Perforator Flaps: Principles and Techniques

Tenekeci, Göktekin

doi:10.5772/intechopen.71270

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…It is drawn as two opposing V-Y flaps oriented parallel to the longitudinal axis of the defect but is performed as a single multiperforator fasciocutaneous advancement flap. 21,29 The design of the flap is based on the randomly located vascular perforators, creating two identical opposing flaps to fashion a double keystone flap (Figs. 1 and 2).…”

Section: Surgical Techniquementioning

confidence: 99%

Using the keystone design perforator island flap in large myelomeningocele closure

Formentin

Andrade

Matias

et al. 2019

Neurosurgical Focus

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OBJECTIVEMany repair techniques have been proposed to treat large myelomeningocele (MMC), and although effective in many cases, some of these techniques can be complex and time consuming, with complications such as cerebrospinal fluid (CSF) leakage, flap loss, tip necrosis, and wound dehiscence. The purpose of this study was to analyze cases of large skin defects and the methods applied and to report the outcomes of the keystone design perforator island flap (KDPIF) technique for large MMC closure.METHODSThe authors performed a retrospective review of all neonatal patients who had undergone KDPIF for MMC closure in the period from 2013 to 2018. All patients had a diagnosis of lumbosacral MMC based on obstetric ultrasound. The neurosurgeons and plastic surgeons had selected the cases after concluding that primary closure would be unlikely. The design of the flap is based on the randomly located vascular perforators, creating two identical opposing flaps to fashion a double keystone flap. During wound closure, V-Y advancement of each end of the double flap in the longitudinal axis creates redundancy in the central portion of the flap and reduces the horizontal tension. After discharge, both the neurosurgery and plastic surgery teams followed up all patients, tracking the results with photography.RESULTSNo skin flap dehiscence or necrosis, infection, or CSF leakage was detected, proving the reliability of the flap. One of the patients required further surgery for the large skin defects after insufficient intrauterine closure of the MMC and successfully underwent KDPIF treatment. Another patient (14.3%) had severe neonatal sepsis, which ultimately led to death. A ventriculoperitoneal shunt was required after the skin defect repair in 5 (83.3%) of the 6 surviving patients. Exceptional aesthetic results were achieved for all patients during the follow-up.CONCLUSIONSThe KDPIF technique is based on well-known vascular perforators of the intercostal, lumbar, and gluteal regions. Wound tension is widely distributed by the flap and, as a consequence, relevant tissue bulk, reliable vascularity, and important geometrical versatility are provided. In addition, most of the muscles and fascia are preserved, which is another advantage in terms of minimizing secondary morbidity to local tissue rearrangement. The use of KDPIF closure was successfully shown to be a viable alternative for more complex MMCs that present with large skin defects.

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Section: Surgical Techniquementioning

confidence: 99%

Using the keystone design perforator island flap in large myelomeningocele closure

Formentin

Andrade

Matias

et al. 2019

Neurosurgical Focus

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“…[12] Cutaneous vascular perforators (CVPs) are angiocutaneous folds that contain skin or subcutaneous tissue and are provided by puncturing vessels with small measurements (0.5-0.8 mm). [13] The human body is estimated to contain more than 350 CVPs. [14] Perforators are classified as direct or indirect depending on the source of their vascular supply.…”

Section: Introductionmentioning

confidence: 99%

Pain relief effect of angiopuncture therapy on patients with postoperative pain: A clinical trial

Han,

Feng,

Guo

et al. 2024

Medicine

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Background: The objective of this study is to study the pain relief effects of angiopuncture therapy in patients with postoperative pain. Methods: Forty-one patients were randomly selected based on the inclusion and exclusion criteria. Doppler imaging was performed to locate the cutaneous perforator. Angiopuncture was performed on the first postoperative day. A Numerical Rating Scale was used to evaluate the degree of pain before and after angiopuncture. Utilizing the paired t test or Wilcoxon signed rank test, all pre- and post-data were examined, and further subgroup analysis based on time was performed. Results: Variance analysis revealed a significant difference before and after angiopuncture (P < .05). The results of the subgroup analysis showed the pain-relieving effect of angiopuncture for postoperative pain patients at the time points of 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours was apparent (P < .05). Conclusion: The angiopuncture therapy approach may assist in pain relief in patients with postoperative pain.

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“…Perforator-based flaps are one of the most effective reconstruction strategies, resulting in the development of many new flaps, each associated with new pedicles distributed throughout the body and all offering significant benefits. Perforator flaps are cutaneous and subcutaneous tissue patches that are supplied by perforator arterial branches that originate from the main vascular bundles and travel intramuscularly or intraseptally [ 1 , 2 ]. The efficacy of perforator-based flaps has been proven internationally [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

Ismail,

Zulfiqar,

Sami

et al. 2024

Cureus

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Objective: To determine the diagnostic accuracy of smartphone thermal imaging for preoperative perforator mapping in perforator-based flaps, taking visual inspection as gold standard. Methodology: It was a cross-validation study conducted at the Department of Plastic Surgery, Dr. Ruth K. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. All adult patients aged 18 to 40 years of either gender undergoing perforator flap surgery were included. Each patient followed the same treatment regimen, which involved the preoperative identification of the perforator location using the FLIR One camera. Subsequently, confirmation was achieved during the surgical procedure through visual inspection. A two-by two table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Results: The mean age of the patients was 30.10±6.87 years, ranging from 18 to 40 years. Most of the patients were males (58.7%), and 41.3% were females. Almost 80.4% were pedicle flaps, and 19.6% were free flaps. The accuracy of thermal imaging was found to be 83.2%, with a sensitivity of 84.3%, a specificity of 80%, a PPV of 92.9%, and a NPV of 62.2%, respectively. Conclusion: Smartphone-based thermal imaging is useful for the diagnosis of perforators and has high sensitivity and specificity.

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Perforator Flaps: Principles and Techniques

Cited by 8 publications

References 30 publications

Using the keystone design perforator island flap in large myelomeningocele closure

Using the keystone design perforator island flap in large myelomeningocele closure

Pain relief effect of angiopuncture therapy on patients with postoperative pain: A clinical trial

Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

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