ABSTRACT
The main principles for plastic and reconstructive surgery is to choose the flap donor site with the least damage to the body, so that the recipient site can obtain the best appearance and maximum functional recovery. Perforator flaps are widely used in the field of repair and reconstruction because they conform to this concept. The polyfoliate perforator flap is a special form of the perforator flap. Through the ingenious design, the width can be changed to the length, so that the donor site of the flap can be directly closed; and only one donor site needs to be damaged and a group of blood vessels are anastomosed. It reduces the damage to the body and shorten the operation time. This kind of flap has become a hot spot in clinical repair of large and irregular wounds. The segmented perforator flap further enriches the connotation of the perforator flap and expand the indications of the perforator flap. This article systematically reviews the historical development and evolution of the polyfoliate perforator flap, summarises the clinical application progress of the polyfoliate perforator flap in recent years, and aims to further promote the application and development of the polyfoliate perforator flap in the repair of complex wounds.
ABSTRACT
Objective:To report the clinical effect of using polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects of extremities.Methods:From April 2017 to January 2020, 21 cases of soft tissue defect in extremities were repaired by polyfoliate ALTPF, including 11 cases of traffic accident trauma, 8 of machine crush injury, and 2 of iatrogenic complications. There were 14 cases in calf and ankle, and 7 in hand and wrist. The area of defect was 17.0 cm×12.0 cm-20.0 cm×14.0 cm. Eight cases were complicated with fracture and bone exposure, 13 with tendon and nerve exposure. Thirteen cases had 2 adjacent wounds and 8 had large wound. The polyfoliate ALTPF was designed for wound repair. The patients entered follow-up regularly. The last follow-up included the colour, texture, shape, sensation of the flap and the scar of the donor area.Results:There was no infection in the recipient site of all 21 patients after operation, and all flaps survived. Two cases had venous crisis, with 1 was found in 5 hours after operation. Emergency exploration found that there were thrombosis in anastomosed veins. The flap survived completely after the thrombus removed and the embolized vein was anastomosed again. Another case was found with venous crisis at 1 lobe of flap in 2 hours after operation. Emergency exploration found that the anastomotic site between the superficial vein from the medial edge of the flap to the great saphenous vein and the superficial vein of the recipient area was embolised. The flap survived completely after the thrombus removed and the embolized veins was anastomosed again. The wounds of all donor sites healed in the first stage. All patients were followed-up for 6-30 (mean 12.3) months. All flaps had good colour and texture, with slightly bloated appearance and dull sensation. There was only a linear scar in the donor area, and the appearance evaluation was good.Conclusion:Polyfoliate ALTPF can be used to repair 2 large or adjacent wounds in 1 stage, reduce the damage of donor site. It is an ideal method to repair large or adjacent wounds of limb.
ABSTRACT
This is a report of a complex defects in the right upper extremity treated in the Department of Hand and Microsurgery, 521 Hospital of Norinco Group, in October 2016. The patient received multi-transfers of flaps for one-stage reconstruction, including a double-paddled ALTPF and a compound flap of the great toe and the second toe. Vascular compromises occurred in flaps on the 2nd day after surgery. All the flaps were rescued and survived completely after surgical exploration. Followed-up at 3 year after surgery showed that the appearance and function of the affected limb recovered well. The flexion and extension of elbow and wrist were normal. The pinch function of the reconstructed thumb and index finger recovered well.
ABSTRACT
Objective:To explore the effects of specially formed radial collateral artery perforator flaps in reconstruction of the complex digit defects.Methods:From April, 2014 to March, 2020, 20 patients with multiple digit injuries combined with bone defects were treated by digit reconstruction with radial collateral artery chimeric and polyfoliate perforator flaps. Of the 20 patients, 7 patients were treated by chimeric perforator flaps, 12 by polyfoliate perforator flaps and 1 by chimeric polyfoliate perforator flap. Altogether 28 perforator flaps and 13 bone flaps were taken. The size of perforator flaps were 9.5 cm×4.0 cm to 4.0 cm×2.0 cm, and bone flap were 1.5 cm×0.6 cm×0.6 cm to 2.5 cm×1.0 cm×0.6 cm. All the donor sites were closed directly. Regular follow-up was performed. Function and clinical effect evaluation of repaired digits were made according to the Standard for Upper Limb Function Assessment of Hand Surgery Society of Chinese Medical Association and Sensory Function Assessment Criteria of British Medical Research Council (BMRC).Results:Twenty-seven flaps survived without any event. Venous congestion occurred in 1 flap with partial skin necrosis. Postoperative follow-up lasted from 3 months to 3.5 years (average 17.5 months). The appearance and texture of all flaps were good. All bone flaps properly healed. Sensory recovery achieved S 4 in 8 flaps, S 3 in 16 flaps and S 2 in 4 flaps. Hand function evaluation showed excellent in 12 patients and good in 8 patients. Conclusion:The specially formed radial collateral artery perforator flaps have the features of various designs with reliable blood supply, and are effective in repair of multiple digit injuries combined with soft tissue and bone defects.
ABSTRACT
Objective To investigate the design,incisional method and clinical experiences of using the mi cro-dissected polyfoliate anterolateral thigh perforator flap to repair of complex soft tissue defect in extremities.Methods From June,2017 to September,2018,12 cases of different kinds of complex soft tissue defect in extremities were repaired by micro-dissected free polyfoliate anterolateral thigh perforator flap.Each flap was divided into two cutaneous perforators to give two separate flap with a common vascular supply.The flaps were cut from the superficial layer of the deep cervical fesciae and without fascia lata.The donor sites were treated by subcutaneous cosmetic suture.Patients were followed-up by outpatient service,telephone and WeChat video to observe and record the flap's appearance,sensory recovery,extremities function and the scars of the donor site to evaluate its clinical efficacy.Results All flaps survived without vascular crisis happened except one-leaf necrosis occurred,which healed with local flap transferring.The donor sites remained linear scars.The mean flap thickness of this group after micro-dissection was (4.5±0.5) mm.All the patients were followed-up for 5-15 months.The 2 point discrimination ranged between 0.5-2.0 cm.Sensory restoration ranking was S3-S3+.The range of montion of wrist joint was 65°-90°,and that of ankle joint was 40°-60°.Conclusion The micro-dissected polyfoliate anterolateral thigh perforator flap is an ideal method for complex and irregular multiple sites soft tissue defect in extremities as it can keep good economic benefit and minimal damage to the donor site.