Toe resurfacing with a thin thoracodorsal artery perforator flap

Kim, Youn Hwan; Kim, Ki Ho; Sung, Kun-Yong; Kim, Jeong Tae; Kim, Sang Wha

doi:10.1002/micr.30007

Cited by 10 publications

(15 citation statements)

References 29 publications

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“…Revascularization techniques, such as bypass surgery and percutaneous transluminal angioplasty (PTA), can increase the distal circulation, which is favorable for flap survival (Kim, Naidu, & Kim, ; Oh et al, ; Randon et al, ), thereby improving the success rate of free tissue transfer. Microsurgical free tissue transfer techniques have been developed for resurfacing areas where the skin is particularly thin, including the foot and ankle area (Jeon et al, ; Kim et al, , Kim, Kim, Sung, Kim, & Kim, ; Kim et al, ; Youn, Kim, Kim, & Hwang, ). Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, ; Kim et al, , ).…”

Section: Introductionmentioning

confidence: 99%

“…Microsurgical free tissue transfer techniques have been developed for resurfacing areas where the skin is particularly thin, including the foot and ankle area (Jeon et al, ; Kim et al, , Kim, Kim, Sung, Kim, & Kim, ; Kim et al, ; Youn, Kim, Kim, & Hwang, ). Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, ; Kim et al, , ). Numerous articles describe the used of anterolateral thigh perforator flaps and thoracodorsal artery perforator (TDAP) flaps for successful limb salvage (Jeon et al, ; Kim et al, , ; Youn et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…The mortality rate of patients with diabetes following amputation is high, between 39% and 80% at 5 years (Chou et al, 2016;Hong & Oh, 2012;Oh et al, 2013;Moran, Illig, Green, & Serletti, 2002;Moulik, Mtonga, & Gill, 2003) and amputation of the contralateral limb occurs within 2 years of the first amputation in approximately 50% of patients (Ecker & Jacobs, 1970;Kucan & Robson, 1986;Oh et al, 2013) The combination of revascularization with free tissue transfer for the treatment of diabetic lower leg and foot soft tissue defects leads to successful salvage of the diabetic limb (Briggs, Banis Jr., Kaebnick, Silverberg & Acland, 1985;Chou et al, 2016;Hong & Oh, 2012;Moran et al, 2002). Revascularization techniques, such as bypass surgery and percutaneous transluminal angioplasty (PTA), can increase the distal circulation, which is favorable for flap survival (Kim, Naidu, & Kim, 2010;Oh et al, 2013;Randon et al, 2010) Kim, Kim, Sung, Kim, & Kim, 2017;Kim et al, 2016;Youn, Kim, Kim, & Hwang, 2015). Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, 2013;Kim et al, 2016Kim et al, , 2017.…”

Section: Introductionmentioning

confidence: 99%

“…Revascularization techniques, such as bypass surgery and percutaneous transluminal angioplasty (PTA), can increase the distal circulation, which is favorable for flap survival (Kim, Naidu, & Kim, 2010;Oh et al, 2013;Randon et al, 2010) Kim, Kim, Sung, Kim, & Kim, 2017;Kim et al, 2016;Youn, Kim, Kim, & Hwang, 2015). Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, 2013;Kim et al, 2016Kim et al, , 2017. Numerous articles describe the used of anterolateral thigh perforator flaps and thoracodorsal artery perforator (TDAP) flaps for successful limb salvage (Jeon et al, 2013;Kim et al, 2013Kim et al, , 2016Kim et al, , 2017Youn et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, 2013;Kim et al, 2016Kim et al, , 2017. Numerous articles describe the used of anterolateral thigh perforator flaps and thoracodorsal artery perforator (TDAP) flaps for successful limb salvage (Jeon et al, 2013;Kim et al, 2013Kim et al, , 2016Kim et al, , 2017Youn et al, 2015). An improved understanding of perforator and vascular anatomy, coupled with advances in microsurgery, has resulted in the recent development of the chimeric flap technique.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Sung

Jang²,

Kim³

et al. 2018

Microsurgery

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Revascularization techniques, such as bypass surgery and percutaneous transluminal angioplasty (PTA), can increase the distal circulation, which is favorable for flap survival (Kim, Naidu, & Kim, 2010;Oh et al, 2013;Randon et al, 2010) Kim, Kim, Sung, Kim, & Kim, 2017;Kim et al, 2016;Youn, Kim, Kim, & Hwang, 2015). Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, 2013;Kim et al, 2016Kim et al, , 2017. Numerous articles describe the used of anterolateral thigh perforator flaps and thoracodorsal artery perforator (TDAP) flaps for successful limb salvage (Jeon et al, 2013;Kim et al, 2013Kim et al, , 2016Kim et al, , 2017Youn et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Sung

Jang²,

Kim³

et al. 2018

Microsurgery

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Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles

2017

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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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Toe resurfacing with a thin thoracodorsal artery perforator flap

Abstract: Toe resurfacing with thin thoracodorsal artery perforator flaps appears to be a safer and more reliable option than amputation for preserving their function. © 2015 Wiley Periodicals, Inc. Microsurgery 37:312-318, 2017.

Cited by 10 publications

References 29 publications

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles

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

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