Reliable transfer of multiple perforator‐based pedicled flaps: Surgical technique and clinical outcomes

Kwon, Jae Hyun; Lee, Kyeong‐Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa Ik; Oh, Kap Sung; Mun, Goo‐Hyun

doi:10.1002/micr.22427

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Since the description of the "freestyle" perforator concept by Wei and Mardini (2004), the use of perforator flaps became commonly employed in clinical practice (Kwon et al, 2017;Lecours et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Since the description of the “freestyle” perforator concept by Wei and Mardini (2004), the use of perforator flaps became commonly employed in clinical practice (Kwon et al, 2017; Lecours et al, 2010). After the identification of a potential perforator vessel adjacent to any defect, its meticulous dissection from surrounding tissue allows a greater mobility of the flap for advancement or rotation around its vascular axis (Saeed, Narayan, & Troisi, 2018; Scaglioni, Giuseppe, & Chang, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

et al. 2020

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Soft tissue defects in the buttock area are often related to decubitus ulcers, which are usually small to medium-large size and can be regularly treated with local flaps. However, when the defects have bigger size, such as those involving the whole gluteal region, the coverage can become more challenging, since this specific area needs both a good resistance to pressure and an acceptable functional result. The most common solution for similar cases is the use of multiple local flaps, or, in extreme situations, a free flap. In particular, local flaps based on perforator vessels are, in selected cases, a consolidated alternative to free flap allowing an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. Here we present a case of a large mycosis fungoides nidus of the gluteal region measuring 25 cm × 18 cm reconstructed using two large perforator flaps adjacent to the defect combined with a remote one for coverage of the donor site. The cranial flap was designed based on a perforator arising from the superior gluteal artery and transferred into the defect by means of a V-Y advancement, while the two caudal propeller flaps in the posterior thigh were both based on perforators of the profunda femoris artery and rotated 180 , respectively. To obtain a tension-free cover of the donor site defect we applied the concept of "sequential" propeller flaps. Post-operative course was uneventful and the patient was ambulatory with assistive devices after 1 week. At 6 months follow-up, wounds were completely healed without complications and a good functional result was obtained. This report showed the great coverage potential of multiple perforator-based local flaps when properly combined allowing primary closure of the donor site. In particular, we managed to reconstruct a total gluteal defect using just ipsilateral side tissue, reducing morbidity, and obtaining a stable result.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

et al. 2020

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“…In fact, large-scale tissue defects often occur in clinical practice. The traditional perforator flap directly supplies a small anatomical area, but cross zone flap is expected to repair a large range of defects (17). In 1987, Taylor (18) proposed the "angiosome" theory that states that the donor site of each well-known perforator vessel not only includes the skin and subcutaneous tissue within its distribution range, but also the 3-dimensional structure of the corresponding muscles, tendons, bones, and other tissues in the same area.…”

Section: Discussionmentioning

confidence: 99%

An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap

Wanyan¹,

Zhong-ming²,

Zhang³

et al. 2022

Ann Transl Med

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Background: This study sought to explore the application value of indocyanine green angiography (ICGA) in the harvest of multi-angiosome perforator flap and the effect of low molecular weight heparin (LMWH) on the survival of postoperative flap.Methods: Twenty-four SD male rats were selected to construct a three-angiosome perforator flap model with the unilateral iliolumbar artery perforator. They were randomly divided into two groups: the control group was injected with indocyanine green (ICG) into the femoral vein during the operation, and the fluorescence signal was collected and quantitatively analyzed using Real-Time Image Guided System to determine the intraoperative fluorescence imaging length. The experimental group was injected subcutaneously with LMWH (400 U/kg) after 0.5 h postoperatively, and the control group was injected with the same amount of normal saline. The injection was repeated at the same time each day from 0 to 7 days postoperatively. After the flap was sutured in situ, ICGA was performed at 0, 1, 3, 5, and 7 days postoperatively to observe the vascular structure of the two groups of flaps. The flap survival length of the control group was counted at 7 days postoperatively, and the correlation between the intraoperative fluorescence imaging length and the survival length at 7 days postoperatively was calculated. The proportion of distal necrosis of the flaps between the two groups was compared at 7 days postoperatively. Results:The average length of intraoperative fluorescence imaging in the control group was 6.29±0.50 cm, and the survival length of the flap at 7 days postoperatively was 8.24±0.52 cm. The actual survival length was higher than the intraoperative fluorescence imaging length, with a ratio of 1.31±0.08. The difference was statistically significant (P<0.05). At 7 days postoperatively, the flap necrosis ratio of experimental group and control group were 10.92%±1.30% and 19.11%±1.19%, and the flap necrosis ratio of experimental group was lower than that of control group (P<0.001).Conclusions: ICGA can locate the position of perforator, and can be used to predict and observe the length of distal survival of multi-angiosome perforator flap postoperatively. LMWH can promote the distal survival of flap and reduce flap necrosis.

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“…It should be not ignored that the flap size and weight tended to be larger in the multiple‐perforator group. Clinically, surgeons are more accustomed to preparing more than one perforator when a large volume flap is needed (Baumann et al, 2010; Karaaltin et al, 2011; Kwon et al, 2017; Mulvey et al, 2013). More muscles and nerves may be involved in the dissection process to obtain more perforators; however, our results did not increase the incidence of donor‐site complications.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis

et al. 2022

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Background: Perforator-based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single-and multiple-perforator-based free perforator flaps in free-flap reconstruction.Methods: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov between January 2000 and June 2021 to identify studies that reported data on the outcomes of free perforator flaps. Two authors individually extracted data and performed quality assessment. Outcomes, including partial flap loss, total loss, fat necrosis, arterial insufficiency, venous insufficiency, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications, were evaluated.Results: Thirty-two studies with 2498 flaps were included in our analysis. No significant difference was found in the rates of partial loss and arterial insufficiency of flaps, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications. However, the multiple-perforator group showed significantly lower rates of total loss (relative risk [RR] = 1.08, 95% confidence interval [CI]: 0.78-1.79, p = .754), fat necrosis (RR = 1.79, 95% [CI]: 1.36-2.36, p = .000) and venous insufficiency (RR = 1.72, 95% CI: 1.07-2.79, p = .026) than the singleperforator group. Conclusion:The rates of total loss, fat necrosis and venous insufficiency in the multiple-perforator group were lower than those in the single-perforator group.Hence, we recommend that multiple perforators be included in the free perforator flap when appropriate, to yield better clinical outcomes in reconstruction. | INRODUCTIONPerforator flaps soon gained popularity after they were introduced by Koshima in 1989 for use in soft-tissue reconstructions (Koshima & Soeda, 1989). After Mardini et al. (2003) introduced the concept of free-style flaps into perforator flaps, they were widely used in reconstructive surgery. Perforator flaps have many advantages, including providing extensive soft tissue, at least one reliable perforator, a long vascular pedicle, no need to ensure obvious muscle and less donor site weakness and morbidity (Ciudad et al., 2021; Kamali et al., 2017; Lee Yi-hao Liu and Shou-cheng Yin contributed equally to this work.

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Reliable transfer of multiple perforator‐based pedicled flaps: Surgical technique and clinical outcomes

Abstract: This report suggests that through meticulous dissection of pedicles of sufficient length, the multiple perforator-based pedicled flaps can be successfully transposed while minimizing the risk of pedicle tethering. © 2015 Wiley Periodicals, Inc. Microsurgery 37:105-111, 2017.

Cited by 6 publications

References 24 publications

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap

Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis

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