Free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand

Abstract Background Hand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.The feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand needs to be confirmed in clinical practice. Methods Fifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated. Results The flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12–26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Mean score of scars at the donor site were assessed using the modified Vancouver scar scale (VSS) was 2.7. A puffed appearance in the recipient area was noted in four patients. To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs. Conclusion Free thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

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Free Thoracodorsal Artery Polyfoliate Perforator Flaps for Repairing Multiple Soft Tissue Defects in the Hand

10.21203/rs.3.rs-461312/v1 ◽

2021 ◽

Author(s):

Wenquan Ding ◽

Jianbo Xue ◽

Yingling Zhou ◽

Lingfeng He ◽

Xiaofeng Wang

Keyword(s):

Soft Tissue ◽

Evaluation System ◽

Operative Time ◽

Donor Site ◽

Active Movement ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Short Operative Time ◽

Thoracodorsal Artery ◽

Tissue Defects

Abstract Background: Hand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.To confirm the feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand. Methods: Fifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated. Results: The flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12-26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Obvious scar hyperplasia was noted in three patients. A puffed appearance in the recipient area was noted in four patients.To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs. Conclusion: Free thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

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

Foot & Ankle International ◽

10.1177/107110070502600302 ◽

2005 ◽

Vol 26 (3) ◽

pp. 191-197 ◽

Cited By ~ 15

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.

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Strategy of harvesting extended thoracodorsal artery perforator flaps for resurfacing the large soft-tissue defects of extremities

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2021.11.035 ◽

2021 ◽

Author(s):

Cheng-Ta Lin ◽

Su-Zhen Wu ◽

Lee-Wei Chen

Keyword(s):

Soft Tissue ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Thoracodorsal Artery ◽

Artery Perforator ◽

Tissue Defects

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

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.105956 ◽

2012 ◽

Vol 45 (03) ◽

pp. 478-484 ◽

Cited By ~ 10

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.

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Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606559 ◽

2017 ◽

Vol 33 (S 01) ◽

pp. S27-S33 ◽

Cited By ~ 5

Author(s):

Martina Corno ◽

Salvatore D'Arpa ◽

Pietro Di Summa ◽

Igor Pellegatta ◽

Luigi Valdatta ◽

...

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Donor Site ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Muscle Flaps ◽

Limb Reconstruction ◽

Lower Limb Reconstruction ◽

Tissue Defects

AbstractSoft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge in perforator anatomy and their mapping, a new era of lower limb reconstruction has begun. Propeller flap could be raised on any suitable perforator vessel and, without the aid of microsurgical anastomosis, used to restore small- to middle-sized soft tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous free flaps and the applicability of the propeller flaps in lower limb reconstruction.

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

European Journal of Plastic Surgery ◽

10.1007/s00238-021-01830-4 ◽

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.

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