Reconstruction of Extensive Lower Limb Defects with Thoracodorsal Axis Chimeric Flaps

Abstract

Therapeutic, IV.

A thoracodorsal artery perforator chimeric free flap for prevention of microvascular pedicle compression in lower extremity reconstruction

“…The combination of multiple independent components can increase the flap size to permit reconstruction of extensive defects; it can also provide multiple tissue types for reconstructing complex defects, such as multiple defects, irregularly shaped defects, and three‐dimensional defects, and for obliterating dead spaces. The flexibility of design and customized reconstruction optimize functional reconstruction . The anterolateral thigh flap with the vastus lateralis muscle flap, the LD perforator flap and muscle flap, and the serratus anterior (SA) muscle flap or parascapular flap 7 are used as the chimeric flap.…”

“…The flexibility of design and customized reconstruction optimize functional reconstruction . The anterolateral thigh flap with the vastus lateralis muscle flap, the LD perforator flap and muscle flap, and the serratus anterior (SA) muscle flap or parascapular flap 7 are used as the chimeric flap.…”

“…The flaps for the foot and ankle area often require long vascular pedicles to approach a healthy proximal vessel, such as the dorsalis pedis or anterior tibial vessels. While harvesting the chimeric flap, the vascular pedicle should be dissected proximally to gain maximal length and diameter; in this way, most anastomosis sites can be moved away from the zone of injury . However, the approach to the recipient vessel from the defect is troublesome and often requires either an additional skin incision, which can produce a further defect, or a tunneling procedure, which can obstruct postoperative venous outflow.…”

“…Skin and soft tissue defects of the foot and ankle region resulting from trauma, tumor, diabetes, or infection are challenging for the reconstructive surgeon, and often require microsurgical tissue transfer for limb salvage. The selection of a suitable flap for the specific location and extent of the defect is important, as well as the selection of a suitable recipient vessel . Following radical debridement of necrotic tissue and preparation of the wound bed, surgeons should seek healthy vessels for safe reconstruction.…”

Soft-tissue coverage of exposed orthopaedic trauma implants

“…Harvesting both the latissimus and serratus as a combined (''chimeric'') flap has significant potential, and recently Kim et al 28 reported the successful use of a chimeric latissimus-serratus anterior myocutaneous free flap for coverage of massive leg soft-tissue defects. Unique in that the vascular pedicle is superficial to the muscle, the source vessels may be the lateral thoracic artery or a short pedicle version from a branch of the thoracodorsal artery.…”