J reconstr Microsurg 2018; 34(01): 013-020
DOI: 10.1055/s-0037-1606122
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Application of Tissue Expansion with Perforator Flaps for Reconstruction of Challenging Skin Lesions

Hainan Zhu1, *, Zhen Gao1, *, Mathias Tremp2, Tao Zan1, Qingfeng Li1, Feng Xie1, Bin Gu1
  • 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
  • 2Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
Further Information

Publication History

21 February 2017

22 June 2017

Publication Date:
13 September 2017 (eFirst)


Background One set of perforators can supply its own perforasome as well as the adjacent perforasome. The process of tissue expansion can mimic the effect of surgical delay to include more perforasomes into the perforator flap. By combining the perforasome theory with the technique of tissue expansion, large and various expanded perforator flaps can be achieved.

Methods From July 2007 to July 2014, we performed eight different types of expanded perforator flaps in a total of 83 cases: 41 supraclavicular artery perforator flaps, 11 superficial cervical artery perforator flaps, 15 lateral thoracic perforator flaps, 6 internal mammary artery perforator flaps, 6 thoracoabdominal perforator flaps, 2 facial artery perforator flaps, 1 posterior interosseous perforator flap, and 1 ulnar collateral artery perforator flap. During the follow-up period, the survival rate, color, texture, and retraction of the flaps were assessed.

Results The dimensions of the flaps ranged from 8 × 6 to 25 × 25 cm. Minor flap necrosis occurred in 20.5% of the cases, and severe flap necrosis developed in 2.4% of the cases. The donor sites were closed primarily in all but three cases. During the follow-up period (average, 13 months; range, 8–18 months), no flap contracture was observed with a good color and texture match.

Conclusion By combining the concept of perforasome with the technique of tissue expansion, flaps with large dimensions and reliable blood supply can be achieved, allowing a more flexible design to reconstruct various and challenging skin lesions.



* These two authors contributed equally to this work and should be listed as co-first authors of this paper.