The Combined Flap Based on a Single Vascular Source: A Clinical Experience with 32 Cases

Yamamoto, Yuhei; Nohira, Kunihiko; Minakawa, Hidehiko; Takeno, Naokazu; Sugihara, Tsuneki; Shintomi, Yoshihisa

doi:10.1097/00006534-199606000-00010

Cited by 25 publications

(13 citation statements)

References 16 publications

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“…Several vascular systems have been reported for design of the branch-based combined flap. These include dorsalis pedis, 3 deep circumflex iliac, 4 lateral circumflex femoral, [5][6][7] and subscapular systems. [8][9][10] The subscapular system has been found to offer the greatest variety of tissue components, such as muscle, skin, fascia, and bone.…”

Section: Discussionmentioning

confidence: 99%

Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle

Gao

Jiang

et al. 2008

Microsurgery

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Repair of multiple soft tissue defects on hand often pose a difficult problem to the reconstructive surgeons with employing a limited number of reliable flaps and recipient vessels. This report is to explore the feasibility and advantage of the treatment of multiple soft tissue defects on hand with combined island flaps based on branches of the circumflex scapular system. From 2002 to 2006, nine patients had transfer of the scapular lobulated combined flaps based on the transverse branch, ascending branch, and descending branch of the circumflex scapular vascular pedicle for coverage of soft-tissue defects over injured hands. Follow-up ranged from 6 months to 24 months with average 12.1 months' all of nine flaps completely survived without complications. Arterial insufficiency was found in one flap because of the pedicle compression in the subcutaneous tunnel. The blood supply to flap was restored after the compression was released. All transferred flaps showed good appearance without significantly swelling and congestion. Two flaps underwent secondary debulking surgery. At 6 months postoperatively, partial protective sensation (S1) was restored in the flaps. The donor sites were directly closed in six cases. Skin grafts were used to cover the donor sites in other three cases. All of donor sites healed without complications. Our report shows that the management of multiple soft tissue defects on hand in complex hand injuries with lobulated flaps of circumflex scapular system can obtain good results for its good appearance and low donor site complications. It is probably the optimal surgical intervention for these injuries.

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Section: Discussionmentioning

confidence: 99%

Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle

Gao

Jiang

et al. 2008

Microsurgery

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“…These tissues may be assembled in a composite or a chimeric fashion for a variety of three-dimensional surgical demolitions in the head and neck. [3][4][5] The numerous independent vascular branches from the LCFA system allow freedom in positioning harvested skin, muscle and bone for single-stage reconstruction of compound defects. The preoperative planning required for these composite reconstructive strategies is more intricate than that for standard cases, especially in trauma cases.…”

Section: Discussionmentioning

confidence: 99%

“…Knowledge of this vascular territory allows for multiple tissues (anterolateral thigh skin, vastus lateralis muscle, rectus femoris muscle, tensor fascia lata muscle, and iliac crest) to be elevated independently or collectively, providing single or composite tissues flaps for complex three dimensional defects. [3][4][5][6] Primary microsurgical reconstruction of lower-extremity injuries for the explicit purpose of wound coverage results in a functional cripple. These patients require additional operative interventions and rehabilitation to achieve a functional state.…”

mentioning

confidence: 99%

Lateral Circumflex Femoral Artery System: Warehouse for Functional Composite Free-Tissue Reconstruction of the Lower Leg

Lin

Wei

Lin

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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“…Flaps including multiple skin territories and bone based on a singular subscapular artery have been described for various defects. 16,17 In our patient, all of the above-mentioned options had to be excluded because of the destruction of recipient vessels or failure to deliver the necessary amount of skin. Even though a latissimus dorsi flap could have been sufficient to cover the defect with its muscle mass, the inadequate size of the overlying skin island with added skin grafts was thought to be unacceptable.…”

Section: Discussionmentioning

confidence: 99%

The Free ???Mutton Chop??? Flap: A Fascio-Musculocutaneous Flap for the Reconstruction of the Entire Sacral and Perineal Area

Vogt

Kall²,

Lahoda³

et al. 2004

Plastic and Reconstructive Surgery

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A wide selection of fasciocutaneous and musculocutaneous flaps is available for the reconstruction and coverage of extensive soft-tissue defects in the pelvic area. 1,2 The sacrum and perineum can be particularly difficult in patients who have suffered tumor related tissue destruction followed by multimodal radiation therapy. 3 In some cases, the residual pelvic floor area is not suitable for skin grafts, instead requiring composite flaps for adequate wound closure. Occasionally, the defect size will preclude the use of adjacent regional flaps. In these cases, a free musculocutaneous flap will be the only eligible solution. 2 We describe a case of a 46-year-old man who presented with a longstanding history of gigantic condylomata acuminata of the anus and rectum. The histological examination of various biopsies showed that the patient had developed several foci of squamous cell carcinoma that required an abdominoperineal resection and radical débridements. The residual defect needed coverage by an extended free flap. A musculocutaneous free flap based on the lateral circumflex pedicle of the femoral artery including a large anterior skin island, fascia, rectus femoris, sartorius, and tensor fasciae latae muscle was successfully transferred to a temporary arteriovenous loop anastomosed to the femoral vessels. CASE REPORTA 46-year-old man had been suffering from gigantic condylomata acuminata of the anus for several years. Biopsies showed evidence of a squamous cell carcinoma arising in the tumor. Radical resection of the rectum and the entire bilateral integument of the buttocks, including the gluteus maximus and medius muscles in addition to the ischial skin and prostate, followed by a left-sided U-loop colostomy, was performed by the colorectal surgeon (Fig. 1). Before soft-tissue reconstruction, the diverting colostomy was converted into a permanent left-sided colostomy. Plastic Reconstructive ProcedureAs a result of multiple metastatic lesions of the squamous cell carcinoma in the wound bed, which were removed, it was decided to cover the soft-tissue defect with a composite tissue transfer followed by postoperative radiation brachytherapy of the local metastases.A free flap with a large skin island and appropriate muscle was considered the only suitable option for closure to withstand the adjuvant irradiation. Because no regional recipient vessels were available, an arteriovenous loop was designed anastomosing the proximally based saphenous vein of the right leg to the right femoral artery in an end-to-side fashion (Fig. 2). The loop was placed subcutaneously above the anterior superior iliac spine of the pelvis in proximity to the lateral margin of the sacral wound.The only conceivable flap to meet the requirements in this patient was a large musculocutaneous free flap of the left leg. This flap had been described previously only as a pedicled flap or so-called "mutton chop" flap.The dominant arterial pedicle supplying the rectus femoris muscle originated directly from the femoral artery, not, as usual, from ...

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The Combined Flap Based on a Single Vascular Source: A Clinical Experience with 32 Cases

Cited by 25 publications

References 16 publications

Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle

Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle

Lateral Circumflex Femoral Artery System: Warehouse for Functional Composite Free-Tissue Reconstruction of the Lower Leg

The Free ???Mutton Chop??? Flap: A Fascio-Musculocutaneous Flap for the Reconstruction of the Entire Sacral and Perineal Area

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