Reconstruction of Cicatricial Microstomia and Lower Facial Deformity by Windowed, Bipedicled Deep Inferior Epigastric Perforator Flap

Jin, Xiaolei; Teng, Li; Zhao, Min; Xu, Jiajie; Ji, Ying; Lu, Jianjian; Zhang, Bo

doi:10.1097/sap.0b013e3181955c9f

Cited by 17 publications

(10 citation statements)

References 28 publications

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“…However, harvesting a bi-pedicled flap has some disadvantages, including a longer operative time, a higher incidence of technical difficulties, and a steep learning curve. 8 Moreover, a bipedicled forehead flap may introduce a hair-bearing scalp into nonhair-bearing areas, in which case laser therapy is needed to remove the unwanted hair. 21 An expanded thoracoacromial artery perforator flap has also been used for perioral defect reconstruction and is an option when a good adjacent donor site is unavailable.…”

Section: Discussionmentioning

confidence: 99%

“…However, each method has its own limitations and drawbacks. For example, unattractive skin grafts usually do not meet patients’ high aesthetic requirements; 1 local flaps require an adequate amount of uninvolved skin in adjacent regions; 2–5 free flaps are frequently too bulky, and microvascular anastomosis is technically challenging 6–8 . Ideally, facial defects are repaired with like-with-like tissue similar to the facial skin in color, texture, thickness, and hair-bearing characteristics.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“… 6 – 11 Although expanded flaps have been used widely for facial reconstruction and are satisfactorily thin, their size has been reported to be insufficient to cover the whole face. 12 – 17 An alternative is the bipedicled deep inferior epigastric perforator flap, which Jin et al 18 introduced in 2009 for cicatricial microstomia reconstruction. However, this flap can be bulky, especially when it is harvested from obese patients.…”

Section: Discussionmentioning

confidence: 99%

Bipedicled “Superthin” Free Perforator Flaps for Facial Burn Scar Reconstruction

Vinh

Anh

Tien

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:“Superthin flap” is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients.Methods:This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 × 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively.Results:Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction.Conclusion:Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope of previously used “superthin flaps.”

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“…Due to the advantages mentioned above, the DIEP flap is also used for reconstruction of the head and neck, lower extremity, and urogenital areas (4)(5)(6)(7). However, the conventional transverse design of the DIEP flap has poor perfusion in zone IV, which limits the flap size (8,9). Though the transverse DIEP flap size can be extended using a pre-expansion procedure or anastomosis with another vessel, these procedures are timeconsuming and surgically complex (10,11).…”

Section: Introductionmentioning

confidence: 99%

Strategies for selecting perforator vessels for transverse and oblique DIEP flap in male pediatric patients: Anatomical study and clinical applications

Cui

Qing

et al. 2022

Front. Pediatr.

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BackgroundTransverse and oblique deep inferior epigastric artery perforator (DIEP) flaps are widely used in breast, lower extremity, urogenital, head and neck reconstruction. In this report, we present our experience with selecting perforator vessels for transverse and oblique DIEP flaps based on an anatomical study and clinical cases.Materials and methodsA detailed anatomical study of the DIEP flap was carried out using a standardized injection of lead oxide in 10 fresh cadavers. Additionally, 35 male pediatric patients (age 5–12 years) underwent lower extremity reconstruction with a DIEP flap. A transverse DIEP flap was used when the defect template did not exceed zone IV, while an oblique DIEP flap was used when the defect template exceeded zone IV.ResultsPerforators located below the umbilicus in zones I and II were rich in transverse anastomoses across the midline of the abdominal wall, which is the basis for the transverse DIEP flap. Perforators lateral to the umbilicus in zone I had true anastomoses with the musculophrenic artery, the morphological basis for the oblique DIEP flap. The DIEP flap design was transverse in 20 patients and oblique in 15. Flap sizes ranged from 8 × 4.5 cm2 to 24 × 9 cm2. One oblique DIEP flap was necrosed totally, and it was repaired by a latissimus dorsi musculocutaneous flap.ConclusionThe transverse DIEP flap design based on the perforator located below the umbilicus in zone I is recommended for small skin and soft tissue defects. We recommend the use of the oblique DIEP flap design based on the perforator lateral to the umbilicus in zone I as an extended flap to reconstruct large tissue defects.

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Reconstruction of Cicatricial Microstomia and Lower Facial Deformity by Windowed, Bipedicled Deep Inferior Epigastric Perforator Flap

Cited by 17 publications

References 28 publications

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

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

Bipedicled “Superthin” Free Perforator Flaps for Facial Burn Scar Reconstruction

Strategies for selecting perforator vessels for transverse and oblique DIEP flap in male pediatric patients: Anatomical study and clinical applications

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