Pre-expanded Brachial Artery Perforator Flap

Liu, Yuanbo; Zang, Mengqing; Tang, Maolin; Zhu, Shan; Zhang, Jianhua; Zhou, Yu

doi:10.1016/j.cps.2016.08.006

Cited by 12 publications

(25 citation statements)

References 18 publications

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“…15,[22][23][24][25][26] The majority of the existing literature on BAP flap has revolved around the use of handheld Doppler ultrasound to identify the perforators of the medial arm. 2,[8][9][10]27 However, our clinical experience echoes recent reports in the literature that challenge the utility of Doppler in this area as differentiating signals of the brachial artery from that of its perfo-rators can be difficult. 1,14,28,29 Color duplex ultrasonography allows for direct visualization of the vascular anatomy, but it can be time-intensive, particularly for intraoperative use, and requires a relatively steep learning curve.…”

Section: Discussionsupporting

confidence: 60%

“…Previous anatomical studies showed that septocutaneous perforators of the brachial artery provide the predominant blood supply to the medial arm skin. 7,8 The vessels typically give rise to several perforators distributed between the proximal, middle, and distal portions of the upper arm. Both cadaveric and clinical studies have aimed to clarify the distribution of these perforators, particularly in the proximal and distal regions that can support a pedicled flap.…”

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confidence: 99%

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Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

et al. 2020

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The tissues of the medial arm as a donor site for perforator flap design have several advantages. However, they are relatively underused with limited reports, partly due to unreliable perforator anatomy. Therefore, we aimed to review our preliminary experience using indocyanine green (ICG) angiography to design and elevate preexpanded pedicled brachial artery perforator (BAP) flaps for regional reconstruction. All patients underwent soft tissue reconstructions using a preexpanded BAP flap in two or three stages. ICG angiography was used to localize perforators during both expander insertion and flap elevation. The pedicle was divided at the third stage 3 weeks following flap elevation for head and neck cases. Sixteen patients underwent reconstructions of the head and neck (n = 13) or shoulder/trunk (n = 3) using 14 perforator-plus and 2 propeller BAP flaps. In total, 50 perforators were identified using ICG imaging, all of which were appreciable during both expander placement and flap elevation. Thirty-five perforators were directly visualized during flap elevation, and an additional 15 perforators were not explored but incorporated into the flap. All flaps survived without necrosis, and the donor sites healed uneventfully without complications. The medial arm provides thin and pliable skin for the resurfacing of regional defects with relatively minimal donor-site morbidity. With the assistance of ICG angiography, perforators of the brachial artery can be reliably identified, facilitating the preexpansion and elevation of pedicled BAP flaps for use in head–neck and trunk reconstruction.

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Section: Discussionsupporting

confidence: 60%

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confidence: 99%

Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

et al. 2020

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“…But the skeletonized vascular pedicle could lengthen the pedicle to avoid kinking or twisting of the pedicle. 18 Finally, the facial and neck scar could be dissection to form a “scar flap.” This “scar flap” could be used to cover the ventral wound of pre-expanded flap pedicle (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience

Chen

et al. 2022

Journal of Craniofacial Surgery

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Purpose: To present our experience with pre-expanded medial upper arm flap in facial and neck reconstruction. Patients and Methods: This was a retrospective study operated between January 1st, 2001 and January 1st, 2021, at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Staged face and/or neck reconstruction was performed. Results: Forty-one patients were treated in our institution and thirty-eight patients (forty-three flaps) were included in this cohort as. They ranged from 6 to 44 years old. There was no total flap loss in the cohort. Partial flap necrosis was observed in the earlier patients (4 cases). Conclusion: Pre-expanded medial upper arm flap is well matched to the facial and neck skin in color, texture, and thickness. Considering the excellent aesthetic outcomes, this flap is a good alternative for selected patients with soft tissue defects of the head and neck.

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“…25 Therefore, ICG angiography could be used to evaluate a flap's venous drainage; however, it was reported that venous congestion in the distal flap was rarely observed in the brachial artery perforator flap. 26 With the aid of ICG angiography, vascular injury during the flap splitting process could be minimized, and blood supply to the split flap could be guaranteed.…”

Section: Discussionmentioning

confidence: 99%

Periorbital and Perioral Defect Reconstruction Using the Split Pre-Expanded Medial Arm Flap Aided by Using Indocyanine Green Angiography

Zhu

Zang

et al. 2021

Journal of Craniofacial Surgery

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The pre-expanded medial arm flap provides suitable skin for the resurfacing of a periorbital or perioral defect. However, the flap must be intraoperatively split to imitate the appearance of the oral or ophthalmic fissure, which can compromise flap perfusion. This study aimed to evaluate the safety and effectiveness of splitting pre-expanded medial arm flaps with the aid of indocyanine green angiography. All 8 patients underwent periorbital or perioral soft tissue reconstruction using a split pre-expanded medial arm flap. Flap splitting was aided by indocyanine green angiography. It was used during 2 stages of the procedure, tissue expander placement and flap transfer. The pedicle was divided 3 weeks later, and the flaps were used to resurface the defect. The distal portion of the flap was split into a fishmouth pattern in 5 patients and a window pattern in 3 patients. The donor sites were closed directly or by using a latissimus dorsi myocutaneous flap. There were no perioperative complications or flap necrosis. A pre-expanded split medial arm flap could be an option for the reconstruction of periorbital and perioral defects. With the assistance of indocyanine green angiography, vessel distribution and distal flap perfusion can be reliably evaluated, facilitating the safe splitting of the flap for the reconstruction of defects.

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Pre-expanded Brachial Artery Perforator Flap

Cited by 12 publications

References 18 publications

Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience

Periorbital and Perioral Defect Reconstruction Using the Split Pre-Expanded Medial Arm Flap Aided by Using Indocyanine Green Angiography

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