Reliable Harvesting of a Large Thoracodorsal Artery Perforator Flap with Emphasis on Perforator Number and Spacing

Self Cite

Section: Discussionsupporting

confidence: 78%

Is Holm Zone III safe from fat necrosis in medial row perforator‐based deep inferior epigastric perforator flaps?

Lee

Nam

et al. 2014

Self Cite

“…Several modified approaches have been described in the literature for large soft tissue defect reconstruction considering primary closure of the donor site. Hwang et al () introduced a chimeric perforator flap to expand the surface of the flap to reconstruct very large wounds, but an additional skin grafting procedure was unavoidable, which resulted in a bulky appearance and unsatisfactory color match. Bigdeli et al () reported that a conjoined parascapular and latissimus dorsi free flap is a large and reliable flap for simultaneous one‐stage reconstruction of complex and unusually large soft‐tissue defects in the knee region.…”

Section: Discussionmentioning

confidence: 99%

Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

Qing

et al. 2019

Background One‐stage reconstruction of complex soft tissue defects of the extremities is a challenging problem. Repair of complex soft tissue defects requires adequate skin tissues to cover the large surface wound and special tissues for obliterating the dead space. The chimeric flap is one of the most popular approaches for reconstruction of complex soft tissue defects. However, the problems of donor‐site morbidity and inability to repair very large defects at one‐stage remain. The purpose of this study was to present our clinical experience using sequential chimeric perforator flaps for reconstruction of complex extremity defects with primary closure of the donor site. Methods From August 2013 to March 2017, 12 patients with complex soft tissue defects underwent extremity reconstruction using sequential chimeric perforator flaps, which were composed of a chimeric anterolateral thigh perforator (ALTP) flap and an additional free perforator flap. The skin paddles were placed side‐by‐side to cover the large surface soft tissue defects, and the muscle component was used to obliterate the dead space. Of these patients, one was injured by a crushing accident, while the other 11 patients were injured in traffic accidents. Results The size of the skin paddles ranged from 26 cm × 8 cm–10 cm × 6 cm to 30 cm × 8.5 cm–29 cm × 9 cm. The muscle paddle size ranged from 2 cm × 3 cm × 4 cm to 22 cm × 4 cm × 2 cm. All‐components of the sequential chimeric flaps survived in all‐patients. Vascular compromise was observed in one case. One case suffered minor wound‐edge necrosis and was treated conservatively. Primary closure of donor‐site was successfully achieved in all‐patients, and all‐donor‐site wounds healed uneventfully. The mean follow‐up time was 15.25 months. Most of the cases showed a satisfactory contour, and only two patients presented with mildly bulky appearance that treated with a debulking procedure. Conclusions The sequential chimeric perforator flap is an alternative procedure for reconstruct complex soft tissue defects of the extremities. This approach allows for flexible design, a larger cutaneous area, and low donor site morbidity.

“…As mentioned previously, recent studies have proposed ALT flaps to be superior to subscapular system flaps (Dayan et al, ; Demirkan et al, ; Demirkan et al, ; Di Candia et al, ; Friji et al, ). Kim et al (Hwang et al, ) aimed to establish potential rationales behind the apparent preference for the ALT over the LD flap (a component of the subscapular system, as listed above). Their study concluded that the limitations of the LD flap were mostly misconceptions; it is not essential to change the position of the patient, a two‐team approach can be used, and the absence of adequate perforators rate was similar to the ALT flap (6.04% in LD vs. 5.4% in ALT) giving no clear objective advantage of the ALT over the LD flap.…”

Section: Discussionmentioning

confidence: 99%

Use of the subscapular system by maintaining unilateral decubitus placement without repositioning in microvascular free tissue transplantation

Forte

Oliver

McRae³

et al. 2019

Background In microvascular free‐tissue harvest and transfer, the need for repositioning from lateral decubitus position and the inability to use a two‐team approach are major drawbacks of the subscapular system. We present our experience with the subscapular system for upper and lower extremity reconstruction using a two‐team approach without need for repositioning. Methods We conducted a retrospective chart review for all patients undergoing free flap transplant based on the subscapular system to the upper or lower extremity at our microsurgical facility from January 1, 2007 to December 31, 2011. Only cases not requiring intraoperative repositioning were included. Sixty‐four patients underwent the two‐team approach (37 upper extremity and 27 lower extremity transplants). Flap types included latissimus dorsi musculocutaneous, partial superior latissimus, dorsal thoracic fascia, serratus, scapular bone, and thoracodorsal artery perforator, either alone or as chimeric flaps. All patients were placed in the lateral decubitus position for the duration of the surgery. Results The ipsilateral subscapular system was used in 16% of cases for lower extremity defects, where the anterior tibial vessels served as recipient vessels. The contralateral subscapular system was used in all remaining cases for upper extremity or the vast majority for lower extremity (84%) defects, where either the superficial femoral, genicular, popliteal, sural, or posterior tibial vessels served as recipient vessels. With the exception of one partial flap loss secondary to infection, all flaps survived. Conclusions Proper lateral decubitus positioning allows for a two‐team approach without compromising safety or outcomes.