Recent Advances in Microsurgery

Mohan, Anita T.; Saint‐Cyr, Michel

doi:10.1016/j.cps.2020.07.002

Cited by 11 publications

(12 citation statements)

References 124 publications

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“…8 In recent years, the chimeric perforator flap has been considered the appropriate option for three-dimensional reconstructive surgeries for wounds with deep dead space. 9,10 For the recipient area, the chimeric perforator flap can realise the relative separation of the skin flap and the muscle flap so that the muscle flap can be accurately embedded in the deep dead space, and the flap can cover the skin defect, achieving precise repair and avoiding a bloated shape. For the donor site, the volume of the skin flap and muscle flap can be precisely designed to reduce damage to the donor site.…”

Section: Introductionmentioning

confidence: 99%

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

Sui

Khan

Qing

et al. 2023

International Wound Journal

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Trauma or lesion resection often causes complex wounds with deep soft tissue defects in extremities. Simply covering with a skin flap will leave a deep dead space resulting in infection, non‐healing wounds, and poor long‐term outcomes. Thus, effectively reconstructing complex wounds with dead space leaves a clinical challenge. This manuscript presents our experience using chimeric medial sural artery perforator (cMSAP) flap, to reconstruct complex soft tissue defects of the extremities, thereby exploring broader analysis and indications for future reference. Between March 2016 and May 11, 2022, patients (8 males and 3 females) with a mean age of 41 years (range from 26 to 55 years) underwent reconstructive surgery with the cMSAP flap. The cMSAP flap consists of an MSAP skin paddle and a medial sural muscle paddle. The size of the MSAP skin paddle ranged between 9 × 5 cm and 20 × 6 cm, and the size of the medial sural muscle paddle ranged between 2 × 2 cm and 14 × 4 cm. Primary closure of the donor site was achieved in all cases. Of the 11 patients, the cMSAP flap survived in 10 cases. The vascular compromise occurred in one special case and was treated with surgical procedures. The mean follow‐up duration was 16.5 months (range of 5–25 months). Most patients present satisfactory cosmetic and functional results. The free cMSAP flap is a good option for reconstructing complex soft tissue defects with deep dead space in extremities. The skin flap can cover the skin defect, and the muscle flap can fill the dead space against infection. In addition, three types of cMSAP flaps can be used in a broader range of complex wounds. This procedure can achieve an individualised and three‐dimensional reconstruction of the defects and minimise the donor site morbidities.

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Section: Introductionmentioning

confidence: 99%

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

Sui

Khan

Qing

et al. 2023

International Wound Journal

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“…[1][2][3][4] These new ideas have changed the thinking and approach for reconstructive surgery based on detailed anatomy and physiology, further accommodating the concept of the reconstructive elevator in yielding functional and aesthetic results with efficiency, leading to better quality of life. [1][2][3][4][5][6][7][8][9][10][11] However, the recovery of sensation other than the plantar foot, fingers, and hands has been overlooked or even neglected after reconstruction with flaps. Enhancing sensory recovery Background: The recovery of sensation for noninnervated perforator flaps is not well understood.…”

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confidence: 99%

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confidence: 99%

The fate of sensation in non-innervated perforator free flaps in the lower extremity

Kim

Cho

Abdelfattah

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Reconstructive microsurgery has evolved, introducing new concepts such as perforator flaps, propeller flaps, elevation of skin flaps on multiple planes, and supermicrosurgery. [1][2][3][4] These new ideas have changed the thinking and approach for reconstructive surgery based on detailed anatomy and physiology, further accommodating the concept of the reconstructive elevator in yielding functional and aesthetic results with efficiency, leading to better quality of life. [1][2][3][4][5][6][7][8][9][10][11] However, the recovery of sensation other than the plantar foot, fingers, and hands has been overlooked or even neglected after reconstruction with flaps. Enhancing sensory recovery Background: The recovery of sensation for noninnervated perforator flaps is not well understood. This prospective study aims to evaluate the quality, tendency, and related factors for recovery of sensation. Methods: A total of 187 patients over a 6-year period were evaluated at intervals of 3, 6, 12, and +24 months for demographic data and sensory tests [Semmes-Weinstein (SW) monofilament test, static two-point discrimination, temperature, and pain] on peripheral and central regions of the flap. Further detailed assessment using the SW monofilament test was made according to flap thickness, size, type, and recipient sites. Factors correlated to poor recovery were evaluated. Results: Among the flaps tested, the 5.07 SW monofilament test revealed that the peripheral flap sensory recovery was achieved in 72% at +24 months with a significantly increasing linear trend (P < 0.001). However, the central recovery was noted in only 26% to 28%. The two-point discrimination was achieved in 21% without a significant trend, whereas temperature and pain showed significant improvement, achieving 49% and 64% on the peripheral region and 22% and 31% for the central region, respectively. The flap thickness, size, type, and recipient sites did not exert significance. Only smoking was a significant factor, with 13 times higher odds of hindering sensory recovery. Conclusions: The SW monofilament test, temperature, and pain sensation on the periphery of the flap showed increasing trend of recovery over the +24 months. Among the various factors, only smoking attenuated recovery. Understanding the fate of sensory recovery in noninnervated perforator flaps will allow the surgeons to further customize the reconstruction based on the defect and maximize efficiency.

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“…Accordingly, as reconstructive surgeons, we started this study based on the hypothesis that there may be cases in which an absence or severe variant of the thoracodorsal artery, the main pedicle of LD flap, may affect the procedure. 12 We collected preoperative chest computed tomography (CT) angiography results of patients who were candidates for LD flap breast reconstruction following full mastectomy for breast cancer. We analyzed the collected data and have reported on patterns of the thoracodorsal artery and its branches by identifying the vascular anatomy of the axillary artery and its branches.…”

mentioning

confidence: 99%

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Lee

Cho

Kang

et al. 2023

J Reconstr Microsurg

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BACKGROUND The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest CT angiography. PATIENTS AND METHODS We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. RESULTS 700 blood vessels were classified according to the KNUPS TDA classification, 388 (185 Rt. and 203 Lt.), 126 (64 Rt. and 62 Lt.), 91 (49 Rt. and 42 Lt.), 57 (27 Rt. and 30 Lt.), and 38 (25 Rt. and 13 Lt.) vessels were classified as Type I, II, III, IV, and V, respectively. Among 350 patients, 205 patients showed matching types for Lt. and Rt. vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with Type I, II, III, IV, and V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with Types I+II, I+III, I+IV, I+V, II+III, II+IV, II+V, III+IV, III+V, and IV+V, respectively. CONCLUSIONS While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes.

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Recent Advances in Microsurgery

Cited by 11 publications

References 124 publications

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

The fate of sensation in non-innervated perforator free flaps in the lower extremity

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

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