Three-Dimensional Computed Tomographic Angiography Study of the Interperforator Flow of the Lower Leg

Sur, Yoo Joon; Morsy, Mohamed; Mohan, Anita T.; Zhu, Lin; Michalak, Gregory J.; Lachman, Nirusha; Laungani, Alexis; Alphen, Nick van; Saint‐Cyr, Michel

doi:10.1097/prs.0000000000002111

Cited by 17 publications

(14 citation statements)

References 20 publications

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“…16 Greater knowledge of the interlinking channels between perforators allow for larger more reliable flaps to be raised, as perfusion studies have shown, single perforators of the PTAP and PAP can perfuse flaps approximately 40% of the lower leg surface area each, between the ankle to knee joint. 17 In certain circumstances where the perforators are not audible on Doppler, we have used the endoscope to directly visualize the perforators prior to raising the flap. 18 We used our experience from perforator dissection in free flaps to provide a pedicle dissection as long as possible all the way to the source vessel to allow maximum pedicle freedom.…”

Section: Discussionmentioning

confidence: 99%

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Wong

Deek

Hsu

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Summary Background: The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects. Patients and methods: Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects. Results: Flaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin grafting. Complications requiring secondary surgery occurred in 18% (11/61) of the cases. Six required secondary skin grafting (10%). One RF-ALT flap was converted into a free flap, one PAP required arterial supercharging, and three pedicled RF-ALT flaps required venous supercharging. Image analysis showed that these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The higher length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover.

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Section: Discussionmentioning

confidence: 99%

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Wong

Deek

Hsu

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…9 El trauma del miembro o la patología vascular periférica afectan el flujo sanguíneo del miembro complicando aún más el panorama. 10 Gracias a varios estudios anatómicos se han revelado arterias perforantes confiables, como las de la arteria tibial posterior [11][12][13] fácilmente identificables con ecografía Doppler.…”

Section: Resultsunclassified

Colgajo de perforante de la arteria tibial posterior. Serie de casos. [Posterior tibial artery perforator flap. Case series]

Cicco

Zamboni

Barla

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: Los defectos de cobertura en la pierna son un problema difícil de solucionar debido a las características propias de la región anatómica. Por ello, se han desarrollado distintas estrategias de reconstrucción, y los colgajos de perforante fasciocutáneos son los que se utilizan con más frecuencia.Objetivos: Presentar la alternativa terapéutica, describir la técnica quirúrgica, los resultados y las complicaciones del colgajo de perforante de la arteria tibial posterior para el tratamiento de defectos de cobertura en la pierna.Materiales y Métodos: Se realizó una revisión retrospectiva de los pacientes tratados con colgajo fasciocutáneo en la pierna y operados en nuestro Centro. Se analizaron variables demográficas preoperatorias. Se describen la técnica quirúrgica y las indicaciones en cada paciente. Se analizaron variables posoperatorias, como las complicaciones y la supervivencia del colgajo.Resultados: Se incluyeron 12 hombres tratados con colgajo de perforante de la arteria tibial posterior.El promedio de edad en el momento de la cirugía fue de 52 años (rango 29-77). El seguimiento máximo fue de 55 meses y el mínimo, de 5 meses (promedio 18). Hubo dos colgajos con sufrimiento transitorio, una falla parcial y una falla total.Conclusiones:El colgajo de perforante de la arteria tibial posterior ha de ser considerado una opción válida en el tratamiento de heridas de pequeño y mediano tamaño de la pierna. Provee de tejido similar en grosor, textura y color en el sitio receptor con buenos resultados clínicos y estéticos. ABSTRACTIntroduction: Coverage defects in the leg are a challenge due to the particulars of the anatomy in said area, different reconstruction strategies have been developed, being the fasciocutaneous perforator flaps the most frequently used. The aim of this paperis to discuss the therapeutic alternative and to describe the surgical technique, the results and the complications of the posterior tibial artery perforator flap (PTAPF) to treat coverage defects.Materials and Methods: We performed a retrospective review of patients treated with a fasciocutaneous flap. We analyzed preoperative demographic variables. The surgical technique and the indications in each patient are described. Finally, the postoperative variables, such as complications and flap survival, were analyzed.Results: Twelve patients (all male) treated with PTAPF were included. The average age at the time of surgery was 52 years (range: 29-77 years). The maximum follow-up was 55 months, with a minimum of 5 months (average: 18 months). There were two flaps with transient congestion that reverted spontaneously: one partial failure and one total failure.Conclusions: PTAPF should be considered a viable option for the treatment of small- and medium-sized leg wounds, since they provide similar tissue thickness, texture and color on the recipient site, achieving good clinical and cosmetic results.

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“…The situation is even more complicated when the blood flow is affected by the limb trauma or the peripheral vascular pathology [5]. Reliable perforator arteries have been known thanks to several anatomic studies, such as those from the posterior tibial artery [13,14] which are easily identified by Doppler sonography. Most of them are septocutaneous and they have a higher diameter on the proximal third of the leg [13,16].…”

Section: Discussionmentioning

confidence: 99%

Posterior Tibial Artery Perforator Flap Series of Cases

Carabelli

Cicco

Barla

et al. 2019

International Journal of Orthoplastic Surgery

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Coverage defects in the leg, are a difficult problem to confront due to the characteristics of the anatomical region. For this reason, different reconstruction strategies have been developed, being the fasciocutaneous perforator flaps the most frequently used. The aim of this manuscript is to present the therapeutic alternative, to describe the surgical technique, the results and the complications of the posterior tibial artery perforator flap (CPATP) for the treatment of coverage defects. We performed a retrospective review of patients treated with a fasciocutaneous flap at the level of the leg operated at our center. We analyzed preoperative demographic variables. The surgical technique and the indications in each patient are described. Finally, the postoperative variables such as complications and the survival of the flap were analyzed. Twelve patients treated with CPATP were included. All male. The average age at the time of surgery was 52 years (range 29-77 years). The maximum follow-up of 55 months, with a minimum of 5 months (average 18 months). There were two flaps with suffering that reverted spontaneously, a partial failure and a total failure. The posterior tibial artery perforator flap should be considered a valid option in the treatment of wounds of small and medium size of the leg. They provide similar tissue in thickness, texture and color in the recipient site with good clinical and aesthetic results.

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Three-Dimensional Computed Tomographic Angiography Study of the Interperforator Flow of the Lower Leg

Abstract: Therapeutic, V.

Cited by 17 publications

References 20 publications

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Colgajo de perforante de la arteria tibial posterior. Serie de casos. [Posterior tibial artery perforator flap. Case series]

Posterior Tibial Artery Perforator Flap Series of Cases

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