The Pacman Perforator-Based V-Y Advancement Flap for Reconstruction of Pressure Sores at Different Locations

Bonomi, Stefano; Salval, André; Brenta, Federica; Rapisarda, Vincenzo; Settembrini, Fernanda

doi:10.1097/sap.0000000000000613

Cited by 14 publications

(6 citation statements)

References 32 publications

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“…The author, in this study, elicits the benefits of SBPBPF over the multiple perforator-based Pacman flaps introduced by Stefano Bonomi. 8 This is the only closely relatable study to the author's current study. This is the first clinical study on the single best perforator-based Pacman flap, and the author showed in this study that the success rate is better than Bonomi et al The age and gender distribution in the Bonomi et al study were comparable to the current author's study.…”

Section: Discussionmentioning

confidence: 84%

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Retrospective Cohort Observational Study on the Single Best Perforator-Based Pacman Flap in the Reconstruction of Stage IV Sacral Region Pressure Ulcers

Balakrishnan

Mariappan

Janardhanam

2020

Indian J Plast Surg

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Introduction Single best perforator-based Pacman flap (SBPBPF) fortifies the advancement and transposition flap biogeometry principles with robust blood supply of perforator flaps to provide cover for the sacral pressure sore of any dimension. This article describes the biogeometry and technique of raising the SBPBPF. Aim To assess the outcomes of reconstruction of stage IV sacral pressure sore using the SBPBPF. Materials and Methods A preliminary cadaver study was done in 24 gluteal specimens in fresh cadavers to determine the anatomical details of perforators of the perisacral region. From 2015 to 2017, 42 myelopathic patients (40 males and 2 females; quadriparetic n = 2 and paraplegic/paraparetic n = 40) underwent SBPBPF reconstruction of stage IV sacral pressure sore. Their documents were analyzed in this retrospective study. All were followed-up for an average period of 12.5 months. Results Cadaver study revealed significant perforators arising from seven different source vessels in the perisacral region. In the clinical study, average size of the paddle harvested was 168 cm2 on a single best perforator. On an average, the size of the single best perforator harvested with the flap was 1.5 mm. None had early failures of flaps. Thirty-nine patients had well-settled flaps at the end of follow-up period except three (7%) who developed late recurrence due to loss of compliance with offloading instructions. Two experienced mild collections (flap complication rate was 4.76%) in the immediate postoperative period that healed uneventfully. The overall complication rate was 11.9%. Conclusion SBPBPF is an excellent addendum to reconstructive tool for stage IV sacral pressure sores.

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Section: Discussionmentioning

confidence: 84%

“…Bonomi 8 et al introduced the perforator-based Pacman flap (named so after the shape of the flap) (►Fig. 1) for reconstruction of pressure sores.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Cohort Observational Study on the Single Best Perforator-Based Pacman Flap in the Reconstruction of Stage IV Sacral Region Pressure Ulcers

Balakrishnan

Mariappan

Janardhanam

2020

Indian J Plast Surg

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“…Detection of the perforator provides us to dissect the flap base more extensively allowing increased flap mobility (19,20). Furthermore, Bonomi et al (21),suggested that perforator bsed V-Y advancement flap can be designed with Pacman modification to enhance soft tissue coverage for the defect. We preferred perforator based flap in a V-Y advancement design essipecially for cachectic patients and when the donor site laxity did not allow primary closure.…”

Section: Discussionmentioning

confidence: 99%

Algorithms for perforator-based flaps in different anatomical locations

Can

Ekinci

2022

Journal of Health Sciences and Medicine

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Introduction: Perforator-based flaps can be planned in any anatomic location in the body when there is a detectable perforator. Although preoperative perforator mapping ensures safety and versatility of these flaps, there is no consensus yet about flap planning in different anatomical locations. Material and Method: 28 patients underwent perforator-based flap surgery for different anatomical locations as face (5), sternum (3), back (5), lomber (4), sacral (4) and scrotal (4) areas, leg (2) and foot (1). 19 of the patients were male while 9 were female. The mean age was 58.1±13.5 (22-80 years). Perforator-based flaps were planned as V-Y design in face, sacral and scrotal areas while as perforator plus transposition flaps for lomber area, leg and sternum. On the other hand, for foot the flap was planned as subcutaneous-pedicled turnover flap. Results: The mean follow-up time was 10 months (3-36 months). Partial flap necrosis is seen in all 3 patients who had underwent flap surgery on the lower extremity. There were no other complications seen in short- or long-term follow-ups. Comorbid diseases were not statistically significant on complications rates (P>0.05). Conclusion: V-Y flap for the face and the sacral area; and perforator plus transposition flap for back ,lomber area and sternum are suggested as the ideal flap modifications for these anatomical locations. On the other hand, perforator-based flaps should not be used as a first choice in reconstruction of lower extremity defects.

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“…[ 1 ] In addition to complete debridement of necrotic tissue and sufficient coverage with healthy tissue, careful selection of flaps for pressure sore reconstruction should be achieved to reduce donor site morbidities and to provide additional opportunities for further surgical reconstruction. [ 1 – 3 ] Gluteal perforator flaps are the current mainstay of pressure sore reconstruction because of their superiority over conventional musculocutaneous flaps. These superior aspects include the lack of the need to sacrifice the muscles and major vessels.…”

Section: Introductionmentioning

confidence: 99%

“…The V-Y advancement flap is reliable and simple, but its limited mobility is a challenging problem. [ 3 ] The propeller flap is relatively free of flap movement, but vascular compromise due to pedicle twisting or kinking can occur. [ 2 , 9 ] Moreover, flap harvest time is relatively longer because either intra-muscular dissection or skeletonization of the pedicle is often indispensable.…”

Section: Introductionmentioning

confidence: 99%

Retrospective study of freestyle perforator-based peninsular flaps

Yoon

Kim

et al. 2018

Medicine

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This study aimed to present a simple, fast, and safe technique, called freestyle perforator-based peninsular flap (FPBPF), for pressure sore reconstruction.Among the 21 patients who underwent pressure sore reconstruction between May 2013 and October 2016, 12 patients (Group A) and 9 patients (Group B) were subjected to perforator-based island flap (PBIF) and FPBPF, respectively. We retrospectively reviewed and statistically analyzed the data of both groups.All flaps completely survived in both groups. No significant differences were found in patient demographics, complications, hospital stay, and follow-up period. The mean arc of rotation (102.50 ± 17.645° vs 83.33 ± 14.142°; P = .01), mean flap harvest time (35.83 ± 2.552 minutes vs 20.88 ± 1.763 minutes; P < .001), and mean operative time (145.41 ± 6.788 minutes vs 131.66 ± 10.770 minutes; P = .002) were significantly decreased in Group B compared with Group A.The FPBPF is a simpler and faster technique than the PBIF. FPBPF is a good modality with a few complications for sore reconstruction.

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The Pacman Perforator-Based V-Y Advancement Flap for Reconstruction of Pressure Sores at Different Locations

Cited by 14 publications

References 32 publications

Retrospective Cohort Observational Study on the Single Best Perforator-Based Pacman Flap in the Reconstruction of Stage IV Sacral Region Pressure Ulcers

Retrospective Cohort Observational Study on the Single Best Perforator-Based Pacman Flap in the Reconstruction of Stage IV Sacral Region Pressure Ulcers

Algorithms for perforator-based flaps in different anatomical locations

Retrospective study of freestyle perforator-based peninsular flaps

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