Retrospective study of freestyle perforator-based peninsular flaps

Yoon, Chi Sun; Kim, Chang G.; Kim, Hoon; Kim, Kyu N.

doi:10.1097/md.0000000000010168

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…This also possibly allowed preservation of surrounding minor perforators, which would otherwise be transected during perforator skeletonization. Our planned design and technique are unique in reconstruction of large defects with SGAP flaps, where the harvest of a “perforator flap” does not require “dissection of the perforator.” Especially, the later modifications described in our series with an intact skin bridge can also be considered as perforator-based peninsular type flap 45,46 …”

Section: Discussionmentioning

confidence: 94%

“…Especially, the later modifications described in our series with an intact skin bridge can also be considered as perforator-based peninsular type flap. 45,46 In all our cases, by design, keeping the singular dominant perforator at the most proximal aspect of the flap allowed for the maximum freedom of transposition. Even in large and long flaps, we did not observe any flap necrosis, which indicates that, keeping the perforator at the proximal aspect is reliable in perfusing a large flap.…”

Section: No Perforator Dissection or Skeletonizationmentioning

confidence: 92%

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A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects

et al. 2022

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Background: Large midline sacral defects are reconstructive challenges. Superior gluteal artery perforator (SGAP) flap provides enough tissue and versatility to cover large defects; however, a single flap may be insufficient. We present a technique to cover large defects using single SGAP flaps. Methods: Large sacral defects (>100 cm 2 ) reconstructed with single SGAP flaps were included. Angle of transposition (45°-60°) was determined based on the tissue laxity and mobility of gluteal area. Perforator identification, intramuscular dissection, or skeletonization was not performed. Outcomes were measured as achieving durable reconstruction, flap viability, and complications. Results: There were 17 patients (12 male, 5 females; aged 25-72 years) with different etiologies. The mean flap surface area (136.1 ± 45.6 cm 2 , between 9 Â 8 and 26 Â 10 cm) was smaller than the mean defect surface area (211.1 ± 87.2 cm 2 , between 10 Â 10 and 28 Â 14 cm) (P < 0.001). All flaps survived with no partial or complete flap loss. Minor dehiscence in 4 patients (2 at donor site and 2 at recipient site) healed with dressing changes or using negative-pressure vacuum therapy. All patients had durable outcomes without any recurrence. Conclusion: Single unilateral SGAP flaps can be used to completely cover midline large sacral defects. It is important to design the flaps to have a joint side with the defect in the proximal part and use the intrinsic mobility of gluteal soft tissues for the closure. Flaps can be (1) planned to be smaller than the defects, (2) harvested with no intramuscular perforator dissection or pedicle skeletonization, and (3) transposed with an angle less than 60°.

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Section: Discussionmentioning

confidence: 94%

Section: No Perforator Dissection or Skeletonizationmentioning

confidence: 92%

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects

et al. 2022

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“…They can provide a safe and reliable reconstruction of very extensive defects with excellent tissue match, following the principle of replacing like-with-like, a low donor side morbidity and, differently from propeller flaps, they do not imply pedicle twisting (Yoon et al, 2018). Perforator flaps can be dissected on a known perforating vessels or can be harvested as "freestyle," as first introduced by Wei and Mardini (2004).…”

Section: Discussionmentioning

confidence: 99%

“…Thanks to the identification and retrograde dissection of the selected perforator and the skeletonization of the pedicle throughout its whole length, these flaps overcome the drawbacks of classical subcutaneous pedicled flaps, allowing to gain further mobility, a greater advancement and/or a larger arch of rotation, with less tension on wound edges. They can provide a safe and reliable reconstruction of very extensive defects with excellent tissue match, following the principle of replacing like‐with‐like, a low donor side morbidity and, differently from propeller flaps, they do not imply pedicle twisting (Yoon et al, 2018). Moreover, the underlying muscle tissue is spared for an eventual secondary salvage reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Soft tissue reconstruction of the trunk with pedicled perforator and musculocutaneous flaps: A single‐center comparative retrospective study

Cammarata,

Toia,

Maltese

et al. 2023

Microsurgery

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BackgroundSoft tissue trunk reconstruction is often challenging. Although free microvascular flaps are a feasible option in case of extensive defects involving deep structures, pedicled flaps represent a good alternative, especially if harvested and dissected with a “microsurgical” approach. The aim of this study is to evaluate the feasibility of trunk reconstruction with the use of pedicled flaps, according to the application of our reconstructive algorithm, and to compare it to other reconstructive methods.Patients and MethodsFrom January 2017 to December 2021, we retrospectively analyzed patients who underwent soft tissue reconstruction of the trunk with pedicled flaps at the authors' institution. Patient's demographic, clinical and surgical characteristics and postoperative complications were recorded and analyzed by descriptive statistics. A comparative analysis was made between the study group and two other groups who underwent reconstruction of trunk defects with free flaps and skin grafts, respectively, at the authors' institution.ResultsForty‐seven patients were included in the study. Patients' age ranged between 36 and 82 years (mean: 57.8 years). Twenty‐eight patients were male, while 19 patients were female. In 76.6% of patients (36 out of 47), reconstructive procedures were performed to repair defects resulting from cancer resection. Reconstruction of superficial defects was always achieved with perforator flaps (n = 25). In case of full‐thickness defects, reconstruction was carried out with musculocutaneous flaps (n = 22); latissimus dorsi and vastus lateralis were the most used flaps for chest and abdominal wall reconstruction, respectively. In our series, we observed only one case of total flap loss requiring re‐operation under general anesthesia. Minor complications occurred in 8.5% of cases (4 out of 47 patients). We observed two cases of partial flap necrosis and two cases of wound dehiscence. In the skin grafts group (n = 53), the mean age was 54.5 years (range 39–85) and 56% of patients were male (n = 30). In 66% of cases (n = 30) the defect resulted from oncological resection. The overall complication rate was 18.8% (n = 10). In the free flaps group (n = 10), the mean age was 49.0 years (range 29–77) and 60% of patients (n = 6) were male. In 70% of cases (n = 7) the defect was caused by oncological resection. Complications occurred in two patients (20%).No statistically significant differences were found in terms of overall complication rate between the study group and the two comparative groups (p = .48). A significant correlation was found between the reconstructive method and the type and size of the defect, with reconstruction through free flaps being associated with larger (344.0 vs. 220.4 cm2) (p = .04) and full‐thickness defects (80.0% vs. 46.8%) (p < .01) if compared to pedicled flaps.ConclusionsIn the new era of microsurgery, pedicled flaps represent a valid alternative to free flaps for the majority of soft tissue defects of the trunk. In our series, no statistically significant differences in terms of complications were found between reconstructions of similar defects achieved with pedicled and free flaps, and free flap use was limited to extensive full‐thickness defects. In addition, the rate of postoperative complications with pedicled flaps found in our cohort was lower than the rate reported in the literature.

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“…Variations in perforators have been described to include freestyle flaps, perforator-based peninsular flaps, and wound edge perforator flaps. 53 One perforator flap that deserves special mention is the internal pudendal artery perforator flap. 10).…”

Section: Freestyle Perforator Flapsmentioning

confidence: 99%

Best Solutions for Perineal and Pressure Sore Reconstruction

Bialowas

Nguyen

Patel

2021

Plastic &Amp; Reconstructive Surgery

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erineal defects and pressure sores are frequently encountered in practice, and their management may be challenging. Colorectal cancer is the third most common cancer in the United States, with an estimated 43,300 new cases diagnosed in 2020. 1,2 An estimated 2.5 million patients yearly are treated for pressure ulcers. 3 Management of these conditions can be associated with complication rates as high as 66 percent in some series, which further compounds the costs and implications of managing these wounds. [4][5][6][7][8][9][10] Even with optimized care, they still represent a tremendous burden to health care systems, costing upward of $9.1 billion dollars per year. 3 The goal of this article is to provide an update on the newly available evidence in the management of perineal defects and pressure sores by addressing knowledge gaps and areas of controversy that exist in the reconstruction of these defects. PERINEAL RECONSTRUCTIONMany factors are known to affect the outcomes of perineal defect reconstruction. [10][11][12][13] These factors need to be considered and optimized to achieve successful reconstruction of perineal defects (Table 1). Although the restoration of sexual function is an important part of the reconstructive process, its discussion is beyond the scope of this review.Perineal reconstruction can be complicated in patients who require neoadjuvant radiation therapy before resection. Studies have shown a significant difference in local recurrence rates with increased circumferential resection margins. Patients with 10-mm margins have a 5-year survival rate of 80 percent in comparison to a 34 percent 5-year survival rate in patients with less than 1-mm

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Retrospective study of freestyle perforator-based peninsular flaps

Cited by 7 publications

References 23 publications

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects

Soft tissue reconstruction of the trunk with pedicled perforator and musculocutaneous flaps: A single‐center comparative retrospective study

Best Solutions for Perineal and Pressure Sore Reconstruction

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