scholarly journals Perforator flaps based on the deltoid branch of the thoracoacromial artery: anatomical study

2021 ◽  
Vol 15 (1) ◽  
pp. 36-43
Author(s):  
Philippe Manyacka Ma Nyemb ◽  
Christian Fontaine3 ◽  
Véronique Duquennoy-Martinot ◽  
Xavier Demondion
Keyword(s):  
Perforator Flap ◽  
Anatomical Study ◽  
Free Flaps ◽  
Average Diameter ◽  
Cervical Region ◽  
Anatomical Landmarks ◽  
Perforator Flaps ◽  
Thoracoacromial Artery ◽  
Lateral Triangle ◽  
Perforator Arteries

Objectives: Tissue defects in the lateral triangle of the neck and the anterior cervical region represent a high demand for plastic and reconstructive surgery. Their management most often requires regional or free flaps. The perforator flap based on the deltoid branch of the thoracoacromial artery (TAA) may be a good solution for these indications. The objective of this work is to propose anatomical landmarks to raise perforator flaps pedicled on the deltoid branch of the TAA. Methods: We carried out dissection of 24 perforator flaps based on the deltoid branch of the TAA, in body donor specimens preserved in a glycerin-rich, formalin-free solution. The TAA was first injected with methylene blue. The vascular territory, location of perforators relative to known landmarks, along with the flap’s potential amplitude and arc of rotation were studied. Results: The main perforating arteries of the flap were located in the middle of the deltopectoral groove, often surrounded by adipose tissue in 18 out of 24 dissections. In 22 out of 24 dissections, there were at least 2 perforator arteries originating from the deltoid branch. The average diameter of the perforator arteries was 1 mm. The flap’s amplitude of movement made it possible to reach in all cases the lateral triangle of the neck and the anterolateral cervical region. Conclusion: The thoracoacromial artery has already been used for perforator flaps. However, the individualization of its deltoid branch offers to practitioners new surgical options. This anatomical study of the perforator flap based on the deltoid branch of the TAA made it possible to review the anatomical bases for the raising of this flap, and to fix useful landmarks for the surgeon in order to propose an easily feasible surgical technique.

Free versus Pedicled Perforator Flaps for Lower Extremity Reconstruction: A Multicenter Comparison of Institutional Practices and Outcomes

2018 ◽  
Vol 34 (08) ◽  
pp. 572-580 ◽  
Author(s):  
Keith Koh ◽  
Terence Goh ◽  
Christopher Song ◽  
Hyun Suh ◽  
Peter Rovito ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Soft Tissues ◽  
Perforator Flap ◽  
Free Flaps ◽  
Careful Consideration ◽  
Pedicled Flap ◽  
Perforator Flaps ◽  
Body Regions ◽  
Significant Difference

Background Of all body regions, lower extremity wounds have been and remain the greatest challenge. Perforator free flaps have been accepted as a reasonable option to solve this dilemma but require the complexity of microsurgery. As a consequence, the possibility that pedicled perforator flaps could supplant even perforator free flaps has recently gained intense enthusiasm. Methods A retrospective investigation was undertaken to compare the validity for the use of perforator flaps of all types at three dissimilar institutions, that is, a university, a regional center, and a community hospital. All flaps performed in the 5-year period, 2011 to 2015, were included to allow at least 1-year follow-up before data analysis. A total of 433 free perforator flaps and 52 pedicled perforator flaps had been performed specifically for the lower extremity. Results Patient demographics, wound etiology, and comorbidities were similar for all institutions. Free flaps were more commonly needed after trauma and for chronic ulcers. Pedicled flaps were more likely an option after tumor excision. Large defects or those involving the foot were better served by free flaps. Overall success for free perforator flaps was 90.1% and for pedicled perforator flaps was 92.3%, with no significant difference noted (p = 0.606) between institutions. Peripheral vascular disease was the only significant comorbidity risk factor for both free and pedicled flap failure. Conclusion Perforator flaps in general have become a reasonable solution for soft tissue defects of the lower extremity. Following careful consideration of the etiology, dimensions, location, patient comorbidities, and presence of adequate perforators, a pedicled or free perforator flap could potentially be successful. Pedicled perforator flaps, if adequate healthy soft tissues remain adjacent to the defect, forecast a continuance of the evolution in seeking simplicity yet reliability by the best flap possible for soft tissue closure of the lower limb wound.

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

2003 ◽  
Vol 11 (1) ◽  
pp. 23-27 ◽  
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.

scholarly journals Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

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.

scholarly journals THE APPLICATION OF THE DISTAL POSTERIOR TIBIAL ARTERY PERFORATOR FLAPS IN CHRONICS WOUNDS

2021 ◽  
Vol 8 (7) ◽  
Keyword(s):  
Lower Limb ◽  
Chronic Wounds ◽  
Skin Flap ◽  
Perforator Flap ◽  
Free Flaps ◽  
Posterior Tibial Artery ◽  
Perforator Flaps ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Artery Perforator

INTRODUCTION: The reconstruction of lesions in the distal third of the leg is one of the challenges for surgeons. In this scenario, the use of posterior tibial perforator flaps is being used more and more in surgical practice due to their versatility and aesthetic results. MATERIALS AND METHODS: This research consists of an integrative review carried out from a bibliographic survey in the PUBMED and Virtual Health Library (BVS) search platforms. After reading the full 20 articles in total, an overlap of four articles present in the two searches was observed, thus resulting in a total of 16 articles included in this review. RESULTS: The treatment of chronic lower limb wounds caused by infection, diabetes mellitus and osteomyelitis has always been a formidable task. Perforator-free flaps are generally recommended as the therapy of choice in the treatment of chronic lower limb wounds. DISCUSSION: The advantages of the application of the posterior tibial artery skin flap is ideal for small leg defects to reconstruct the exposed bone and tendon. As it is local tissue, it substitutes as tissue. The distal posterior tibial artery perforator flap is a beneficial technique, in the plastic and reconstructive surgery field, especially for the treatment of chronic lower extremity wounds. Keyword : CHRONIC WOUNDS, DISTAL POSTERIAL TIBIAL ARTERY, PERFORATOR FLAP, PLASTIC SURGERY

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

2020 ◽  
Author(s):  
Mario Cherubino ◽  
Alberto Bolletta ◽  
Tommaso Baroni ◽  
Giuseppe Di Taranto ◽  
Luigi Losco ◽  
...  
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Vascular Anatomy ◽  
Perforator Flap ◽  
Anatomical Study ◽  
Ulnar Artery ◽  
Donor Site Morbidity ◽  
Vascular Supply ◽  
Perforator Flaps ◽  
Level Of Evidence

Abstract Background The purpose of this study is to document the vascular anatomy of the free ulnar artery proximal perforator flap and to highlight the possibility of harvesting it based on the perforators originating from the posterior ulnar recurrent artery (PURA), to spare both the main axis of vascular supply to the hand. In addition, we present a case series of five patients treated for soft tissue defects of the hand with free ulnar artery proximal perforator flaps. Methods Ten specimens of anterior forearm were dissected in this study to register number and characteristics of ulnar perforators. The dissection was focused on the perforators originating from the larger branch of the ulnar artery, the PURA, at the proximal third of anteromedial forearm. The anatomical dissections were evaluated in relationship with clinical dissections performed during flap harvesting in five patients. Results In three of the specimens dissected, the proximal perforator originated from the PURA, and in the other seven specimens, it originated directly from the ulnar artery. Five cases of reconstruction of the hand were performed with success using the free ulnar artery proximal perforator flap, and in two cases, the perforator from the PURA was found and it was possible to raise the flap based on this branch of the ulnar artery. Conclusion The free ulnar artery proximal perforator flap can be harvested in two different manners for the same skin island of the forearm. When possible, harvesting it form the PURA allows lengthening of the pedicle. In our experience, this flap presents many advantages such as thinness and hairlessness; it allows preservation of the ulnar neurovascular bundle with an acceptable donor site morbidity. Level of evidence: IV.

scholarly journals Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Di Deng ◽  
Feng Xu ◽  
Jifeng Liu ◽  
Bo Li ◽  
Linke Li ◽  
...  
Keyword(s):  
Clinical Application ◽  
Cancer Metastasis ◽  
Perforator Flap ◽  
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 × 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.

scholarly journals Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

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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