Download PDF
J Reconstr Microsurg 2021; 37(01): 017-021
DOI: 10.1055/s-0040-1715814
Review Article

Combined Tissue Transfer for Extensive Lower Limb Complex Defects: Flow-through Flaps, Chimera, and “Orochi” Flaps

Isao Koshima
1   International Center for Lymphedema (ICL), Hiroshima University Hospital, Hiroshima City, Japan
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Perforator flaps can be raised anywhere in the body, with minimal donor-site deformity, and can be made into custom-made combined composite flaps, especially for severe complex defects such as osteomyelitis of the lower limbs. Here, we report on the representative application of the combined tissue transfers for complex leg defects. For a wide range of complex defects in the lower extremity, it is necessary to perform reliable revascularization by bypass or flow-through type or vein graft. At the same time, a chimeric or “Orochi” type combined transfer using a minimally invasive perforator flaps and a well-vascularized bone flap are useful. In the case of nerve palsy, it could be possible to combine vascularized nerve flaps. Combined tissue transfers with less invasive donor will be more available in the future.

Keywords

combined tissue transfer - Orochi flap - complex defect - chimera flap - flow-through flap

Note

This work is based on the content published so far and the content presented at the 60th Annual Meeting of Japanese Society of Plastic and Reconstructive Surgery, Fukuoka, April 13, 2018.




Publication History

Received: 24 April 2020

Accepted: 15 July 2020

Article published online:
07 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Koshima I, Kawada S, Etoh H, Kawamura S, Moriguchi T, Sonoh H. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities. Plast Reconstr Surg 1995; 95 (02) 252-260
    CrossrefPubMedGoogle Scholar
  • 2 Koshima I, Fujitsu M, Ushio S, Sugiyama N, Yamashita S. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg 2005; 115 (01) 155-162
    CrossrefPubMedGoogle Scholar
  • 3 Koshima I, Saisho H, Kawada S, Hamanaka T, Umeda N, Moriguchi T. Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs. Plast Reconstr Surg 1999; 103 (05) 1483-1490
    CrossrefPubMedGoogle Scholar
  • 4 Koshima I, Narushima M, Mihara M. et al. New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb. J Plast Reconstr Aesthet Surg 2010; 63 (01) 140-145
    CrossrefPubMedGoogle Scholar
  • 5 Koshima I. Classification of combined or connected tissue (flap) transfers. Rely. Ann Plast Surg 1994; 33 (04) 462
    PubMedGoogle Scholar
  • 6 Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg 1993; 92 (03) 411-420
    CrossrefPubMedGoogle Scholar
  • 7 Koshima I, Hosoda M, Moriguchi T, Hamanaka T, Kawata S, Hata T. A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full-thickness defect of the mental region. Ann Plast Surg 1993; 31 (02) 175-180
    CrossrefPubMedGoogle Scholar
  • 8 Koshima I. A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, Siamese, chimeric, mosaic, and chain-circle flaps. Acta Med Okayama 2001; 55 (06) 329-332
    PubMedGoogle Scholar
  • 9 Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg 2011; 127 (04) 1720-1729
    CrossrefPubMedGoogle Scholar
  • 10 Yoshimatsu H, Yamamoto T, Hayashi N, Kato M, Iida T, Koshima I. Reconstruction of the ankle complex wound with a fabricated superficial circumflex iliac artery chimeric flap including the sartorius muscle: a case report. Microsurgery 2017; 37 (05) 421-425
    CrossrefPubMedGoogle Scholar
  • 11 Tang L, Pafitanis G, Yang P. et al. Combined multi-lobed flaps: a series of 39 extensive hand and multi-digit injuries one-staged reconstructions using modified designs of ALT, DPA and chimeric linking flaps. Injury 2017; 48 (07) 1527-1535
    CrossrefPubMedGoogle Scholar
  • 12 Koshima I, Imai H, Yoshida S. et al. The ‘Orochi’ flap concept: multi-stage combined flap using sequential flaps. Int Microsurg J 2019; 3 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 13 Koshima I, Inagawa K, Urushibara K, Moriguchi T. One-stage facial contour augmentation with intraoral transfer of a paraumbilical perforator adiposal flap. Plast Reconstr Surg 2001; 108 (04) 988-994
    CrossrefPubMedGoogle Scholar
  • 14 Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N. Free thin paraumbilical perforator-based flaps. Ann Plast Surg 1992; 29 (01) 12-17
    CrossrefPubMedGoogle Scholar
  • 15 Soutar DS, Scheker LR, Tanner NS, McGregor IA. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 16 Foucher G, van Genechten F, Merle N, Michon J. A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap. Br J Plast Surg 1984; 37 (02) 139-148
    CrossrefPubMedGoogle Scholar
  • 17 Koshima I. IMC (International Microsurgery Club) Webinar: New Area on Super-Micro to Nanomicrosurgery. May 2. 2020 (518 audiences all over the world)
    PubMedGoogle Scholar
  • 18 Koshima I. RSCM Webinar, Live Lecture from Hiroshima: Supermicro to Nanomicrosurgery: A New Era. Universitas Indonesia, June 9, 2020
    PubMedGoogle Scholar
  • 19 Fernandez-Garrido M, Lopez Penha TR, Qiu SS. Flow-through flaps in the absence of an arterial gap for extremity defect reconstruction: minimizing the donor-site morbidity. J Reconstr Microsurg 2019; 35 (05) 329-334
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Hamscha UM, Weninger WJ, Freystätter C, Tzou CH, Radtke C. Anatomical study of a chimeric fascio-osteomyocutaneous fibula flap for free microvascular tissue transfer. J Reconstr Microsurg 2019; 35 (06) 438-444
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Karir A, Stein MJ, Shiga S, Zhang J. Reconstruction of lower extremity defects using the serratus anterior free flap: a systematic review and retrospective case series. J Reconstr Microsurg 2020; 36 (02) 116-126
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Baek SM. Two new cutaneous free flaps: the medial and lateral thigh flaps. Plast Reconstr Surg 1983; 71 (03) 354-365
    CrossrefPubMedGoogle Scholar
  • 23 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
    CrossrefPubMedGoogle Scholar
  • 24 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
    CrossrefPubMedGoogle Scholar
  • 25 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96 (07) 1608-1614
    CrossrefPubMedGoogle Scholar
  • 26 Blondeel PN, Van Landuyt KH, Monstrey SJ. et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112 (05) 1378-1383 , quiz 1383, 1516, discussion 1384–1387
    CrossrefPubMedGoogle Scholar
  • 27 Koshima I, Nanba Y, Tsutsui T. et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg 2004; 113 (01) 233-240
    CrossrefPubMedGoogle Scholar
  • 28 Suzuki K, Kino Y, Kondo K, Kimata I, Miyazaki Y. Analysis of LDMC flap for runover injury in children. J Japan Soc Reconstr Microsurg 1995; 8 (03) 172-173
    PubMedGoogle Scholar
  • 29 Koshima I, Narushima M, Mihara M. et al. Island medial plantar artery perforator flap for reconstruction of plantar defects. Ann Plast Surg 2007; 59 (05) 558-562
    CrossrefPubMedGoogle Scholar
  • 30 Koshima I, Fukuda H, Soeda S. Free combined anterolateral thigh flap and vascularized iliac bone graft with double vascular pedicle. J Reconstr Microsurg 1989; 5 (01) 55-61
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Namba Y, Kimata Y, Koshima I, Sugihara S, Sato T. Fibular osteoadiposal flap for treatment of tibial adamantinoma: a case report. Acta Med Okayama 2006; 60 (04) 233-236
    PubMedGoogle Scholar
  • 32 Koshima I, Kawada S, Etoh H, Kawamura S, Morigichi T, Sonoh H. Flow-through anterior thigh flaps for one-stage reconstruction of soft tissue defects and revascularization of ischemic extremities. Plast Reconstr Surg 1995; 95 (02) 252-260
    CrossrefPubMedGoogle Scholar