• Archives of Plastic Surgery
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• v.36 no.5
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• pp.559-564
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• 2009

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.70-76
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• 2006

This study investigated the clinical application of anterolateral thigh (ALT) perforator flap in reconstruction of soft tissue defect of lower extremity. There were twenty-one patients who had been taken soft tissue reconstruction with anterolateral thigh perforator flap. There were 19 males and 2 females between 3 and 65 years (mean, 36 years). This study included 4 cases of pedatric case of under 10-year-old. All cases were a cutaneous flap. Flap size averaged $160\;cm^2\;(20{\sim}450\;cm^2)$. 19 cases were musculocutaneous perforator flaps and 2 were septocutaneous perforator. T-shaped pedicle were used to reconstruct and to preserve major artery of lower extremity in 2 cases. 19 cases flaps survived completely and 2 cases flap were marginal necrosis partially. There was venous congestion in one case of type of reverse island flap but that was improved after salvage procedure with leech. While the donor sites were closed directly in 5cases, 16 cases underwent skin graft. ALT flap is suitable for coverage of defects in lower extremity where have various condition and reliable in children as in adult.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.595-599
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• 2010

Purpose: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. Methods: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. Results: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was $6{\times}4\;cm$. The largest flap dimension was $14{\times}7\;cm$. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. Conclusion: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.109-116
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• 2017

Background The effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser-Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik). Methods Nine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively. Results The measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures. Conclusions The liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.37-42
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• 2016

Purpose: Soft tissue coverage of the distal leg and ankle region represents a surgical challenge. Beside various local and free flaps, the perforator flap has recently been replaced as a reconstructive choice because of its functional and aesthetic superiority. Although posterior tibial artery perforator flap (PTAPF) has been reported less often than peroneal artery perforator flap, it also provides a reliable surgical option in small to moderate sized defects especially around the medial malleolar region. Materials and Methods: Seven consecutive patients with soft tissue defect in the ankle and foot region were enrolled. After Doppler tracing along the posterior tibial artery, the PTAPF was elevated from the adjacent tissue. The average size of the flap was $28.08{\pm}9.31cm^2$ (range, 14.25 to $37.84cm^2$). The elevated flap was acutely rotated or advanced. Results: Six flaps survived completely but one flap showed partial necrosis because of overprediction of the perforasome. No donor site complications were observed during the follow-up period and all seven patients were satisfied with the final results. Conclusion: For a small to medium-sized defect in the lower leg, we conducted the close-by islanded PTAPF using a single proper adjacent perforator. Considering the weak point of the conventional propeller flap, this technique yields much better aesthetic results as a simple and reliable technique especially for defects of the medial malleolar region.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.29-36
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• 2018

Background The emergence of breast-conserving surgery combined with radiotherapy as the treatment of choice for early stage breast cancer has resulted in greater focus on oncoplastic breast surgery. The use of perforator flaps has particularly gained in reputation for its effectiveness in the reconstruction of partial breast defects in Korean women. Herein, we present our experience with the use of thoracodorsal artery perforator (TDAP) and lateral intercostal artery perforator (LICAP) flaps. Methods This study included 33 patients who underwent breast reconstruction using TDAP or LICAP flaps at our hospital from January 2011 to December 2014. Data from patient medical records, and patient satisfaction surveys, which were conducted 12 months postoperatively, were retrospectively evaluated. Results TDAP and LICAP flap-based reconstructions were performed in 14 and 19 patients, respectively. Five patients developed complications that required additional intervention. Overall patient satisfaction was observed to be excellent in 15 (46%) patients, and good in 12 (36%). Conclusions Based on our experience, oncoplastic breast surgery using TDAP or LICAP flap is an effective remodeling technique for small-to-moderate breast defects in Korean women with smaller breasts.

• Archives of Plastic Surgery
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• v.51 no.4
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• pp.408-416
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• 2024

Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator. Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021. Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed. Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT-TFL can be harvested for large, complex, multicomponent, and multidimensional defects.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.523-528
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• 2023

The Gustilo IIIB tibiofibular fractures often result in long bone loss and extensive soft tissue defects. Reconstruction of these complex wounds is very challenging, especially when it includes long bone grafts, because the donor site is limited. We describe our experience using a set of chimeric ipsilateral vascularized fibula grafts with a thoracodorsal artery perforator free flap to reconstruct the traumatic tibia defects. A 66-year-old male suffered a severe comminuted tibia fracture and segmented fibula fracture with large soft tissue defects as a result of a traffic accident. He also had an open calcaneal fracture with soft tissue defects on the ipsilateral side. All the main vessels of the lower extremity were intact, and the cortical bone defect of the tibia was almost as large as the fractured fibula segment. We used an ipsilateral vascularized fibula graft to reconstruct the tibia and a thoracodorsal artery perforator flap to resurface the soft tissue, using the distal ends of peroneal vessels as named into sequential chimeric flaps. After 3 weeks, the calcaneal defect was reconstructed with second thoracodorsal artery perforator free flap. Reconstruction was successful and allowed rapid rehabilitation because of reduced donor site morbidity.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.87-93
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• 2008

Purpose: Because of good blood supply of the pedicled perforator flap and its advantage of not requiring vessel anastomosis compared to pedicled flap, it is widely used recently. The authors intended to report the results of various pedicled perforator flaps which have been performed to reconstruct the soft tissue defects and the utility of the flap. Methods: The study was conducted for 12 cases of pedicled perforator flap which were performed at the plastic surgery department of the current hospital from the period of June, 2005 to August, 2008. Four patients were male and eight patients were female and their age was ranged from 22 to 74 years old with mean age of 42.6 years old. The sites were 1 case on face, 3 cases on chest, 3 cases on back, 4 cases on coccyx, and 1 case on foot. Results: The defect sites of all patients were successfully reconstructed by using the pedicled perforator flap. Although most of the flaps revealed congestion at the early stage after the surgery, they were recuperated within few days. One case of skin flap was reported to be partially necrotized in old age woman who has no reliable perforator. Other than that, all defects were covered successfully and acceptable aethetically. Conclusion: As stated in above, the pedicled perforator flap has many useful advantages than the conventional pedicled flap and various free flap. Unless free flap must be required, the use of pedicled perforator flap is recommended by first choice for soft tissue coverage.

• Archives of Plastic Surgery
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• v.47 no.6
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• pp.535-541
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• 2020

The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.