Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps

2021 ◽  
Author(s):  
Lan Sook Chang ◽  
Youn Hwan Kim ◽  
Sang Wha Kim
Keyword(s):  
Free Flaps ◽  
Burn Scar ◽  
Scar Contracture ◽  
Thoracodorsal Artery ◽  
Artery Perforator

Designing Lateral Thoracic Wall Perforator Flaps for Breast Reconstruction Using the Ultrasound

2021 ◽  
Author(s):  
Marzia Salgarello ◽  
Giuseppe Visconti
Keyword(s):  
Breast Reconstruction ◽  
Duplex Ultrasound ◽  
Free Flaps ◽  
Thoracic Wall ◽  
Perforator Flaps ◽  
Thoracodorsal Artery ◽  
The Us ◽  
Latissimus Dorsi Myocutaneous Flap ◽  
Artery Perforator ◽  
Color Duplex Ultrasound

Abstract Background Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps. Patients and Methods From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap. Results Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed. Conclusion Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.

Resurfacing of Face and Neck Using Superthin Thoracodorsal Artery Perforator Free Flaps

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lan Sook Chang ◽  
Jung Han Lim ◽  
Youn Hwan Kim
Keyword(s):  
Free Flaps ◽  
Thoracodorsal Artery ◽  
Artery Perforator

scholarly journals Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Soo Yeon Lim ◽  
Gyeong Hoe Kim ◽  
Il Hoon Sung ◽  
Dong Woo Jang ◽  
Jung Soo Yoon ◽  
...  
Keyword(s):  
Free Flaps ◽  
Respiratory Arrest ◽  
Surgical Approaches ◽  
Peripheral Gangrene ◽  
Ischemic Change ◽  
Walking Aids ◽  
Management Protocol ◽  
Thoracodorsal Artery ◽  
Artery Perforator

Symmetrical peripheral gangrene (SPG) is rare but devastating complication which is characterized by symmetrical ischemic change of the distal extremities. In this report, we describe our management protocol for SPG, focusing on surgical approaches. Between January 2007 and February 2016, 10 thoracodorsal artery perforator (TDAP) free flaps were performed in 6 patients with SPG. Three patients were male and mean age was 56 (range, 44–69) years. All the patients were in shock. The causes of shock were sepsis in 4 cases, respiratory arrest in 1 case, and hypovolemia in 1 case. Eight transmetatarsal amputations and 2 Lisfranc amputations were performed. Flap sizes ranged from 7 × 11 cm to 25 × 15 cm. There were 3 cases of partial necrosis of the flap: two healed conservatively with dressings and one required skin graft. Three of the patients were later able to walk independently at Functional Ambulation Classification (FAC) level 6, one patient could walk independently on level surfaces at FAC level 5, and 2 could walk independently using walking aids, classified at FAC level 4. The average follow-up period was 18 (range, 6–54) months. In patients with SPG, minimal bone amputation and foot salvage with TDAP flaps were successful. Separate reconstruction of bone and soft tissue had good outcomes.

scholarly journals Reconstruction of a Mangled Hand with a Thoracodorsal Artery Perforator Free Flap: A Report of Two Cases

2021 ◽  
Vol 26 (1) ◽  
pp. 57-62
Author(s):  
Hyun Sik Park ◽  
Dong-Jin Kim ◽  
Joing Ick Hwang
Keyword(s):  
Free Flap ◽  
Surgical Flaps ◽  
Perforator Flap ◽  
Free Flaps ◽  
Soft Tissue Defects ◽  
Anterolateral Thigh ◽  
Thoracodorsal Artery ◽  
Radial Forearm ◽  
Artery Perforator ◽  
Tissue Defects

Mangled hands are a severely injured condition that is a rare and challenging problem for reconstructive surgeons. Surgical flaps such as anterolateral thigh, radial forearm, or thoracodorsal artery flaps have been used for multiple-digit resurfacing. In this report, we describe two cases of complex defects that included multiple digits in patients who underwent reconstruction with thoracodorsal artery perforator (TDAP) free flaps. All massive soft tissue defects were completely covered with a TDAP free flap. The thinner perforator flap could be harvested, and the patients regained the ability to pinch and grasp. Therefore, the authors present two cases of mangled hands successfully treated with TDAP free flap.

scholarly journals Perforator-based flaps for the treatment of burn scar contractures: a review

2017 ◽  
Vol 5 ◽  
Author(s):  
C. M. Stekelenburg ◽  
R. E. Marck ◽  
P. D. H. M. Verhaegen ◽  
K. W. Marck ◽  
P. P. M. van Zuijlen
Keyword(s):  
Clinical Significance ◽  
Controlled Trial ◽  
Free Flaps ◽  
Term Outcome ◽  
Burn Scar ◽  
Long Term Outcome ◽  
Scar Contracture ◽  
Contracture Release

Abstract Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising; however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial; ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.

scholarly journals Comparison of skin elasticity and stiffness of the thoracodorsal artery perforator flap and commonly used flaps in head and neck reconstruction

2019 ◽  
Author(s):  
zhenhu ren ◽  
Kun Wu ◽  
Wen-jun Yang ◽  
Yue He ◽  
Jing-Zhou Hu
Keyword(s):  
Head And Neck ◽  
Perforator Flap ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Skin Elasticity ◽  
Forearm Flap ◽  
Thoracodorsal Artery ◽  
The Difference ◽  
Thoracodorsal Artery Perforator Flap ◽  
Artery Perforator

Abstract Background Reconstruction of oral and maxillofacial defects requires soft and ductile flaps. Thoracodorsal artery perforator flap (TDAP) has good plasticity, but it is not widely used in the repair of oral and maxillofacial defects. The main aims of this study are to compare the skin elasticity and hardness of various free flaps commonly used in reconstructive surgery, and to explore the advantages and disadvantages of TDAP.Methods The elasticity and stiffness of the most commonly used free flaps in our department were measured by ElastiMeter and SkinFibroMeter. The elasticity and stiffness values of TDAP, anterolateral thigh flap, anterior medial femoral flap and forearm flap were measured respectively.Results The elasticity of TDAP was the lowest among all flaps, and the difference was statistically significant, except for the forearm flap (p = 0.000; p = 0.000; p = 0.06). The stiffness of TDAP was the lowest among all skin flaps, and the difference was statistically significant (p = 0.000; p = 0.000; p = 0.000).Conclusions TDAP is indeed suitable for reconstruction of head and neck defect, especially oral and oropharyngeal defect. Due to the ductile texture of TDAP, it is very conducive to the recovery of the morphology and function of oral and oropharyngeal organs.

scholarly journals Resurfacing the donor sites of reverse sural artery flaps using thoracodorsal artery perforator flaps

2021 ◽  
Vol 48 (6) ◽  
pp. 691-698
Author(s):  
Se Won Oh ◽  
Seong Oh Park ◽  
Youn Hwan Kim
Keyword(s):  
Knee Joint ◽  
Lower Extremity ◽  
Skin Graft ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Split Thickness Skin Graft ◽  
Scar Contracture ◽  
Thoracodorsal Artery ◽  
Sural Artery ◽  
Artery Perforator

Background The reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps.Methods From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases).Results Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021).Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

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