Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

Abstract

Objective The aim of the present study was to report a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP) to achieve dead space filling, Achilles tendon bridging, and skin resurfacing simultaneously with minimal donor‐site morbidity. Methods From September 2012 to May 2016, a retrospective study was carried out on six pediatric patients with composite soft tissue defects of the heel that were repaired with the chimeric DIEP flap. The chimeric flap design included a flap of the anterior sheath of the rectus, a block of rectus muscle, and a large skin paddle. All the parts were supplied by a common artery. After harvesting the flap, all element parts were inserted at the corresponding sites in a tension‐free manner. With one set of vessel anastomoses at the recipient site, accurate repair with tendon reconstruction, dead space elimination, and wound covering were accomplished. The donor site incisions were closed initially. Data on patient age, medical history, injury severity, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow‐up were collected and reviewed. Results Five of the six chimeric DIEP flaps survived without complications. The remaining one case experienced partial necrosis of the skin paddle caused by venous congestion, which healed after routine dressing changes. Primary donor site closure was accomplished in all cases. The mean follow‐up was 18.6 months (range, 10–36 months). Five patients had satisfactory aesthetic and functional outcomes; one patient needed a secondary debulking procedure. Compared to the unaffected side, the affected side showed no obvious difference for ankle movement, tiptoe function, and patient gait during the follow‐up period. Good ankle function was observed in all patients. There was no donor site breakdown, with only a slightly noticeable linear scar. Conclusion The chimeric DIEP flap reduced the operative time, solved the problem of deficiency of recipient vessels, and attained satisfactory functional and aesthetic outcomes with low donor site morbidity. Therefore, it is a promising option for three‐dimensional reconstruction of composite defects with dead space and Achilles tendon defects as well as skin loss in children.

Ortho‐oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft‐tissue defects after oncologic resections

“…One‐hundred‐fourteen full‐text articles were assessed for eligibility. Seventy of these were excluded and the remaining forty‐four have been divided based on type of technique reported: local flaps (Liu et al, 2014; Masquelet et al, 1992; Nguyen et al, 2023; Ring et al, 2016; Woo et al, 2022; Zelken & Lin, 2016), free flaps (Akdag et al, 2018; Battiston et al, 2015; Calotta et al, 2018; Cherubino et al, 2020; Colterjohn et al, 1997; He et al, 2022; Kim et al, 2021; Kozusko et al, 2019; Medina 3rd et al, 2014; Musharafieh et al, 2001; Namdar et al, 2010; Nosrati et al, 2012; Periasamy et al, 2023; Sailon et al, 2009; Sayyed et al, 2022; Ulusal et al, 2005; Yu et al, 2021), perforator flaps (D'Arpa et al, 2014; Ellabban et al, 2020; Khan et al, 2020; Kwon et al, 2021; Lee et al, 2017; Li et al, 2021; Lin et al, 2021; Pignatti et al, 2011; Ring et al, 2016; Toia et al, 2017), skin grafts (Asif et al, 2018; Kang et al, 2019; Leclère & Casoli, 2016; Schneider et al, 2009; Shimizu & Kishi, 2012) and free bone (fibula) or osteocutaneous transfer (de Boer et al, 1990; El‐Gammal et al, 2002; Han et al, 1992; Toma et al, 2007).…”

“…The vertical deep inferior epigastric perforator flap has been also successfully used for selected lower extremity soft tissue reconstructions (Akdag et al, 2018). Along with the latissimus dorsi, the RAF is commonly used in microsurgical reconstruction for pediatric patients (Yu et al, 2021). The muscle component of the flap is ideal for filling dead space, a crucial factor in lower extremity reconstruction, while the cutaneous component provides coverage.…”

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap

“…16 However, the traditional pedicled musculocutaneous flap lacks flexibility because of a close connection between the skin flap and muscle component, making it unsuitable for repairing the complex defect where the dead space and the skin defect are at different locations. 9,17 The SGAP flap is commonly used for repairing defects in the sacrococcygeal region. 1 Nevertheless, the perforator flap cannot provide abundant bulk to kill the dead space effectively because of the lack of muscle components.…”

“…A previous systematic review and meta-analysis identified gluteal-based and vertical rectus abdominis musculocutaneous flaps as the 2 most common options for soft tissue reconstruction after sacrectomy 16 . However, the traditional pedicled musculocutaneous flap lacks flexibility because of a close connection between the skin flap and muscle component, making it unsuitable for repairing the complex defect where the dead space and the skin defect are at different locations 9,17 . The SGAP flap is commonly used for repairing defects in the sacrococcygeal region 1 .…”

The versatile thoracodorsal artery perforator flap for extremity reconstruction: from simple to five types of advanced applications and clinical outcomes

“…In this way, skin and deep tissue defects can be repaired simultaneously by anastomosing a group of blood vessels. In addition, the latissimus dorsi muscle has an abundant blood supply and a good capacity to resist infection [ 30 ]. Additionally, the muscle paddle can be accurately harvested according to the size of the dead space, which not only improves the quality of recipient site repair but also preserves the integrity of the latissimus dorsi to the greatest extent possible.…”