Synchronous Bilateral Local Medial Sural Artery Perforator Flaps for “Hooker Knees”

2020 ◽  
pp. 1-3
Author(s):  
Geoffrey Hallock ◽  
Geoffrey Hallock
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Ambulatory Patient ◽  
Perforator Flaps ◽  
Basic Principles ◽  
Tissue Ischemia ◽  
Sural Artery ◽  
Artery Perforator

Pressure sores restricted to the knee region in an ambulatory patient are extremely unusual. However, this can be an occupational hazard for the prostitute who is not given the courtesy of adequate breaks to prevent simultaneous bilateral knee tissue ischemia. The existence of this condition to date has been poorly discussed in the reconstructive literature. Yet treatment varies little from the basic principles for pressure sore management. Once that is completed, the medial sural artery perforator flap donor site usually remains uninvolved by any etiological mechanisms and provides a local flap with a long pedicle that potentially can permit the necessary synchronous coverage of the bilateral “hooker knee.”

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

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.

Minimally invasive soft tissue reconstruction with free peroneal artery perforator flap

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

<p> </p><p><span style="font-family: Times New Roman;"> 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.</span></p><p> </p>

The Medial Sural Artery Perforator Flap: A Versatile Donor Site for Hand Reconstruction

2011 ◽  
Vol 70 (3) ◽  
pp. 736-743 ◽  
Author(s):  
Cheng-Hung Lin ◽  
Chih-Hung Lin ◽  
Yu-Te Lin ◽  
Chung-Chen Hsu ◽  
Timothy W. Ng ◽  
...  
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Hand Reconstruction ◽  
Sural Artery ◽  
Artery Perforator

scholarly journals Outcome of Free Medial Sural Artery Perforator Flap (MSAP) for Head and Neck Reconstruction: A Systematic Review and Met Analysis

2021 ◽  
pp. 11-20
Author(s):  
M. M. Hosain
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Case Series ◽  
Perforator Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Pedicle Length ◽  
Flap Thickness ◽  
Sural Artery ◽  
Artery Perforator

Introduction: Since first described by Cadavas, A free medial sural artery perforator flap (MSAP) is getting popularity day by day. Specially, where the micro surgeons are desired to have thin, pliable flap with long pedicle and less donor site morbidities. For its above-mentioned characteristics and good outcome, it is now considered as one of the workhorse flaps for head and neck reconstruction. Aims and Objectives: The aim was to find out the feasibilities and versatilities of this flap as workhorse in head and neck reconstruction. As well as taking into consideration of its low donor site morbidities. Methods: A literature search has been performed in July 2020 in various data base including Pub Med, Trip database, Medline and Google Scholler to find out the outcome of head and neck reconstruction with free MSAP Flap. Data then were tabulated and analysed using Microsoft Excel datasheet. Results: The results were promising. Overall, flap survival rate was 95%. Mean flap dimension was 9.3 cm x5.5 cm. Average pedicle length was 10.5 cm. Mean flap thickness was 6mm. Overall complication rate was 16% including 6% wound related and 2% donor site complication. Most of the cases donor site have closed directly (87%). Conclusion: Free MSAP Flap is an ideal workhorse flap for head and neck reconstruction. However, as most of the literatures were case series or personal experiences of surgeons, a multicentre trial with large sample can give us more information.

Medial Sural Artery Perforator Flap

2012 ◽  
Vol 68 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Xue-Tao Xie ◽  
Yi-Min Chai
Keyword(s):  
Perforator Flap ◽  
Sural Artery ◽  
Artery Perforator

A Maxillofacial Surgeon and Trainee's Perspective of the Medial Sural Artery Perforator Flap

2017 ◽  
Vol 55 (10) ◽  
pp. e124-e125
Author(s):  
Nikhil Maini ◽  
Jag Dhanda ◽  
Brian Bisase ◽  
Aakshay Gulati ◽  
Laurence Newman ◽  
...  
Keyword(s):  
Perforator Flap ◽  
Sural Artery ◽  
Artery Perforator

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.

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