scholarly journals Free Peroneal Artery Perforator-Based Flap for Soft Tissue Reconstruction of the Finger

2017 ◽  
Vol 02 (02) ◽  
pp. e136-e139
Author(s):  
Kenji Kawamura ◽  
Hiroshi Yajima ◽  
Shohei Omokawa ◽  
Takamasa Shimizu ◽  
Satoshi Hayashi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Peroneal Artery ◽  
Soft Tissue Reconstruction ◽  
Digital Artery ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Perforator Vessels ◽  
Artery Perforator ◽  
Tissue Defects

Background The peroneal artery perforator-based flap has been widely used as a pedicled propeller flap for soft tissue reconstruction in the lower extremity; however, its application as a free flap has been rarely reported. We report on the utility of the free peroneal artery perforator-based flap for finger soft tissue reconstruction. Methods Twelve patients underwent reconstructions of soft tissue defects of the finger with free peroneal artery perforator-based flaps. The soft tissue defects were located either dorsally and/or laterally on the fingers. The size of the flaps ranged from 5 × 2 to 8 × 3 cm. The length of the vascular pedicles ranged from 4 to 5 cm. The artery and vein of the perforator vessels were anastomosed in the finger to the digital artery and subcutaneous vein, respectively. Results All twelve flaps survived completely, and the donor site in the lower leg was closed primarily in all cases. Secondary defatting was performed in six cases, while in the remaining cases, thinning of the flap was performed when the flap was transferred. Conclusion The advantages of the free peroneal artery perforator-based flap for finger soft tissue reconstruction include the following: the flap is flexible and can be thinned to match the texture of the finger; elevation of the flap is easy; the donor site can be closed primarily; there is no need to sacrifice any main arteries in the lower leg; and the diameter of the perforator vessels is suitable for anastomosis to the digital artery and subcutaneous vein in the finger.

Minimally invasive soft tissue reconstruction with free peroneal artery perforator flap

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Kenji Kawamura ◽  
Hiroshi Yajima ◽  
Shohei Omokawa ◽  
Takamasa Shimizu ◽  
Naoki Maegawa ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Donor Site ◽  
Perforator Flap ◽  
Peroneal Artery ◽  
Soft Tissue Reconstruction ◽  
Perforator Flaps ◽  
Major Vessel ◽  
Tissue Reconstruction ◽  
Artery Perforator

<p> </p><p><span style="font-family: Times New Roman;"> The development of a concept of perforator flap has dramatically changed the soft tissue reconstructive surgery. The surgery with perforator flaps enables to minimize donor-site morbidity by preserving important tissues including the muscle and the major vessel. The peroneal artery perforator flap is one of perforator flaps that can be harvested from the lower leg. The peroneal artery perforator flap has been widely used as a local flap for soft tissue reconstruction in the lower extremity; however, the free peroneal artery perforator flap transfer has been little reported. Utilities of the free peroneal artery perforator flap for soft tissue reconstruction of the extremities are reported, and minimally invasive flap surgery with perforator flaps is reviewed.</span></p><p> </p>

scholarly journals Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects

2012 ◽  
Vol 45 (03) ◽  
pp. 478-484 ◽  
Author(s):  
Celalettin Sever ◽  
Fatih Uygur ◽  
Yalcin Kulahci ◽  
Huseyin Karagoz ◽  
Cihan Sahin
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Reconstruction Method ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Reconstructive Procedures ◽  
Thoracodorsal Artery ◽  
Tdap Flap ◽  
Artery Perforator ◽  
Tissue Defects

ABSTRACT Objective: The thoracodorsal artery perforator (TDAP) flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. The optimal reconstruction method should provide thin, and well-vascularized tissue with minimal donor-site morbidity. The indications for the use of this particular flap with other flaps are discussed in this article. Materials and Methods: Thirteen patients underwent soft tissue reconstruction using TDAP flaps between 2009 and 2011. Of those, there were four cases of antecubital burn contracture, three cases of axillary burn contracture, two cases of giant hair cell nevus of upper extremity, two cases of axillary reconstruction following severe recurrent hidradenitis, and two cases of crush injury. All patients were male and their ages ranged from 20 to 23 (average, 21 years). The mean follow-up period was 8 months (range, 4-22 months). Results: All reconstructive procedures were completed without any major complications. Minor complications related to transfered flaps were wound dehiscence in one case, transient venous congestion in two cases. Minor complication related to the donor site was seroma in one case. The success rate was 100%, with satisfactory cosmetic results. Conclusions: The TDAP flap is a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction. Although the vascular anatomy may be variable, free and pedicled TDAP flap is a versatile alternative for soft tissue defects. It adapts very well to the soft tissue defects with acceptable donor site scar.

scholarly journals Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps

2021 ◽  
Author(s):  
Stephan Alois Steiner ◽  
Riccardo Schweizer ◽  
Holger Klein ◽  
Matthias Waldner ◽  
Pietro Giovanoli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Abstract Background Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction. Methods We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications. Results Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months). Conclusions Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites. Level of evidence: Level IV, therapeutic study.

scholarly journals Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

2017 ◽  
Vol 45 (3) ◽  
pp. 1074-1089 ◽  
Author(s):  
Lifeng Shen ◽  
Yiyang Liu ◽  
Chun Zhang ◽  
Qiaofeng Guo ◽  
Wenhua Huang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Lower Leg ◽  
Soft Tissue Defect ◽  
Venous Congestion ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Propeller Flap ◽  
Perforator Vessel ◽  
Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

scholarly journals Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haoliang Hu ◽  
Hong Chen ◽  
Jinjiong Hong ◽  
Weisheng Mao ◽  
Mintao Tian ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Width Ratio ◽  
Digital Artery ◽  
Soft Tissue Defects ◽  
Clinical Trial Registry ◽  
Perforator Flaps ◽  
And Function ◽  
Artery Perforator ◽  
Tissue Defects

Abstract Background When restoring the appearance and function of the fingers, hand surgeons face a challenge in choosing a suitable surgical method to repair finger skin defects. Methods In this study, we designed a long elliptical flap based on a propeller perforator flap and located slightly toward the dorsal lateral aspect of the finger. The flap with a pedicle consisting of the dorsal perforator of the distal digital artery and dorsal digital artery perforator chain is rotated to cover a large wound on the distal end. From December 2014 to December 2017, 10 patients with finger soft tissue defects were treated with the propeller perforator flap described in this study. Results All flaps survived after surgery, and 2 had a transient venous congestion. After a follow-up period of 3 to 12 months, the static two-point discrimination of the flap was 8.06 ± 1.75 mm, and the range of motion was 149.4 ± 12.9°. This designed flap can span several angiosomes supplied by the perforators. Due to the inclusion of a vessel chain between the dorsal digital artery perforators, the length-to-width ratio of the flap can be up to 3:1. Conclusions This technique increases the size of flap that can be harvested safely while retaining a reliable blood supply. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based on dorsal digital artery perforator chains. Trial registration The registration number of this study is ChiCTR1800014588; it has been retrospectively registered with Chinese Clinical Trial Registry (chictr.org.cn), 18/11/2019.

scholarly journals Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ping Peng ◽  
Zhaobiao Luo ◽  
Guohua Lv ◽  
Jiangdong Ni ◽  
Jianwei Wei ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Kirschner Wire ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Partial Necrosis ◽  
Total Length ◽  
Distally Based ◽  
Artery Perforator ◽  
Pedicle Width ◽  
Tissue Defects

Abstract Background Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, reports on the reconstruction of the defects over the distal forefoot using the DPAPF flaps are scarce. Herein, we describe our experience on the reconstruction of these defects using DPAPF flaps in a considerable sample size. Methods Between February 2005 and August 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. In order to reduce the length of fascial pedicle and the total length of the DPAPF flaps, the ankles were fixed in dorsiflexion using a Kirschner wire before designing the flaps. The flaps were elevated by the anterograde–retrograde approach. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups. Results Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 ± 0.58 cm, the total length of the flap was simultaneously shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from 3.0 cm to 6.0 cm. The fascial pedicle width > 4 cm was found in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05). Conclusions The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. By fixing the ankle in dorsiflexion with Kirschner wire and widening the fascial pedicle appropriately, the top edge and LWR of the flaps will be decreased, and thus the procedures are helpful for the flaps survival.

scholarly journals Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

2020 ◽  
Author(s):  
Ping Peng ◽  
Zhaobiao Luo ◽  
Guohua Lv ◽  
Jiangdong Ni ◽  
Jianwei Wei ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Kirschner Wire ◽  
Fasciocutaneous Flap ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Patient Factors ◽  
Partial Necrosis ◽  
Distally Based ◽  
Artery Perforator ◽  
Tissue Defects

Abstract Background: Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, large studies on this topic, especially DPAPF flaps use for reconstruction of defects over the distal forefoot, are scarce. Herein, we describe our experience on the reconstruction of defects over the distal forefoot using DPAPF flaps.Methods: Between February 2005 and August 2019, 56 DPAPF flaps were used to reconstruct soft-tissue defects in the forefoot. The ankles were fixed in dorsiflexion using a Kirschner wire. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups.Results: Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. The distance between the pivot point and recipient area was reduced by fixing the ankles in dorsiflexion. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05).Conclusions: In combination with fixing of the ankles in dorsiflexion using a Kirschner wire, DPAPF flap is a good option in reconstructing a defect over the distal forefoot.

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