap involves PP as a source vessel above the lateral malleolus (14).…”

Section: Discussionmentioning

confidence: 98%

A study on perforating peroneal artery

Rai

Tonse

Bem

et al. 2020

Muscle Ligaments and Tendons J

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Aims. Peroneal flap with vascular pedicles is considered as a good substitute for limb reconstructions or any other soft tissue defects because of the number of perforating branches given from the PA. Purpose of this study is to evaluate the branching and communicating pattern of distal most perforating peroneal artery (PP). Methods. Dissected lower limbs of 48 cadavers were studied for the course and communications of PP. Results. The study encountered usual as well as variant communications of PP. In about 12% of the study sample PP continued as DPA and in about 6% of the cases it was communicated with DPA dorsal to the talar head region. The most frequent finding in the present study is PP piercing the interosseous membrane between tibia and fibula at about 6 to 6.5cm proximal to the tip of lateral malleolus. In one of the specimens it was piercing the LM at the base of LM. Conclusions. The results of present study imply a cautious dissection to locate an appropriate vascular pedicle for the flap surgery as there are small communications of PP with ATA as well as DPA and PP can also take variant course. Because failure to do so may lead to accidental and serious vascular injuries.

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Section: Discussionmentioning

confidence: 98%

A study on perforating peroneal artery

Rai

Tonse

Bem

et al. 2020

Muscle Ligaments and Tendons J

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“…13,31 When discussing skeletonized flaps, many authors described irrigation with some variety of vasodilator irrigation during the case to prevent spasm that is associated with increased handling of the vessel as the soft tissue attachments are stripped. 6,11,13,16,[31][32][33][34][35] Following dissection and pedicle skeletonization, the flap is then carefully transposed into the defect location, avoiding any tension on the pedicle. 31 During this systematic analysis several common themes emerged.…”

Section: Flap Dissectionmentioning

confidence: 99%

“…41 The protective effect of skeletonization in these instances may also be attributed to the reduction of redundant tissue that might otherwise compromise the blood supply to the flap, specifically venous drainage after flap rotation. 17,30,32,34,35,38,40 Venous congestion continues to be a major complication after pedicled flap transfer. 42,43 Veins are more susceptible to occlusion following rotation due to their low pressure and thin walls.…”

Section: Flap Typementioning

confidence: 99%

“…44 Importantly, this successful adjunct is not without added risk as leeching can lead to increased rates of transfusion and infection. 44,45 While most authors believe that the protective mechanism of skeletonization lies in the reduction of tissue redundancy that precipitates kinking, 17,[32][33][34][35]38 a minority (within the scope of this review) believe that keeping a small amount of soft tissue or muscular cuff around the perforating vessels is actually protective of the fine vasculature and can reduce the risk of kinking and pedicle compression in both rotational and propeller flaps. 13,19,46,47 One author, who is not a proponent of pedicle skeletonization for propeller and rotational flaps, does note that division of any fascial bands that could potential compromise and compress the pedicle was a necessary step.…”

Section: Flap Typementioning

confidence: 99%

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The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review

Soteropulos

Shulzhenko

Nayar

et al. 2020

J Reconstr Microsurg

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Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls of microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined the impact of perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and impact of pedicle skeletonization on perforator-based fasciocutaneous flaps of the lower extremity. Methods PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were reviewed for literature examining perforator-based fasciocutaneous flaps from knee to ankle, from January 2000 through November 2018. The Preferred Reporting Items for Systematic Reviews-Individual Participant Data (PRISMA-IPD) structure was used. Results Thirty-six articles were included for quantitative analysis. Of 586 flaps, 365 were skeletonized (60.1%) with 58 major (9.9%) and 19 minor complications (3.2%). With skeletonization, overall reoperative rate was higher (odds ratio [OR]: 9.71, p = 0.004), specifically in propeller (OR: 12.50, p = 0.004) and rotational flaps (OR: 18.87, p = 0.004). The complication rate of rotational flaps also increased (OR: 2.60, p = 0.04). Notably, skeletonization reduced complications in flaps rotated 90 degrees or more (OR: 0.21, p = 0.02). Reoperative rate of distal third defects (OR: 14.08, p = 0.02), flaps over 48 cm2 (OR: 33.33, p = 0.01), and length to width ratios over 1.75 (OR: 7.52, p = 0.03) was increased with skeletonization. Skeletonization increased complications in traumatic defects (OR: 2.87, p = 0.04) and reduced complications in malignant defects (OR: 0.10, p = 0.01). Conclusion Pedicled, perforator-based flaps can provide a reliable locoregional alternative to free tissue transfer for lower extremity defects. Though skeletonization increased the overall reoperative rate, the complication rate for flaps with 90 degrees or more of rotation was significantly reduced. This suggests skeletonization should be considered when large rotational movements are anticipated to reduce complications that can arise from pedicle compression and venous congestion.

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“…Multiterritory perforator flap have been widely used in clinics for a long time to repair skin defects such as congenital disorders, trauma, tumor ablation, and diabetic foot ulcer ( Cheng et al., 2017 ). Previous studies have revealed that necrosis usually occurs away from the boundary between potential and dynamic territory ( Taylor et al., 1992 ; Fichter et al., 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Detrimental Effect of Sitagliptin Induced Autophagy on Multiterritory Perforator Flap Survival

Chen

Zhang

et al. 2020

Front. Pharmacol.

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Multiterritory perforator flap survival is commonly applied in surgical tissue reconstructions and covering of large skin defects. However, multiple risk factors such as ischemia, reperfusion injury, and apoptosis after reconstructive surgeries cause necrosis in distal parts with outcomes ranging from poor aesthetic appearance to reconstructive failure. A few studies have reported that sitagliptin (Sit) promotes angiogenesis and inhibits apoptosis. However, little is known about Sit-induced autophagy especially on the flap model. Therefore, our study investigated the effect of Sit and its induced autophagy on the perforator flap survival. Ninety male Sprague-Dawley rats were randomly separated into control, Sit, and Sit+3-methyladenine group. Results revealed that Sit significantly promoted flap survival by enhancing angiogenesis, reducing oxidative stress, and attenuating apoptosis. In addition, flap survival was further improved after co-administration with 3-methyladenine to inhibit autophagy. Overall, our results established that Sit has positive effects in promoting survival of multiterritory perforator flap. Sit-induced autophagy was detrimental for flap survival and its inhibition may further improve flap survival.

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Peroneal artery perforator flap for the treatment of chronic lower extremity wounds

Cited by 24 publications

References 23 publications

A study on perforating peroneal artery

A study on perforating peroneal artery

The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review

Detrimental Effect of Sitagliptin Induced Autophagy on Multiterritory Perforator Flap Survival

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