Definition of perforator flap: what does a "perforator" perforate?

Yamamoto, Takumi; Yamamoto, Naoki; Kageyama, Takashi; Sakai, Hayahito; Fuse, Yuma; Tsuihiji, Kanako; Tsukuura, Reiko

doi:10.35772/ghm.2019.01009

Cited by 26 publications

(31 citation statements)

References 10 publications

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“…Superficial, non‐infected ulcers can be treated conservatively very well (Malhotra et al, 2012). Persistent or infected wounds require a multidisciplinary approach for wound care, incorporating serial debridement followed by definitive soft‐tissue reconstruction (Chou et al, 2018; Crowe et al, 2019; Deiler et al, 2000; Elgohary et al, 2018; Fox et al, 2015; Han et al, 2020; Khai Luen & Wan Sulaiman, 2017; Kim et al, 2016; Kimura et al, 2003; Koshima et al, 2001; Nahai et al, 1978; Park et al, 2017; Rainer et al, 2003; Santanelli et al, 2002; Song et al, 2016; Van Landuyt et al, 2005; Yamamoto, 2019; Yamamoto et al, 2016, 2019, 2020). In the current literature, further or exemplary soft‐tissue involvement is not addressed in the treatment regimens.…”

Section: Discussionmentioning

confidence: 99%

Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

et al. 2021

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Charcot foot is can result in bone deformities and soft tissue defects. We report a case of alcohol‐induced Charcot (AIC) foot with soft tissue defect including the weight‐bearing zone of the heel and osteomyelitis, which was successfully reconstructed with free tensor fascia lata true‐perforator flap (TFLtp). A 56‐year‐old male suffered from AIC foot with an 18 × 6 cm defect. Based on the preoperative ultrasound, we identified the overlying upper thigh area offering one of the thickest dermis. A TFLtp flap was raised sparing the TFL muscle based on one perforator without including the main trunk of the transverse/ascending branch of the lateral femoral circumflex vessel. The TFLtp flap was transferred to the heel and anastomosed to the posterior tibial artery in an end‐to‐side fashion. The patient complained no postoperative discomfort of the donor site and was able to walk on his foot after 5 weeks. This case report highlights that the TFLtp flap may offer thick dermis, faster surgery due to perforator level dissection and a concealed donor site.

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Section: Discussionmentioning

confidence: 99%

Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

et al. 2021

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“…Although not assessed in this case, a SCIP fascial flap can be used as a pedicled flap to reconstruct various parts of the abdominal wall (Goh et al, 2015). Since the deep branch of the SCIA has a wide rotation arc and the pivot point of a SCIP fascial flap is more cranial than a pedicled TFL or ALT flap, a pedicled SCIP facial flap has a potential to be a useful option for various abdominal wall reconstruction cases (Yamamoto, 2019; Yamamoto et al, 2019; Yamamoto et al, 2020a; Yamamoto, Saito, et al, 2016b; Yamamoto, Yoshimatsu, & Yamamoto, 2016a).…”

Section: Discussionmentioning

confidence: 99%

“…Free TFL flap or ALT flap transfers are applied in upper abdominal wall reconstruction, utilizing the DIEA as a recipient vessel. However, they require invasive and time‐consuming muscle dissection for elevation, and vessel conditions cannot be assessed after abdominal wall reconstruction because the DIEA is deeper than the reconstructed abdominal wall (Gurunluoglu & Rosen, 2017; Yamamoto et al, 2019; Yamamoto et al, 2020a).…”

Section: Discussionmentioning

confidence: 99%

Free superficial circumflex iliac artery perforator fascial flap for reconstruction of upper abdominal wall with extensive infected herniation: A case report

et al. 2020

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Complex abdominal wall reconstruction is challenging, and vascularized fascia is preferred for active infection cases. Pedicled tensor fascia lata flap is commonly used for lower abdominal wall reconstruction, and free vascularized fascial flap based on the lateral circumflex femoral artery (LCFA) is used for upper abdominal wall reconstruction. However, LCFA‐based flap transfer requires invasive and time‐consuming muscle dissection and a large recipient vessel. The purpose of this report was to present a new application of superficial circumflex iliac artery (SCIA) perforator (SCIP)‐based fascial flap for upper abdominal wall reconstruction. A 70‐year‐old male suffered from a long‐lasting extensive abdominal wall herniation complicated with mesh infection and cutaneous fistulae following multiple herniation repair with synthetic mesh. After complete debridement of infected tissues, there was a 29 x 26 cm full‐thickness abdominal wall defect. Components separation was performed to minimize the defect size, after which 12 x 7 cm defect remained in the upper abdominal wall. A 20 x 10 cm SCIP deep fascial flap was elevated based on the deep branch of the SCIA. The SCIP flap was transferred to the defect to reconstruct the upper abdominal wall. The SCIP was anastomosed to the deep inferior epigastric artery perforator with supermicrosurgical perforator‐to‐perforator anastomosis. Postoperative course was uneventful with good functional and esthetic results of the donor and recipient sites 11 months after the surgery. Although further studies are required, SCIP fascial flap may be an option for upper abdominal wall reconstruction.

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“…Although reported as a useful chimeric flap, TDAP flap cannot include hard deep fascia suitable for joint capsule reconstruction, because the deep fascia of the latissimus dorsi muscle and the serratus anterior muscle are sparse and weak (Kim et al, 2014; Yamamoto, 2019; Yamamoto, Yamamoto, Kageyama, et al, 2020a). Recently, superficial circumflex iliac artery perforator (SCIP) flap has been reported as a useful chimeric flap (Yamamoto, 2019; Yamamoto et al, 2019; Yamamoto, Saito, et al, 2016a; Yamamoto, Yamamoto, Kageyama, et al, 2020a). However, a chimeric SCIP flap has a relatively shorter pedicle, and could not be applied in the present case where a 12‐cm‐long pedicle was required (Yamamoto, 2019; Yamamoto et al, 2019; Yamamoto, Saito, et al, 2016a; Yoshimatsu et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, superficial circumflex iliac artery perforator (SCIP) flap has been reported as a useful chimeric flap (Yamamoto, 2019; Yamamoto et al, 2019; Yamamoto, Saito, et al, 2016a; Yamamoto, Yamamoto, Kageyama, et al, 2020a). However, a chimeric SCIP flap has a relatively shorter pedicle, and could not be applied in the present case where a 12‐cm‐long pedicle was required (Yamamoto, 2019; Yamamoto et al, 2019; Yamamoto, Saito, et al, 2016a; Yoshimatsu et al, 2019). A chimeric DIEP flap seemed an optimal method for the present case.…”

Section: Discussionmentioning

confidence: 99%

A triple‐component deep inferior epigastric artery perforator chimeric free flap for three‐dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis

Yamamoto

2020

Microsurgery

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Reconstruction of a complex knee defect is challenging, especially when complicated with osteomyelitis. Complex knee defect requires multi‐component three‐dimensional reconstruction using a chimeric flap. Although anterolateral thigh (ALT) flap is the most workhorse chimeric flap, another chimeric flap is required when ALT flap is not available. In this report, we present a case of complex knee defect successfully treated with a free triple‐component chimeric deep inferior epigastric artery perforator (DIEP) flap transfer. A 36 year‐old male sustained right above‐knee amputation and Gustilo IIIB open fracture of the left patella after being run over by a train. Stump formation was performed for the right limb amputation, and the left knee wound resulted in skin necrosis complicated with patella osteomyelitis. After debridement, the left knee wound showed a 3 × 2 cm articular capsule defect, 5 × 2 cm exposed patella stump, and a 16 × 9 cm skin defect. A triple‐component chimeric DIEP flap, containing a 7 × 3 cm rectus abdominis muscle (RAM), a 3 × 2 cm RAM's fascia, and a 23 × 10 cm skin was transferred. The RAM's fascia was used to reconstruct the joint, the RAM to cover the exposed patella's stump and the reconstructed joint, and the skin paddle to cover the skin defect. Six months after the surgery, the patient could walk without osteomyelitis recurrence, and there was no limitation in the left knee joint's range of motion. Although indication is limited, a multi‐component chimeric DIEP flap may be an option for three‐dimensional reconstruction of a complex defect.

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Definition of perforator flap: what does a "perforator" perforate?

Cited by 26 publications

References 10 publications

Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

Free superficial circumflex iliac artery perforator fascial flap for reconstruction of upper abdominal wall with extensive infected herniation: A case report

A triple‐component deep inferior epigastric artery perforator chimeric free flap for three‐dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis

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