Thin Perforator Flaps for Reconstruction of the Lower Extremity

Ebner, Peggy J.; Gould, Daniel J.; Patel, Ketan M.

doi:10.1055/s-0039-1695740

Cited by 6 publications

(9 citation statements)

References 27 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 To date, there have been few large series examining outcomes of perforator flap reconstruction in the lower extremity, and particularly thin perforator flaps. 5,34,35 Furthermore, extending the concept of perforator flaps to using a perforator as a recipient is a logical choice based on the physiology of the flap.…”

Section: Discussionmentioning

confidence: 99%

Are Perforators Reliable as Recipient Arteries in Lower Extremity Reconstruction? Analysis of 423 Free Perforator Flaps

Power

Cho

Kwon

et al. 2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Background: Perforator flaps have revolutionized lower limb reconstruction by offering single-stage thin, pliable coverage with an excellent aesthetic match. Although anastomosis of the flap to a major artery remains the gold standard, perforator-to-perforator anastomosis has several advantages, including expedient recipient dissection and increased recipient options in vessel-depleted extremities. The aim of this study was to compare flap survival when a perforator or major artery was used as a recipient vessel. Methods: A retrospective cohort of free perforator flaps for lower limb reconstruction was reviewed. Demographics, comorbidities, vascular status, defect characteristics, operative details, and complications were recorded. Outcomes for perforator and major artery recipients were compared. Results: Four hundred twenty-three flaps were performed for various reasons using perforator flaps. The total limb salvage rate was 98.8 percent. Total and partial flap failure rates were 6.1 percent and 9.0 percent, respectively. Comparing perforator recipients [n = 109 (25.8 percent)] to major artery recipients [n = 314 (74.2 percent)], there was no significant difference in total (p = 0.746) or partial flap failure (p = 0.212). Significant factors between the groups included larger flap size with major artery recipients (p = 0.001) and shorter operative time when using a perforator recipient (p = 0.012) Conclusions: Perforator-to-perforator anastomosis is a reliable option that affords equivalent rates of flap success compared to major artery anastomosis in lower extremity reconstruction. The authors advocate using a major artery recipient in defects where the axial vessels are easily accessible. A perforator recipient is a viable alternative in defects where access to the axial vessels is inconvenient and in patients with limited recipient options. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

show abstract

Section: Discussionmentioning

confidence: 99%

Are Perforators Reliable as Recipient Arteries in Lower Extremity Reconstruction? Analysis of 423 Free Perforator Flaps

Power

Cho

Kwon

et al. 2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…15 Some subsequent publications have created the term "ultrathin ALT flap" or "super-thin ALT flap" for the periscarpal elevation of ALT flaps. 16,17 This work however adheres to the initial nomenclature by Hong and coworkers.…”

mentioning

confidence: 99%

Evaluation of the Suprafascial Thin ALT Flap in Foot and Ankle Reconstruction

Thiele

Weiss

Braig

et al. 2021

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Distal lower extremity reconstruction can be challenging in terms of flap design. Bulky flaps result in limited mobility accompanied with the need of customized footwear. Raising the ALT-flap in a superficial fascial plane (thin ALT-flap) can be beneficial. This study evaluates thin ALT-flaps for lower distal extremity reconstruction. Methods In a retrospective study, patients that underwent microvascular extremity reconstruction at the level of the ankle and dorsal foot at the University of Freiburg from 2008–2018 were reviewed. Results 95 patients could be included in the study (35 perforator flaps, 8 fascia flaps and 54 muscle flaps).Among the perforator flaps, 21 ALT-flaps were elevated conventionally and 14 in the superficial fascial plane (thin ALT-flap). Among the conventional ALT-flaps, there was one flap loss (5%) and one successful revision (5%). 5(24%) flaps received secondary thinning. 57%(n = 12) were able to wear conventional footwear. There were 2(15%) successful revisions of thin ALT-flaps. 100% of thin ALT-flaps survived and 85%(n = 11) of the patients wore ordinary footwear after defect coverage.Among fascial flaps, 50%(n = 4) had to be revised with 2(25%) complete and 1 (13%) partial flap loss. All patients achieved mobility in ordinary shoes (n = 8).In muscle flaps, there were 7(13%) revisions and 5(9%) flap losses. 5(9%) flaps received secondary thinning. Only 33%(n = 18) were mobile in ordinary footwear. Conclusion The thin ALT-flap is a save one-stage evolution for lower distal extremity reconstruction with a favorable flap survival rate. Compared with conventional ALT-flaps it might be beneficial in reducing the need for expensive custom fitted shoes and secondary thinning procedures.

show abstract

“…We calculated the ratio of these dimensions (B/A); if the ratio was greater than 0.75, we decided to harvest a bipedicle DIEP flap (►Fig. 1).…”

Section: Flap Designmentioning

confidence: 99%

“…Keywords: Perforator flap; Large defect reconstruction, Deep inferior epigastric perforator flap Large soft tissue defects of the extremities are difficult to cover, even though various options have been suggested. Perforator flaps have been shown to precisely match the defect and provide good functional and aesthetic outcomes in extremity reconstruction 1 . However, increasing flap size is a risk factor for major complications and flap failures in large defects of the extremities.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Surgical Considerations of One-Stage Reconstruction of Large Extremity Defects Using a Thin Deep Inferior Epigastric Perforator Flap

2022

View full text Add to dashboard Cite

Background One-stage reconstruction with ‘thin perforator flaps’ has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is commonly utilized flap in breast reconstruction (BR). The purpose of this study is to present the versatility of DIEP flaps for the reconstruction of large defects of the extremities. Methods Patients with large tissue defects on extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included. 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. Results Overall, 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. Conclusion A 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.

show abstract

Thin Perforator Flaps for Reconstruction of the Lower Extremity

Cited by 6 publications

References 27 publications

Are Perforators Reliable as Recipient Arteries in Lower Extremity Reconstruction? Analysis of 423 Free Perforator Flaps

Are Perforators Reliable as Recipient Arteries in Lower Extremity Reconstruction? Analysis of 423 Free Perforator Flaps

Evaluation of the Suprafascial Thin ALT Flap in Foot and Ankle Reconstruction

Surgical Considerations of One-Stage Reconstruction of Large Extremity Defects Using a Thin Deep Inferior Epigastric Perforator Flap

Contact Info

Product

Resources

About