Resurfacing of Face and Neck Using Superthin Thoracodorsal Artery Perforator Free Flaps

Chang, Lan Sook; Lim, Jung Han; Kim, Youn Hwan

doi:10.1097/scs.0000000000008249

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Of the strategies used to manage patients with CR, Z-plasty had the highest success rate at 62.5%. As new strategies for managing postburn neck contracture with flap reconstructions emerge, [15][16][17] larger studies that can inform best practices to prevent CR are needed. When following patients postoperatively, on average, CR (256.4 ± 249.4 days) presented later than initial contracture (128.9 ± 84.9 days).…”

Section: Discussionmentioning

confidence: 99%

The Development and Management of Neck Burn Scar Contracture Recurrence

Jeong,

Alessandri-Bonetti,

Pandya

et al. 2024

Ann Plast Surg

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Introduction Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications. Methods A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included. Results A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2). Conclusions This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.

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Section: Discussionmentioning

confidence: 99%

The Development and Management of Neck Burn Scar Contracture Recurrence

Jeong,

Alessandri-Bonetti,

Pandya

et al. 2024

Ann Plast Surg

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“…Superthinning methods have been implemented in conventional thin flaps to impressively reduce the subcutaneous fat layers. Studies have reported ranges of 1.5–6 mm of thickness for superthin SCIP flaps (Kim et al, 2015; Lee et al, 2017), 3–5 mm for superthin TDAP flaps (Chang et al, 2022; Hattori et al, 2020), and 3–6 mm for superthin ALT flaps (Suh et al, 2022; Xie et al, 2016). This technique may lead to subdermal plexus injury, leading to flap compromise despite the high level of dexterity the authors performed (Lee et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Proximal peroneal perforator flap, cadaveric study, and clinical applications for shallow defect reconstructions

et al. 2023

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Purpose: Peroneal artery perforator offers a versatile range of microvascular tissue transfer methods from local flaps to vascularized osteocutaneous fibula flaps. It is one of the few flaps that can cover shallow defects that require thin and pliable skin paddles, such as in hands and feet (Han et al., 2018). The proximal region of the lower leg offers such flexible and thin flap compared to the middle and distal lower leg (Winters & de Jongh, 1999). However, the anatomy of the proximal peroneal artery perforator is relatively unknown in literature and its proximity to the common peroneal nerve (CPN) has not yet been studied. This study conducted a cadaveric study and put it in application into clinical settings.Methods: Twenty lower leg specimens were dissected according to the methods of clinical proximal peroneal artery perforator flap harvest. Perforators arising in the proximal lower leg area of between 20 and 40 percentile of fibular length were inspected. Perforator length, location from fibular head, course, and location of CPN were recorded. Clinical reconstruction cases using the proximal lateral lower leg were analyzed. Six patients between the ages of thirty and seventy were included. Five cases were due to trauma, and one from mass excision, but all required thin and pliable flaps for reconstructions in hands or feet. Flaps were designed concentrical oval shapes, and harvest was done similarly to cadaveric perforator dissection, but perforator dissection was done only up to the required pedicle length. Perforator length, flap size, thickness, and long-term complications were recorded.Results: Among 20 specimens, a total of 20 perforators were found in 18 cadavers (90%). Two specimens showed no perforators while two specimens showed multiple perforators. The perforators were located at an average of 101 mm from fibular head, with an average length of 55 mm ranging from 20 to 153 mm. The average size of perforator at origin was 2.0 mm, ranging from 1.0 to 3.6 mm. 45% showed septocutaneous course and 55% intramuscular course. Two out of 20 perforators were shown to arise from source vessels other than the peroneal artery. All clinical cases were successful without complications or debulking for contour shaping. Flap sizes ranged from 15 to 40 cm 2 . Largest flap width was 5 cm, and all donor sites were primarily closed without complications. One year of follow-up showed no complications.

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“…The second misconception is that lateral thoracic region tissue is much bulkier than thigh and inguinal tissue. Based on our experience and knowledge about vessel and perforator anatomy and fat distribution, dissection and defatting skills, we have already harvested thin and super‐thin flaps from the lateral thoracic region (Chang et al, 2022; Kim et al, 2017; Kim, Youn, et al, 2016). Also compared to the proximal thoracic area, once we choose distal perforators during flap harvest, we can harvest thin flaps and perform very short intramuscular dissection due to the thin distal LD muscle.…”

Section: Discussionmentioning

confidence: 99%

“…Initially, the Metzenbaum scissors are used to push and pressure the superficial fat layer of the flap from the margin so that the bulging fat can be easily and safely cut. This process which is named "pushing with pressure and cutting" can continue until the superficial fat tissue is all removed except around the perforator (Chang et al, 2022).…”

Section: Casementioning

confidence: 99%

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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PurposeThe conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics.MethodsThis article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two‐stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named “pushing with pressure and cutting” was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super‐thin TDAp flap only. In two cases (18%), non‐vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series.ResultsAll 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split‐thickness skin graft (STSG) (55%), and three cases of Z‐plasty performed on the first web space (27%). The mean follow‐up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76.ConclusionsWe resurfaced severe soft tissue defects of multiple fingers with thin to super‐thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two‐stage reconstructive strategy of mitten hand creation and proper division timing to create a 3‐dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.

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Resurfacing of Face and Neck Using Superthin Thoracodorsal Artery Perforator Free Flaps

Cited by 4 publications

References 21 publications

The Development and Management of Neck Burn Scar Contracture Recurrence

The Development and Management of Neck Burn Scar Contracture Recurrence

Proximal peroneal perforator flap, cadaveric study, and clinical applications for shallow defect reconstructions

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

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