scholarly journals Reconstruction of the First Web Space Using the Wide-Second Dorsal Metacarpal Artery Perforator Flap

2021 ◽  
Author(s):  
Su Hyun Choi ◽  
Ho Jun Cheon ◽  
Sang Ho Oh ◽  
Sang Hyun Woo
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Extensor Retinaculum ◽  
Dorsal Metacarpal Artery ◽  
The Mean ◽  
Web Space ◽  
Normal Thickness ◽  
Excellent Color ◽  
Artery Perforator

Purpose: This study evaluated the functional and aesthetic outcomes of a wide-second dorsal metacarpal artery perforator flap for reconstruction of the first web space of the hand. This flap sets the proximal edge of the extensor retinaculum as the distal limit.Methods: We measured the preoperative and postoperative angles of the first web space and assessed the quality of the donor site scar in eight patients.Results: The average flap size was 5.5 × 2.8 cm (range, 5.0 × 1.5 cm to 5.0 × 6.0 cm), and all flaps survived completely. The mean postoperative angle was 53°. The mean Vancouver Scar Scale score of the donor site was 4 points, and the patients had near-normal thickness and vascularity values. There was no distortion of the scar, and patients were satisfied with the scar appearance of the donor site.Conclusion: The wide-second dorsal metacarpal artery perforator flap is a useful technique to reconstruct large defects of the first web space. It is easy to raise, thin, and pliable, and has excellent color and tissue matching.

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

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.

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

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.

Characteristics of the Superficial Circumflex Iliac Artery Perforator Flap in a Western Population and a Practice Approach for Free Flap Reconstruction

2020 ◽  
Author(s):  
Charles A. Messa ◽  
Martin J. Carney ◽  
Kristopher Tantillo ◽  
Sammy Othman ◽  
Craig Moores ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Donor Site ◽  
Subcutaneous Fat ◽  
Perforator Flap ◽  
Common Femoral Artery ◽  
Vessel Diameter ◽  
North American Population ◽  
Clinical Series ◽  
The Mean ◽  
Artery Perforator

Abstract Background There has been increasing interest in the superficial circumflex iliac artery perforator (SCIP) flap as a source of thin, pliable soft tissue combined with a favorable donor site. Despite several clinical series from Asia, barriers to adoption include reluctance to perform submillimeter “supermicrosurgery” and the effect of body habitus on flap feasibility. The purpose of this study is to distinguish vascular anatomic characteristics of the SCIP flap in a North American population. Methods Computed tomography angiography was examined in 84 flaps in healthy prospective renal donor patients from a radiographic database. Descriptive statistics as well as linear regression comparing variables to body mass index (BMI) were performed. Results Mean BMI was 27.1 ± 3.5 kg/m2, while the mean patient age was 47.8 ± 11.4 years. The superficial circumflex iliac artery (SCIA) originated from the common femoral artery in 92% cases, with remainder originating from the profunda femoris. The mean vessel diameter was 1.85 mm at source vessel origin. Distance from skin to source vessel averaged 30.7 mm. Suprascarpal subcutaneous thickness averaged 16.5 mm. The mean distance from Scarpa's fascia to vessel origin was 14.1 mm. Direct three-dimensional distance from vessel origin to pubic tubercle was 50.2 mm. A medial and lateral perforator split off of the SCIA was observed in 38 cases (45%). Significant differences were shown when comparing BMI to skin to source vessel distance (p < 0.001), suprascarpal subcutaneous fat thickness (p < 0.001), and fascial distance to vessel origin (p < 0.001). BMI did not significantly affect vessel diameter. Conclusion Despite a significantly higher BMI than many previously published cohorts, the SCIP remains an excellent source of thin and pliable tissue. When dissected closer to the source vessel, a vessel caliber of nearly 2 mm can be achieved, which may obviate the need for “supermicrosurgery” in this population.

First Web Space Reconstruction Using a Dorsal Metacarpal Artery Perforator Flap

2014 ◽  
Vol 133 (1) ◽  
pp. 74e-76e ◽  
Author(s):  
Nisal K. Perera ◽  
Warren M. Rozen ◽  
Vachara Niumsawatt ◽  
Edmund Ek
Keyword(s):  
Perforator Flap ◽  
Dorsal Metacarpal Artery ◽  
Web Space ◽  
Artery Perforator

scholarly journals Case Report: Revisiting the Internal Mammary Artery Perforator Flap: Salvage Option for Circumferential Pharyngo-Esophageal Defects

2021 ◽  
Vol 8 ◽  
Author(s):  
Nicholas Marsden ◽  
Lipi Shukla ◽  
Damien Grinsell
Keyword(s):  
Case Report ◽  
Internal Mammary Artery ◽  
Donor Site ◽  
Perforator Flap ◽  
Oral Intake ◽  
Free Tissue Transfer ◽  
Internal Mammary ◽  
Free Closure ◽  
Artery Perforator

Patients that present with pharyngeal strictures and pharyngocutaneous fistulas in the context of previous reconstruction and post-operative radiotherapy often report significant morbidity and reduction in quality of life. Reconstruction of such defects present a substantial clinical challenge requiring the importation of unirradiated vascularized tissue to facilitate healing in a friable, fibrotic, and vessel depleted tissue bed. The authors present a case report demonstrating an adaptation of the internal mammary artery perforator (IMAP) flap for reliable reconstruction of circumferential pharyngeal defects with primary tension free closure of the donor site. This technique avoids the use of free tissue transfer in a hostile, irradiated neck. The tubed IMAP flap is an excellent option, serving the purposes of reconstruction as well as addressing the patient's presenting issues of a chronic sinus and pharyngeal stricture inhibiting oral intake.

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

2020 ◽  
Vol 45 (8) ◽  
pp. 842-848
Author(s):  
Satoshi Usami ◽  
Kohei Inami ◽  
Yuichi Hirase ◽  
Hiroki Mori
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Soft Tissue Reconstruction ◽  
Level Of Evidence ◽  
Tissue Reconstruction ◽  
The Mean ◽  
Lost To Follow Up ◽  
Pulp Repair ◽  
Sensory Reinnervation

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV

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