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Handchir Mikrochir Plast Chir 2023; 55(02): 126-131
DOI: 10.1055/a-2003-6243
Original Article

Transplantation of Ultra-Long Cross-Donor Conjoined Perforator Flaps with Multiple Blood Supply Sources for Wound Repair

Ultralange „siamesische“ Perforans-Lappenplastiken mit multipler Gefäßversorgung
Zhijin Liu
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
,
Shengzhe Liu
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
,
Junnan Cheng
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
,
Lin Yang
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
,
Tao Zhang
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
,
Jihui Ju 
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
,
Ruixing Hou
1   Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
› Institutsangaben
Funding Information Key Technology Application Research of Suzhou Minsheng Science and Technology Project — SS202092, Special Project of Diagnosis and Treatment Technology for Clinical Key Disease Species of Suzhou — LCZX202026, Youth Medical Talent Project of Jiangsu — QNRC2016224
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Abstract

Objective There are reports about the surgical method and clinical efficacy of using ultra-long cross-donor perforator skin flap transplantation with multiple blood supply sources to repair wounds.

Method Between January 2013 and March 2019, 29 wounds were repaired using ultra-long skin flaps from the donor site of the chest, abdomen and anterolateral thigh. All patients were followed up on a regular basis with a view to the following: appearance of skin flap, function of recipient area and healing of donor area.

Result After the operation, all 28 skin flaps were fine. On the fifth day after the operation, one case of a 47-cm anterolateral thigh flap had dark skin color in the distal-most area measuring about 5 cm×4 cm, and the incision showed slow bleeding. In 11 cases, linear scars with soft edges and no obvious contractures were left in the donor area of the chest and abdomen. Eighteen cases with lateral femoral donor sites healed successfully, with linear scars forming without contracture. Three cases with lateral femoral donor sites had wide linear scars that were slightly above skin level and exhibited no contracture.

Conclusion Transplantation of ultra-long conjoined cross-donor perforator flaps with multiple blood supply is beneficial to wound repair and worthy of clinical promotion.

Zusammenfassung

Ziel Es wird über die chirurgische Methode und den klinischen Nutzen von ultralangen Perforans-Lappenplastiken mit mehreren Gefäßstielen berichtet.

Methode Von Januar 2013 bis März 2019 wurden 29 Haut-Weichteil-Defekte mit ultralangen Perforans-Lappenplastiken im Bereich der Brust, der Bauchwand sowie an oberen Extremität geplant. Die Nachuntersuchung fokussierte sich auf das Erscheinungsbild des Hautlappens, funktionales Ergebnis der Empfängerareale und die Hebedefekt an den Entnahmestellen.

Ergebnis Die Operation verlief bei allen 28 Hautlappen komplikationslos. In einem Fall mit einem 47 cm langen Hautlappen zeigte sich am fünften Tag nach der Operation in dem am weitesten von der Blutversorgung entfernten Areal eine livide Verfärbung. Die Inzision zeigte einen verlangsamten Blutfluss. In 11 Fällen verblieben gerade, strichfömige Narben ohne Kontrakturen. In den 18 Fällen mit lateral-femoraler Entnahmestelle wurde eine zufriedenstellende Heilung mit gerader, strichförmiger Narbenbildung ohne Kontraktur festgestellt. Breite lineare Narben über dem Hautniveau fanden sich in drei Fällen mit lateral-femoralen Entnahmestellen.

Schlussfolgerung Die Transplantation ultralanger „siamesischer“ Perforans-Lappenplastiken mit multipler Gefäßversorgung ist vorteilhaft und kann im klnischen Alltag eingesetzt werden.

Key words

Multiple blood supply - cross-donor area - conjoined flap - perforator flap

Schlüsselwörter

multiple Gefäßversorgung - siamesische Lappenplastik - Perforatorlappen


Publikationsverlauf

Eingereicht: 19. März 2022

Angenommen: 19. Oktober 2022

Artikel online veröffentlicht:
13. Februar 2023

© 2023. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Liu Yuanbo, Zhu Shan,Zang, Mengqing, et al. New technology and new method in the research field of perforator flap [J]. Chinese Journal of Plastic Surgery 2019; 35: 835-846
    CrossrefPubMedSuche in Google Scholar
  • 2 Liu Yuanbo, Tang Maolin The history, evolution and enlightenment of perforator flap [J]. Chinese Journal of Plastic Surgery 2018; 34: 681-687
    CrossrefPubMedSuche in Google Scholar
  • 3 Zhou Zhengbing, Tang Juyu, Wu Panfeng, et al. Combined transplantation of bilateral descending branch of lateral femoral circumflex artery perforator flap combined transplantation for treatment of large area tissue defects of upper limbs [J]. Chinese Journal of Hand Surgery 2019; 35: 183-185
    CrossrefPubMedSuche in Google Scholar
  • 4 Ju Jihui, Zhou Rong, Liu Yuefei, et al. The clinical effect of super-long lateral femoral zone pressurized perforator flap for repairing the wounds of the foot and ankle [J]. Chinese Journal of Burns 2019; 35: 495-500
    CrossrefPubMedSuche in Google Scholar
  • 5 Filobbos G, Chapman T, Khan U. Split anterolateral thigh (ALT) free flap for vulva reconstruction: a case report [J]. J Plast Reconstr Aesthet Surg 2012; 65: 525-526
    CrossrefPubMedSuche in Google Scholar
  • 6 Saint-Cyr M, Wong C, Schaverien M. et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124: 1529-1544
    Suche in Google Scholar
  • 7 Xu Yongqing, Chai Yimin, Zhang Shimin, et al. Expert consensus on perforating propeller flaps [J]. Chinese Journal of Microsurgery 2019; 42: 417-422
    CrossrefPubMedSuche in Google Scholar
  • 8 Koshima I. Freeanterolateralthighflapforreconstructionofhead andneck defects following cancer ablation [J]. Plast Reconstr Surg 2000; 105: 2358-2360
    CrossrefPubMedSuche in Google Scholar
  • 9 Kamali P, Lee M, Becherer BE. et al Medial row perforators are associated with higher rates of fat necrosis in bilateral DIEP flap breast reconstruction. Plast Reconstr Surg 2017; 140: 19-24
    CrossrefPubMedSuche in Google Scholar
  • 10 Zhou Peng, Yang Xindong, Xu Xiangdang, et al. Morphological study of perforating artery in the anterolateral thigh area and flap design [J]. Chinese Journal of Microsurgery, 2007, 30: 203-205, 3-3. 10.3760/cma.j.issn.1001-2036.2007.03.013
    PubMed
  • 11 Tang Maolin,Liu Yuanbo Internal connection between axial flap and vascular body area and perforator area [J]. Chinese Journal of Plastic Surgery 2019; 35: 847-853
    CrossrefPubMedSuche in Google Scholar
  • 12 Swanson EW, Hsu YC, Cheng HT. CTA and contrast-enhanced MRA are equally accurate for localizing deep inferior epigastric perforator flap arteries: A systematic review [J]. Journal of Plastic, Reconstructive & Aesthetic Surgery 2015; 68: 580-581
    CrossrefPubMedSuche in Google Scholar
  • 13 Kammerer S, Mueller-Eschner M, Berkefeld J. et al. Time-resolved 3D Rotational Angiography (4D DSA) of the Lenticulostriate Arteries: Display of Normal Anatomic Variants and Collaterals in Cases with Chronic Obstruction of the MCA [J]. Clinical Neuroradiology 2017; 7: 451-457
    CrossrefPubMedSuche in Google Scholar
  • 14 Xu Tiantian, Lin Ping, Chen Ailan, et al. Application of infrared thermal imaging camera combined with high frequency color Doppler ultrasound in perforator positioning before anterolateral thigh perforator flap transplantation [J]. Chinese Journal of Hand Surgery 2018; 34: 414-417
    CrossrefPubMedSuche in Google Scholar
  • 15 Zhou Rong, Ju Jihui, Yang Liang, et al. Double-leaf anterolateral femoral flap transplantation to repair complex wounds of the foot and ankle [J]. Chinese Journal of Plastic Surgery 2019; 35: 779-784
    CrossrefPubMedSuche in Google Scholar
  • 16 Pierrefeu A, Brosset S, Lahon M. et al. Transverse Facial Artery Perforators: Anatomical, Two- and Three-Dimensional Radiographic Study. Plast Reconstr Surg 2019; 143: 820e-828e
    CrossrefPubMedSuche in Google Scholar
  • 17 Teotia SS, Dumestre DO, Jayaraman AP. et al. Revisiting Anastomosis to the Retrograde Internal Mammary System in Stacked Free Flap Breast Reconstruction: An Algorithmic Approach to Recipient-Site Selection. Plast Reconstr Surg 2020; 145: 880-887
    CrossrefPubMedSuche in Google Scholar