Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Abstract Background Large or complex trachea defects often require some tissue to reconstruct, various flaps have been reported for reconstructing this defect. However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction. Therefore, this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction. Methods Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed. Results All of the pedicled TAAP flaps in our study survived. The flap size ranged from 2 cm × 5 cm to 4 cm × 10 cm, and the size of each island of one double-island flap was 2 cm × 2.5 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities, such as diabetes, hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis. Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment. Conclusion Pedicled TAAP flaps provide a short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

10.21203/rs.3.rs-41623/v2 ◽

2020 ◽

Author(s):

Di Deng ◽

Feng Xu ◽

Jifeng Liu ◽

Bo Li ◽

Linke Li ◽

...

Keyword(s):

Clinical Application ◽

Perforator Flap ◽

Good Choice ◽

Island Flap ◽

Esophageal Reconstruction ◽

Perforator Flaps ◽

Tracheal Reconstruction ◽

Thoracoacromial Artery ◽

The Mean ◽

Artery Perforator

Abstract Background: Large or complex trachea defects often require some tissue to reconstruct,various flaps have been reported for reconstructing this defect.However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction.Therefore,this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction.Methods: Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed.Results: All of the pedicled TAAP flaps in our study survived. The flap size ranged from 2 cm x 5 cm to 4 cm x 10 cm, and the size of each island of one double-island flap was 2 cm x 2.5 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 cm and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities,such as diabetes,hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis.Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment.Conclusion: Pedicled TAAP flaps provide a short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects,especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

10.21203/rs.3.rs-41623/v1 ◽

2020 ◽

Author(s):

Di Deng ◽

Feng Xu ◽

Jifeng Liu ◽

Bo Li ◽

Linke Li ◽

...

Keyword(s):

Clinical Application ◽

Perforator Flap ◽

Island Flap ◽

Esophageal Reconstruction ◽

Perforator Flaps ◽

Tracheal Reconstruction ◽

Thoracoacromial Artery ◽

Reconstruction Methods ◽

The Mean ◽

Artery Perforator

Abstract Background Large or complex trachea defects often require some tissue to reconstruct,various flaps have been reported for reconstructing this defect.However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction.Therefore,this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction. Methods Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed. Results All of the pedicled TAAP flaps in our study survived. The flap size ranged from 5 cm by 2 cm to 4 cm by 10 cm, and the size of each island of one double-island flap was 2.5 cm by 2 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 cm and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities,such as diabetes,hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis.Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment. Conclusion Pedicled TAAP flaps provide a hairless inner lining, short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects,especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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Pitfalls in the management of subglottic paragangliomas at unusual location: a case report and literature review

BMC Surgery ◽

10.1186/s12893-021-01337-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Juanjuan Hu ◽

Haiyang Wang ◽

Jianli Chen ◽

Xuelin Pan ◽

Di Deng ◽

...

Keyword(s):

Case Report ◽

Mixed Type ◽

Perforator Flap ◽

Thyroid Tumors ◽

Tracheal Reconstruction ◽

Case Presentation ◽

Thoracoacromial Artery ◽

Second Stage ◽

Laryngotracheal Reconstruction ◽

Artery Perforator

Abstract Background Subglottic paragangliomas (PGs) are exceptionally rare and unpredictable, occasionally presenting at an atypical location. There are three different clinical forms of subglottic PGs: intraluminal (tracheal PGs), extraluminal (thyroid PGs) and the mixed type (both intraluminal and extraluminal, mixed-subglottic PGs). These tumors are usually misdiagnosed as other relatively common primary thyroid or laryngotracheal tumors, and the treatment is troublesome. Case presentation A 22-year-old male patient with subglottic PGs has been successively misdiagnosed as thyroid tumors and subglottic hemangiomas, and lastly underwent local extended lumpectomy and laryngotracheal reconstruction with a pedicled thoracoacromial artery perforator flap (PTAPF). The patient was decannulated successfully after the second-stage tracheal reconstruction with a local flap, and no evidence of local recurrence and distant metastasis of the tumor until now. Conclusion Subglottic PGs can be easily misdiagnosed as laryngotracheal or thyroid tumors when presented at an atypical location. It is essential for otolaryngologists and head and neck surgeons to remain vigilant against these tumors. If the tumor is not diagnosed or removed completely, patients may encounter a risk of lethal paroxysm, which is incredibly troublesome.

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Posterior intercostal artery perforator flap for posterior trunk reconstruction: Perforator mapping with high-resolution ultrasound and clinical application

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2018.12.005 ◽

2019 ◽

Vol 72 (5) ◽

pp. 737-743 ◽

Cited By ~ 1

Author(s):

Manfred Schmidt ◽

Thomas Moritz ◽

Andreas Shamiyeh ◽

Maximilian Zaussinger ◽

Julia Jakobus ◽

...

Keyword(s):

High Resolution ◽

Clinical Application ◽

Perforator Flap ◽

Intercostal Artery ◽

Posterior Trunk ◽

Artery Perforator

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Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1731764 ◽

2021 ◽

Author(s):

Jourdain D. Artz ◽

Elisa K. Atamian ◽

Clairissa Mulloy ◽

Mark W. Stalder ◽

Jamie Zampell ◽

...

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Imaging Study ◽

Vessel Diameter ◽

Pubic Tubercle ◽

Computed Tomographic ◽

Flap Design ◽

Preoperative Magnetic Resonance ◽

The Mean ◽

Artery Perforator

Abstract Introduction While the originally described transverse profunda artery perforator (tPAP) flap is designed to capture the first profunda perforator, our group hypothesized the dominant perforator may not always be captured in this configuration. This study maps the location of dominant profunda perforators using imaging and cadaveric dissections to determine the probability of capturing dominant perforators with the transverse flap design versus the vertical PAP (vPAP) variant. Methods Fifty preoperative magnetic resonance angiogram or computed tomographic angiogram scans (100 total extremities) were examined from autologous breast reconstruction patients between 2015 and 2019. Profunda perforator characteristics that were examined included the distance from the pubic tubercle to the infragluteal fold (IGF), the distance of the perforators from the IGF, distance posterior to the gracilis, the diameter of the perforator at fascial exit, and total number of perforators present. Profunda perforator dissection was performed in 18 cadaveric extremities. Analysis included mean distance from pubic tubercle, distance posterior to the gracilis, diameter at fascial exit, and total number of perforators. Results In imaging analysis, the mean distance from the IGF to the fascial exit of all dominant perforators was 7.04 cm. The mean diameter of the dominant perforator at the fascial exit was 2.61 mm. Twenty-six thighs (26%) demonstrated dominant perforators that exited the fascia greater than 8 cm below the IGF. In cadaver dissections, the mean distance from the pubic tubercle to the fascial exit of all the dominant perforators was 10.17 cm. Nine cadaver specimens (50%) demonstrated perforators that exited the fascia greater than 8 cm below the estimated IGF. Conclusion The dominant perforator can often be missed in the traditional tPAP design. The vPAP incorporates multiple perforators with a long pedicle, excellent vessel diameter, and favorable donor-site.

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Anterior Intercostal Artery Perforator Flap as a Simple Technique for Partial Breast Reconstruction: Our Institutional Initial Experience

Tumori Journal ◽

10.1177/0300891620931670 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 40-40

Author(s):

R Amira Maher ◽

Ahmed Gamal Eldin Osman ◽

K Fahmy ◽

Nouf M. Ebied ◽

Reda Eissa

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Perforator Flap ◽

Cosmetic Outcome ◽

University Hospital ◽

Intercostal Artery ◽

Breast Size ◽

Cancer Management ◽

The Mean ◽

Artery Perforator

Background: The oncoplastic surgery has brought new dimensions to breast conserving surgery and added the aesthetic principles of breast surgery to breast cancer management. Recently there's a lot of volume replacement techniques without significant donor site morbidity .The anterior intercostal artery perforator (AICAP) flap is a suitable option in partial breast reconstruction for lower pole tumors in small and medium sized breasts. Objectives: The aim of this study is to report our clinical experience with anterior intercostal perforator flap in partial breast reconstruction Methodology: 25 cases were performed between April 2018 to June 2019 at in Ain shams university hospitals for selected patients with lower breast pole tumors with small and medium sized breast and other option like reduction mMDTmoplasty wasn't favorable for them. Results: A total of 25 patient were selected by the multidisplinary team at Ain shams university hospital for partial breast reconstruction with anterior intercostal artery perforator flap . The mean age of the cases was 45.68 with mean body mass index of 32.32. The mean operative time for the flap was 64 minutes while the hospital stay was ranging from 1-2 days .Follow-up for local recurrence was from 6 to 14 months. There was 1 case with wound complication (4%). The cosmetic outcome was assessed by the MDT and a giving score from 1-5 was used with 1 is the least favorable cosmetic outcome and 5 is the best result 76% of the cases scored 5, 14% scored 4, 8% scored 3. According to patient satisfaction a score from 1 to 5 was used with the score 1 is least satisfied and score 5 represents the most satisfaction level, there was 80% of the patient gave the score 5, 12% of the cases gave the score 4 and 8% of the cases gave the score 3 Conclusions: Based on our experience, partial breast reconstruction using AICAP flap is a reliable option for lower breast tumors in small-to-moderate breast size with perfect cosmetic outcome and negligible rate of complication.

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The Use of Magnetic Resonance Imaging in Planning a Pedicled Perforator Flap for Pressure Sores in the Gluteal Region

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734618772399 ◽

2018 ◽

Vol 17 (2) ◽

pp. 106-112

Author(s):

Sun-June Park ◽

Kyeong-Tae Lee ◽

Byung-Joon Jeon ◽

Kyong-Je Woo

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Perforator Flap ◽

Gluteal Region ◽

Pressure Sores ◽

Resonance Imaging ◽

Inferior Gluteal Artery ◽

Perforator Flaps ◽

Superior Gluteal Artery ◽

Artery Perforator

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses. Intraoperatively, the targeted perforator was marked on the skin at the locations measured on the MRI images, and the marked location was confirmed using intraoperative handheld Doppler. Superior gluteal artery, inferior gluteal artery, or parasacral perforators were used for the PPFs. Surgical outcomes were evaluated. A total of 12 PPFs were performed in 12 patients. Superior gluteal artery perforator flaps were performed in 7 patients, inferior gluteal artery perforator flaps were performed in 3 patients, and parasacral perforator flaps were performed in 2 patients. We could identify a reliable perforator on MRI, and it was found at the predicted locations in all cases. There was only one case of partial flap necrosis. There was no recurrence of the pressure sores during the mean follow-up period of 6.7 months (range = 3-15 months). In selected patients with gluteal pressure sores, MRI is a suitable means for not only providing information about disease extent and comorbidities but also for evaluating perforators for PPF reconstructions.

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An assessment of the anatomical basis of the thoracoacromial artery perforator flap

Canadian Journal of Plastic Surgery ◽

10.1177/229255030301100102 ◽

2003 ◽

Vol 11 (1) ◽

pp. 23-27 ◽

Cited By ~ 17

Author(s):

Christopher Robert Geddes ◽

Maolin Tang ◽

Daping Yang ◽

Steven F Morris

Keyword(s):

Head And Neck ◽

Donor Site ◽

Perforator Flap ◽

Neck Region ◽

Donor Site Morbidity ◽

Pedicled Flap ◽

Perforator Flaps ◽

Thoracoacromial Artery ◽

Lateral Thoracic Artery ◽

Anatomical Basis

Background Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. Perforator flaps are becoming increasingly popular for many applications. In the present study, we set out to examine the various perforators of the thoracoacromial axis through the pectoralis major (PM) muscle with respect to their suitability for transfer to the head and neck region as a pedicled flap. Methods A series of 10 fresh cadavers were injected with lead oxide, gelatin and water (250 mL/kg) through the femoral vessels. The cadavers were cooled and the integument was removed. Perforating vessels from the underlying muscles were marked and the resulting angiograms of the integument and deep tissues were compared with the dissection notes describing the course, size and distribution of the perforating vessels. Results The perforators through the PM muscle to the overlying skin included three regional groups: perforators of the thoracoacromial axis; perforators of the medial intercostal vessels; and perforators of the lateral thoracic artery. The major group of perforators supplying the overlying skin was from the intercostal vessels. However, the thoracoacromial axis did consistently give rise to perforators in the upper portion of the PM muscle. In particular, there were reliable perforators from the clavicular and deltoid branches of the thoracoacromial artery. Discussion The present study illustrates the potential clinical applications of a series of perforator flaps based on the thoracoacromial axis, which may be useful in head and neck reconstructive surgery.

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Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2015.10.015 ◽

2015 ◽

Vol 43 (10) ◽

pp. 2057-2065 ◽

Cited By ~ 12

Author(s):

Olivier Camuzard ◽

Rémi Foissac ◽

Charalambos Georgiou ◽

Lucas Andot ◽

Florent Alcaraz ◽

...

Keyword(s):

Clinical Application ◽

Perforator Flap ◽

Anatomical Study ◽

Facial Artery ◽

Artery Perforator

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Minimally invasive soft tissue reconstruction with free peroneal artery perforator flap

Internal Medicine Review ◽

10.18103/imr.v2i8.173 ◽

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

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.

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