Repair of hand scars by a dilated deep inferior epigastric artery perforator flap

Abstract

We have investigated the mapping of several deep inferior epigastric artery perforator (DIEAP) vessels in each patient, the effect of tissue expansion on the variation in the diameter of the DIEAP vessel, and the clinical effect of repair of hand scars by applying a dilated DIEAP flap. From 2000 to 2009, we did some research on this flap using a Doppler probe and computed tomographic (CT) angiography, and found that the inferior epigastric arteries are distributed between 4 cm above the umbilicus and 8 cm below the umbilicus. Most of the vessels are distributed in zones I, II, and III according to the Rand zonal approach. The arteries were rarely found in zone IV, and there was a relatively dense distribution of perforators in the nearby umbilical plane. Most of the biggest perforators were located in the peripheral umbilicus, and the mean (SD) diameter of perforator vessels was increased by 33% (8)% after expansion. The dilated DIEAP flap was used to treat 18 cases of hand scars. After the operation, 16 flaps survived; the two that did not, had slight blood flow defects in the distal portion of the flap, and the overall effects of the treatment were good. After the DIEAP flaps had been expanded for a long time, blood supply and the area of the flap are increased. The flap generated by this method is thin, has good resistance, and a nice appearance, and is therefor a better method for treating wounds of the hand and arm, and claw hand.

Suprafascial pre‐expansion of perforator flaps and the effect of pre‐expansion on perforator artery diameter

“…Moreover, locating the expander under the fascia lata necessitates additional scoring of the fascia and also partial fasciectomy for obtaining enough extensibility of the tissue and harvesting this tissue leads to fascial defects . Previously, only few suprafascially pre‐expanded flap procedures have been demonstrated and most of them are “local perforator based flap” techniques which does not include intramuscular perforator vessel dissection . Considering those, 10 of our flaps were harvested as and represent true perforator flaps that have been transferred either locally or freely.…”

“…The diameter increments might be resulted from the vasodilator release secondary to the ischemic and hypoxic effects of the expansion phenomenon . Additionally, tissue hypoxia and the physical forces may induce a stimulus for angiogenesis which is coordinated by vascular growth factors and self regulatory mechanisms of blood vessels . Shang et al have presented their case series of pre‐expanded pedicled deep inferior epigastric artery perforator based flaps for hand scars and mentioned briefly about their finding that expansion increases the diameter of perforators about 33% .…”

“…For instance, CDU is noninvasive, cause no radiation exposure and is low cost . It is a fact that CDU is a physician dependent device but smaller perforators could also be missed by CT angiography depending on the machine's pixel resolution . In pre‐operative perforator mapping, HHD can only be considered as an adjunct, especially if the case is a pre‐expanded perforator flap procedure …”

“…The advantages and disadvantages of few types of pre‐expanded perforator flap techniques have been covered in previous studies but comprehensive series seem to be still a requisite for a better insight into the issue. Furthermore, to the best of our knowledge, except a study that has made mention of an increase in the diameter of the perforator vessels in the pedicle region, there have been no clinical reports demonstrating the effects of pretransfer expansion of the donor site on the perforator artery's diameter. Therefore, this article specifically addresses the suprafascial pre‐expansion of various perforator flap donor sites and goes through the technical aspects of the procedures.…”

Unusual Branches of Femoral Artery in the Femoral Triangle: A Case Report

“…The inferior epigastric artery perforator flaps are exceedingly used in head and neck (Masià et al, 2011), breast reconstruction (Karunanithy et al, 2011) and scar surgeries (Shang et al, 2011). The inferior epigastric artery is known to have variations in its origin.…”