Reconstructive surgery for foot and ankle defects in pediatric patients: Comparison between anterolateral thigh perforator flaps and deep inferior epigastric perforator flaps

Cao, Zheming; Du, Wei; Qing, Liming; Zhou, Zhengbing; Wu, Panfeng; Yu, Fang; Ding, Pingyu; Xiao, Yue; Pang, Xiaoyang; Liu, Rui; Tang, Juyu

doi:10.1016/j.injury.2019.06.021

Cited by 15 publications

(14 citation statements)

References 31 publications

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“…When placing the flap, each element should be handled carefully; any tethering or twisting could result in necrosis and loss. In our experience, skin flaps longer than 12 cm should be positioned in oblique orientation to ensure adequate blood supply 1,21,44 . The oblique cutaneous flap, which lay in zones I, II, and III, referring to the angiosome anatomy, could avert remote necrosis.…”

Section: Discussionmentioning

confidence: 96%

“…According to previous studies 1,21,44 , one robust perforator with a proper caliber is sufficient to support a skin flap as large as 24 × 8 cm 2 ; one to two perforators were enough for the skin paddle. The outflow of veins was vulnerable because of the thin vessel wall and slower flow.…”

Section: Discussionmentioning

confidence: 99%

“…Based on Cao et al . (2019), the ALT is, therefore, suitable for moderate skin loss (less than 120 cm 2 ) in heels 21 . In addition, the dense and thick skin and subcutaneous tissues of ALT restrict the ability to cover the heel, where elasticity, flexibility, and thinness are required.…”

Section: Discussionmentioning

confidence: 99%

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Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

Luo

2021

Orthopaedic Surgery

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Objective The aim of the present study was to report a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP) to achieve dead space filling, Achilles tendon bridging, and skin resurfacing simultaneously with minimal donor‐site morbidity. Methods From September 2012 to May 2016, a retrospective study was carried out on six pediatric patients with composite soft tissue defects of the heel that were repaired with the chimeric DIEP flap. The chimeric flap design included a flap of the anterior sheath of the rectus, a block of rectus muscle, and a large skin paddle. All the parts were supplied by a common artery. After harvesting the flap, all element parts were inserted at the corresponding sites in a tension‐free manner. With one set of vessel anastomoses at the recipient site, accurate repair with tendon reconstruction, dead space elimination, and wound covering were accomplished. The donor site incisions were closed initially. Data on patient age, medical history, injury severity, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow‐up were collected and reviewed. Results Five of the six chimeric DIEP flaps survived without complications. The remaining one case experienced partial necrosis of the skin paddle caused by venous congestion, which healed after routine dressing changes. Primary donor site closure was accomplished in all cases. The mean follow‐up was 18.6 months (range, 10–36 months). Five patients had satisfactory aesthetic and functional outcomes; one patient needed a secondary debulking procedure. Compared to the unaffected side, the affected side showed no obvious difference for ankle movement, tiptoe function, and patient gait during the follow‐up period. Good ankle function was observed in all patients. There was no donor site breakdown, with only a slightly noticeable linear scar. Conclusion The chimeric DIEP flap reduced the operative time, solved the problem of deficiency of recipient vessels, and attained satisfactory functional and aesthetic outcomes with low donor site morbidity. Therefore, it is a promising option for three‐dimensional reconstruction of composite defects with dead space and Achilles tendon defects as well as skin loss in children.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

Luo

2021

Orthopaedic Surgery

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“…A study that used the chimeric DIEP ap for the reconstruction of post-traumatic drop foot deformity, inter alia, reported that two patients recovered active dorsi exion of the ankle after the surgery [23]. Two studies that compared DIEP and other free aps (anterolateral thigh perforator ap) [24] and circum ex scapular artery perforator ap [25] for the reconstruction of lower extremities in pediatric patients concluded that the DIEP ap might be a good alternative for foot reconstruction; however, other aps showed better morpho-functional outcomes than the DIEP ap. They embraced it as a second option for selected cases in extremity reconstruction and don't explain the technical details.…”

Section: Discussionmentioning

confidence: 99%

One-stage Reconstruction of Large Extremity Defects Using a Thin Deep Inferior Epigastric Perforator Flap

Lee

Park

2021

Preprint

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BackgroundCovering large defects of the extremities remains a great challenge; one-stage reconstruction with ‘thin perforator flaps’ has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is the most commonly utilized flap in breast reconstruction (BR);it provides the largest amount of skin and soft tissue with the advantages of minimal donor site morbidity, relatively easy dissection, and flap elevation. The purpose of this study is to present the versatility of free DIEP flaps for the reconstruction of large defects of the extremities.MethodsPatients with large tissue defects on their extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included in this study. They were minimally followed up for 36 months. We analyzed the etiology and location of the soft tissue defect, flap design, anastomosis type, outcome, and complications. We also considered the technical differences in the DIEP flap between breast and extremity reconstruction.ResultsOverall, six free DIEP flaps were included in the study. The flap size ranged from 15 × 12 to 30 × 16 cm2. All flaps were transversely designed similar to a traditional BR design. Three flaps were elevated with two perforators. Primary closure of the donor site was possible in all cases. Five flaps survived with no complications. However, partial necrosis occurred in one flap.ConclusionsA DIEP flap is not the first choice for soft tissue defects, but it should be considered for one-stage reconstruction of large defects when the circulation zone of the DIEP flap is considered. In addition, this flap has many advantages over other flaps such as provision of the largest skin paddle, low donor site morbidity with a concealed scar, versatile supercharging technique, and a long pedicle.

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“…Preliminary studies have shown that the survival rate after free flap surgery in children is comparable with that in adults 4,5 . Because of the difficulty in dissecting and anastomosing the anterolateral thigh flap in pediatric patients, its application has been rarely reported 6 . Therefore, we performed free anterolateral thigh flap for 26 children with soft tissue defects in extremities between July 2015 and June 2017, to explore the effectiveness and characteristics of free anterolateral thigh flap for reconstruction of extremity soft tissue defects in pediatric patients.…”

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confidence: 99%

Microsurgical Anterolateral Thigh Flap for Reconstruction of Extremity Soft Tissue Defects in Pediatric Patients

Shi¹,

Xu²,

Zhu³

et al. 2022

Ann Plast Surg

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Background: The anterolateral thigh flap is one of the most widely used flaps because it has the advantages of less damage to the donor site, no sacrifice of main blood vessels, and abundant soft tissue. However, the application of anterolateral thigh flap in children is relatively rare because of small blood vessels and rapid physiological changes. The aim of this study was to explore the effectiveness and characteristics of free anterolateral thigh flaps for the reconstruction of extremity soft tissue defects in pediatric patients. Patients and Methods: This study included 26 pediatric patients, with an average age of 6.7 years (range, 2-13 years). There were 5 cases of upper limb defects and 21 cases of lower limb defects, all of which were accompanied by exposed bones or tendons. The causes of defects included traffic injury in 9 cases, mechanical injury in 7 cases, collision injury in 4 cases, spoke injury in 3 cases, cicatricial contracture in 2 cases, and fibroma in 1 case. All defects were reconstructed with free anterolateral thigh flaps. Results: Twenty-six anterolateral thigh flaps were harvested, including 15 fasciocutaneous flaps and 11 musculocutaneous flaps. The mean size of the flap was 73.4 cm 2 (range, 4 Â 3 to 24 Â 8 cm). The donor sites were sutured directly in 19 cases and underwent split-thickness skin grafting in 7 cases. There were 3 cases of vascular crisis, 3 cases of flap edge necrosis, 3 cases of infection, 1 case of pressure ulcer, and 1 case of dehiscence after surgery. Eleven patients had scar hyperplasia in the donor site. A total of 34 reoperations were performed, including 14 flap debulking, 7 debridement, 4 skin graft, 3 vascular crisis re-exploration, and 6 other procedures. Conclusions: Free anterolateral thigh flap was a safe and reliable option for reconstructing soft tissue defects of extremities in pediatric patients. Notably, the incidence of scar hyperplasia in the donor site and the possibility of reoperation in pediatric patients were higher than those in adult patients.

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Reconstructive surgery for foot and ankle defects in pediatric patients: Comparison between anterolateral thigh perforator flaps and deep inferior epigastric perforator flaps

Cited by 15 publications

References 31 publications

Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

One-stage Reconstruction of Large Extremity Defects Using a Thin Deep Inferior Epigastric Perforator Flap

Microsurgical Anterolateral Thigh Flap for Reconstruction of Extremity Soft Tissue Defects in Pediatric Patients

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