Reconstruction of high voltage electric burn wound with exposed shoulder joint by thoracoacromial artery perforator propeller flap

Rout, Debesh Kumar; Nayak, Bibhuti Bhusan; Choudhury, A. K.; Pati, Ajit Kumar

doi:10.4103/0970-0358.138971

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…The perforating vessels, especially the perforating veins, are easily compressed by the surrounding deep fascia fiber bundles due to their thin wall and low pressure [35]. Therefore, the vascular pedicle usually needs to be naked, and different rotation directions (clockwise or counterclockwise) should be assessed intraoperatively; the rotation direction that causes the smallest twist of the pedicle should be selected [36]. The complication rate of propeller flap reconstruction is higher in the extremities than in the trunk.…”

Section: Discussionmentioning

confidence: 99%

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

Wang

Lin

et al. 2021

BMC Musculoskelet Disord

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Background Soft tissue defects in the distal third of the leg and malleolus are difficult to cover and often require free tissue transfer, even for small-sized defects. Propeller flaps were designed as an alternative to free tissue transfer, but are reportedly associated with high complication rates. The aim of our study was to assess our institutional experience with the propeller flap technique and to predict its outcome in lower-limb reconstruction. Methods All patients who had undergone propeller flap reconstruction of a distal leg defect between 2013 and 2018 were included. Demographic, clinical, and follow-up data were analyzed. Results Complications occurred in 17 of 82 propeller flaps (20.7%), comprising 11 cases of partial necrosis and six of total necrosis. There were no significant differences in age, sex, body mass index smoking, diabetes mellitus, and soft tissue defect sites between the groups of patients with versus without flap necrosis (p > 0.05). In univariate analysis, there were also no significant differences between these two groups in the length and width of the fascial pedicle, and the ratio of the flap length to the flap width (p > 0.05). Interestingly, there were significant differences between the two groups in the distance between the flap perforator, the shortest distance from the perforator to the defect location, and the rotation angle of the flap (p < 0.05). In multivariable logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (95% CIs), the shortest distance from the perforator to the defect location was a significant risk factor for flap complications (p = 0.000; OR = 0.806). Receiver operating characteristic curve analysis showed that when the shortest distance from the flap to the wound was less than 3.5 cm, the necrosis rate of the flap was markedly increased (AUC = 76.1); this suggests that the effective safe flap–wound distance was 3.5 cm. Conclusions Propeller flaps are a reliable option for reconstruction in carefully selected patients with traumatic defects of the lower limb and malleolus. We found that the effective safe distance was 3.5 cm from the flap to the wound.

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Section: Discussionmentioning

confidence: 99%

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

Wang

Lin

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…Therefore, the vascular pedicle usually needs to be naked, and different rotation directions (clockwise or counterclockwise) should be assessed intraoperatively; the rotation direction that causes the smallest twist of the pedicle should be selected [35]. The complication rate of propeller ap reconstruction is higher in the extremities than in the trunk.…”

Section: Discussionmentioning

confidence: 99%

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

Wang

Lin

et al. 2021

Preprint

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Introduction: Soft tissue defects in the distal third of the leg and malleolus are difficult to cover and often require free tissue transfer, even for small-sized defects. Propeller flaps were designed as an alternative to free tissue transfer, but are reportedly associated with high complication rates. The aim of our study was to assess our institutional experience with the propeller flap technique and to predict its role in lower-limb reconstruction. Methods: All patients who had undergone propeller flap reconstruction of a distal leg defect between 2013 and 2018 were included. Demographic, clinical, and follow-up data were analyzed. Results: Complications occurred in 17 of 82 propeller flaps (20.7%), comprising 11 cases of partial necrosis and six of total necrosis. There were no significant differences in age, sex, body mass index smoking, diabetes mellitus, and soft tissue defect sites between the groups of patients with versus without flap necrosis (p > 0.05). In the multivariable logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (95% CIs), there were also no significant differences between these two groups in the length and width of the fascial pedicle, and the ratio of the flap length to the flap width (p > 0.05). Interestingly, there were significant differences between the two groups in the distance between the flap perforator and the wound center (p < 0.05) and the rotation angle of the flap (p < 0.05). Receiver operating characteristic curve analysis showed that when the nearest distance from the flap to the wound was less than 3.5 cm, the necrosis rate of the flap was markedly increased (AUC = 76.1); this suggests that the effective safe flap–wound distance was 3.5 cm. Conclusions: Propeller flaps are a reliable option for reconstruction in carefully selected patients with traumatic defects of the lower limb and malleolus. What we found is that What we found is that the ‘effective safe distance’ was 3.5 cm which the distance from the flap to the wound.

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“…And the donor site can be sutured directly in almost all cases. [11][12][13] The perforator flap based on the branches of the thoracoacromial artery therefore has the advantage of this direct suturing of the donor site during the lifting of small and medium-sized flaps. In the same way as in the supraclavicular perforator flaps and the internal thoracic perforator flaps, the perforator flap of the thoracoacromial artery allows a better correspondence with head and neck structures in terms of coloring and skin texture.…”

Section: Discussionmentioning

confidence: 99%

Anatomical study of the clavicular branch of the thoracoacromial artery

Nyemb¹,

Fontaine²,

Duquennoy-Martinot³

et al. 2020

MOJAP

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Introduction: The etiology and the complexity of losses of substances from the chest wall cause technical difficulties during their reconstruction. In order to obtain the best possible functional and morphological results, it is important to appreciate the lesions. When considering soft tissue reconstruction, the dimensions, location and shape of losses of substances, as well as the reliability and the arc of rotation of the chosen flap, must be taken into account. The perforator flap of the thoracoacromial artery and its vascular anatomical bases have been recently studied, concerning the pectoral and deltoid branches. The clavicular branch has only been rarely studied. We propose to study anatomically the clavicular branch of the thoracoacromial artery, in terms of constancy, dimensions and direction, in order to give to practitioners an additional option in the surgery of perforator flaps of the cervical region. Material and methods: We carried out a direct and selective injection of 24 thoracoacromial arteries, on corpses preserved in a low-formalin solution rich in glycerin. The injected solution was made from a mixture of methylene blue and gelatin. Cadaveric dissection was then used to study the location, frequency, and path of the clavicular branch of the thoracoacromial artery. Results: The clavicular branch was absent in more than half of the dissections. The length of its extrafascial pedicle varied between 0.5 and 2.5cm. The length of the pedicle after transmuscular dissection varied between 3 and 6cm. The general direction of this clavicular branch was ascending and medial. Conclusion: Our work shows that when it is present the clavicular branch of the thoracoacromial artery has an extrafascial pedicle which measures 0.5 to 2.5cm, and a transmuscular pedicle from 3 to 6cm. And that its vascular skin territory projects slightly below the clavicle.

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Reconstruction of high voltage electric burn wound with exposed shoulder joint by thoracoacromial artery perforator propeller flap

Cited by 7 publications

References 4 publications

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

Anatomical study of the clavicular branch of the thoracoacromial artery

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