Prospective Comparison of Donor-Site Morbidity following Radial Forearm and Ulnar Artery Perforator Flap Harvest

AbstractThe tissues of the medial arm as a donor site for perforator flap design have several advantages. However, they are relatively underused with limited reports, partly due to unreliable perforator anatomy. Therefore, we aimed to review our preliminary experience using indocyanine green (ICG) angiography to design and elevate preexpanded pedicled brachial artery perforator (BAP) flaps for regional reconstruction. All patients underwent soft tissue reconstructions using a preexpanded BAP flap in two or three stages. ICG angiography was used to localize perforators during both expander insertion and flap elevation. The pedicle was divided at the third stage 3 weeks following flap elevation for head and neck cases. Sixteen patients underwent reconstructions of the head and neck (n = 13) or shoulder/trunk (n = 3) using 14 perforator-plus and 2 propeller BAP flaps. In total, 50 perforators were identified using ICG imaging, all of which were appreciable during both expander placement and flap elevation. Thirty-five perforators were directly visualized during flap elevation, and an additional 15 perforators were not explored but incorporated into the flap. All flaps survived without necrosis, and the donor sites healed uneventfully without complications. The medial arm provides thin and pliable skin for the resurfacing of regional defects with relatively minimal donor-site morbidity. With the assistance of ICG angiography, perforators of the brachial artery can be reliably identified, facilitating the preexpansion and elevation of pedicled BAP flaps for use in head–neck and trunk reconstruction.

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Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature

Folia Medica ◽

10.2478/v10153-011-0090-x ◽

2012 ◽

Vol 54 (2) ◽

pp. 60-65 ◽

Cited By ~ 2

Author(s):

Dimitar D. Pazardzhikliev ◽

Christo D. Shipkov ◽

Ilya P. Yovchev ◽

Regina H. Khater ◽

Ivailo S. Kamishev

Keyword(s):

Case Report ◽

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Functional Results ◽

Donor Site Morbidity ◽

Oral Feeding ◽

Tram Flap ◽

Radial Forearm Free Flap ◽

Radial Forearm

ABSTRACT Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free flap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48- year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free flap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as “excellent” and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable flap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator flap, RFFF, anterolateral thigh and ulnar forearm flap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM flap, latissimus dorsi myocutaneous free flap, pectoralis major musculocutaneous flap and trapezius island flap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

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Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1603351 ◽

2017 ◽

Vol 33 (08) ◽

pp. 557-562

Author(s):

Ji Yim ◽

Yeon Lee ◽

Young Kim ◽

Eun Kim ◽

Taik Lee ◽

...

Keyword(s):

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Vascular Pedicle ◽

Inferior Epigastric Artery ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Time Required ◽

Artery Perforator

Background Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.

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Our early experience in immediate total breast reconstruction with deep inferior epigastric artery perforator flap

International Surgery Journal ◽

10.18203/2349-2902.isj20195410 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4444

Author(s):

Thyagaraj . ◽

Ashrith Iyanahally ◽

B. G. Tilak ◽

M. E. Sham ◽

Ganesh .

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Breast Cancer Diagnosis ◽

Donor Site Morbidity ◽

Diep Flap ◽

Inferior Epigastric Artery ◽

Aesthetic Result ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Artery Perforator

Background: As the breast cancer diagnosis has increased over recent years, patient have become more informative regarding treatment and reconstructive options, hence the expectation of the results will be very high. Reconstruction of breast with best result and less donor site morbidity is the target.Methods: A total of 20 cases were studied between January 2018 to January 2019 at our hospital to assess the outcome of deep inferior epigastric artery perforator (DIEP) flap for immediate breast reconstruction.Results: A total of twenty DIEP flaps were performed. Mean time required for flap harvest was 125 minutes, and time taken for flap inset was 110 minutes. There was no flap loss in any of the twenty cases. Two patients had fat necrosis. All patients were satisfied with aesthetic outcome.Conclusions: DIEP flap has good aesthetic result with less donor site morbidity.

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Donor Site Morbidity after Lumbar Artery Perforator Flap Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1731671 ◽

2021 ◽

Author(s):

Dries Opsomer ◽

Tom Vyncke ◽

Michelle Ryx ◽

Koenraad Van Landuyt ◽

Phillip Blondeel ◽

...

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Significant Risk ◽

Perforator Flap ◽

Significant Risk Factor ◽

Donor Site Morbidity ◽

Diep Flap ◽

Lumbar Artery ◽

Patient Reported ◽

Artery Perforator

Abstract Background The lumbar artery perforator flap is a second-choice flap in autologous breast reconstruction whenever a deep inferior epigastric artery perforator (DIEP) flap is not possible. Ideal candidates are pear-shaped women who do not have enough bulk on the abdomen or thighs. Patient-reported “satisfaction with breasts” is excellent but we were curious about the donor site morbidity. Methods We performed a retrospective study of all lumbar flap breast reconstructions performed between 2010 and 2019. Patients were invited by e-mail and telephone to take part in a BREAST-Q survey. Results One hundred fifty-four flaps were performed in 110 patients. Sixty-three patients filled out the BREAST-Q questionnaire. The most frequently observed donor site complications are seroma (35.1%), dehiscence (8.4%), and hematoma (3.2%). Correction of the donor site scar was performed in 31.8% of patients, lipofilling of the donor flank in 5.2%, and liposuction of the contralateral flank in 18.3% of patients. Body mass index (BMI) was the only significant risk factor for donor site complications. Patient-reported “satisfaction with donor site appearance” was good but significantly lower for primary reconstructions compared with secondary and tertiary procedures. Flap weight significantly influences patient-reported “physical wellbeing of the donor site.” Ninety-seven percent of patients would recommend the surgery to someone in a similar position and would do it all over. Conclusion The lumbar artery perforator flap is a good alternative for breast reconstruction in selected patients. The donor site issues consist mainly of seromas, prolonged discomfort, and a scar that might be noticeable to others, but patient-reported satisfaction is very high.

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Hypopharyngeal, Esophageal, and Neck Reconstruction

10.2310/ps.10064 ◽

2018 ◽

Author(s):

Steven B Chinn ◽

Peirong Yu

Keyword(s):

Perforator Flap ◽

Ulnar Artery ◽

Good Alternative ◽

Radial Forearm Flap ◽

Anterolateral Thigh Flap ◽

Forearm Flap ◽

Anterolateral Thigh ◽

Pharyngoesophageal Reconstruction ◽

Radial Forearm ◽

Artery Perforator

Organ preservation protocols with radiotherapy have become the primary treatment for stage I to III laryngeal and hypopharyngeal carcinoma. Many pharyngoesophageal defects are the result of salvage laryngopharyngectomy following radiation failure, making reconstruction more challenging. Given the detrimental effects of radiation on wound healing, reconstruction bathed in saliva, and the frozen neck with poor recipient vessels, pharyngoesophageal reconstruction requires great attention to detail to avoid catastrophic complications. In this review, we detail the commonly used flaps for pharyngoesophageal reconstruction, including the radial forearm flap, anterolateral thigh flap, and jejunal flap. In recent years, the anterolateral thigh flap has become the optimal flap for this type of reconstruction due to its minimal donor-site morbidity and excellent functional outcomes. Use of a two-skin island anterolateral flap allows for pharyngoesophageal reconstruction with simultaneous neck resurfacing. The profundus artery perforator flap can be a good alternative to the anterolateral thigh flap, whereas the ulnar artery perforator flap may be a good alternative to the radial forearm flap in certain cases. We discuss recipient vessel selection and conclude by outlining important postoperative considerations. This review contains 23 figures, 3 tables and 39 references Key words: anterolateral thigh flap, anteromedial thigh flap, frozen neck, gastro-omental flap, hypopharynx, laryngeal cancer, perforator flaps, pharyngocutaneous fistula, pharyngoesophageal reconstruction, profundus artery perforator flap, radial forearm flap, tracheoesophageal puncture, transverse cervical vessels, ulnar artery perforator flap

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