The Ideal Upper Extremity Flap for Soft Tissue Defects, Radial Artery Perforator Adipofascial Flap

Abstract Background: To locate the anastomosable constant perforator of radial artery on the proximal forarm using ultrasonography, and describe the application of free radial artery flap based on a single proximal perforator in the reconstruction of digital soft tissue defects. Methods: In 20 forarms (10 right and 10 left) from 10 volunteers, the perforators in the proximal half of forarm from radial artery were visualized by ultrasonography. Then the free radial artery perforator flaps based on the single perforator were used for reconstruction of small digital soft tissue defects in 4 cases between October 2017 and May 2018. Results: Of the 20 forarms, anastomosable perforator was constantly detected from the radial artery in the proximal half of forarm. The diameter of the perforator was 0.7±0.1 mm, the pedicle length is 12±3 mm by ultrasonography. Ther location of the perforator is far from elbow crease 8.8±1.4 cm, and the relative distance of the perforator location from elbow crease to wrist crease is 37.2% ± 4.8%. In clinical cases, all the flaps were complete survival. Flap size ranged from 3.5 to 6.5 cm in length and 2.3 to 3.0 cm in width. Donor sites of forearm were closed primarily in all cases. During a mean period of 12 months (8-14 months) follow-up, there were satisfactory results of digital function and cosmesis,and no functional impairments at the donor sites. Conclusions: There is an anastomosable perforator consistent located on the radial artery in the proximal half of forarm. The free radial artery small flap based on this single perforator provides acceptable functional and cosmetic outcomes for the reconsturction of digital soft tissue defects . With the preservation of the main vessel (radial artery) of forearm, this flap provides another reliable option for handsurgery surgeon to reconstruct small digital defects.

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The Free Flap Based on a Single Proximal Perforator of Radial Artery: the Ultrasonography Study and Clinical Applications in Reconstruction of Digital Defect

10.21203/rs.3.rs-36958/v1 ◽

2020 ◽

Author(s):

Guangzhi Wu ◽

Zhan Zhang ◽

Fan Zhang ◽

Yiqun Zhang ◽

Wei Yu

Keyword(s):

Soft Tissue ◽

Radial Artery ◽

Soft Tissue Defects ◽

Proximal Half ◽

Pedicle Length ◽

Cosmetic Outcomes ◽

The Mean ◽

Artery Perforator ◽

Tissue Defects

Abstract Objectives: To locate the anastomosable constant perforator of radial artery on the proximal forarm using ultrasonography, and describe the application of free radial artery flap based on a single proximal perforator in the reconstruction of digital soft tissue defects.Methods: In 20 forarms (10 right and 10 left) from 10 volunteers, the perforators in the proximal half of forarm from radial artery were visualized by ultrasonography. Then the free radial artery perforator flaps based on the single perforator were used for reconstruction of small digital soft tissue defects in 4 cases between October 2017 and May 2018.Results: Of the 20 forarms, anastomosable perforator was constantly detected from the radial artery in the proximal half of forarm. The diameter of the perforator was 0.7±0.1 mm, the pedicle length is 12±3 mm by ultrasonography. Ther location of the perforator is far from elbow crease 8.8±1.4 cm, and the relative distance of the perforator location from elbow crease to wrist crease is 37.2% ± 4.8%. In clinical cases, all the flaps were complete survival. Flap size ranged from 3.5 to 6.5 cm in length and 2.3 to 3.0 cm in width. Donor sites of forearm were closed primarily in all cases. During a mean period of 12 months (8-14 months) follow-up, the mean Brief Michigan Hand Questionnaire (BMHQ) score was 72.9 (60.4-85.4) in the affected hand.Conclusions: There is an anastomosable perforator consistent located on the radial artery in the proximal half of forarm. The free radial artery small flap based on this single perforator provides acceptable functional and cosmetic outcomes for the reconsturction of digital soft tissue defects . With the preservation of the main vessel (radial artery) of forearm, this flap provides another reliable option for handsurgery surgeon to reconstruct small digital defects.

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Thoracodorsal Artery Perforator Flap: Versatile Flap Coverage for Various Soft-Tissue Defects

Journal of Reconstructive Microsurgery ◽

10.1055/s-2006-949096 ◽

2006 ◽

Vol 22 (04) ◽

Author(s):

Suhan Ayhan ◽

Serhan Tuncer ◽

Yakup Sariguney ◽

Sebahattin Kandal

Keyword(s):

Soft Tissue ◽

Perforator Flap ◽

Soft Tissue Defects ◽

Flap Coverage ◽

Thoracodorsal Artery ◽

Thoracodorsal Artery Perforator Flap ◽

Artery Perforator ◽

Tissue Defects

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Reconstruction of soft tissue defects of the lower leg with the distally based medial adipofascial flap

British Journal of Plastic Surgery ◽

10.1016/0007-1226(94)90173-2 ◽

1994 ◽

Vol 47 (2) ◽

pp. 132-137 ◽

Cited By ~ 29

Author(s):

Sin-Daw Lin ◽

Chung-Sheng Lai ◽

Chih-Kang Chou ◽

Chin-Wei Tsai ◽

Chin-Cheng Tsai

Keyword(s):

Soft Tissue ◽

Lower Leg ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Distally Based ◽

Tissue Defects

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Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_19_17 ◽

2018 ◽

Vol 51 (02) ◽

pp. 216-221 ◽

Cited By ~ 4

Author(s):

Deepak Nanda ◽

Shamendra Anand Sahu ◽

Durga Karki ◽

Sanjay Kumar ◽

Amrita Mandal

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Donor Site ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Tibial Artery ◽

Split Skin ◽

Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

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