Local Perforator Flaps in Soft Tissue Reconstruction of the Upper Limb

Abstract

The quality of reconstruction of soft tissue defects in the upper extremity, resulting either from traumatic injury or tumor excision, has relevant implications both from functional and aesthetic standpoints. Various local and free flaps with more or less consistent donor-site morbidity have been described in the past. The recent introduction of the perforator-based flap concept, has led to an evolution in upper extremity reconstruction, optimizing results at the recipient site whilst minimizing damage to the donor site and, performing this in the simplest way possible. In this study between 2001 and 2008, 31 patients having post-traumatic or post-tumor excision soft tissue defects of the upper limb, were treated using local perforator flaps raised according to two different modalities: “pedicled fasciocutaneous” and “transposition fasciocutaneous/cutaneous”. Complete and stable coverage of the soft tissue losses was obtained in all cases with an inconspicuous, only aesthetic, donor-site defect. Superficial or partial necrosis of the tip of the flap, due to venous congestion, was observed in 2 cases of “pedicled fasciocutaneous flap”. An additional surgical procedure was required in only one of these cases. In our series all 9 patients who had a transposition flap, underwent routinely a preoperative echo color Doppler investigation to identify the main perforators. In only one case did the Doppler investigation fail to accurately locate the perforator. Local perforator flaps allow the coverage of medium size defects in the upper extremity, can be raised with a relatively simple surgical technique, have a high success rate and good aesthetic results without functional impairment. In the light of this they can be considered among the surgical choices to resurface complex soft tissue defects of the upper extremity. Preoperative identification of the perforators in case of “transposition flaps” greatly facilitates the operation. In our experience echo color Doppler investigations provided reliable results.

Zusammenfassung

Das Ergebnis der Weichteilrekonstruktion an der oberen Extremität nach Trauma oder Tumorresektion wird sowohl nach funktionellen als auch ästhetischen Kriterien bewertet. Unterschiedliche lokale und freie Lappenplastiken mit einem mehr oder minder ähnlichen Hebedefekt wurden bislang beschrieben. Die Einführung der Perforans-Lappenplastiken hat durch eine Verbesserung der Ergebnisse im Empfängergebiet sowie eine weitere Verringerung des Hebedefekts zu einer Weiterentwicklung der Defektdeckung auch an der oberen Extremität geführt. Zwischen 2001 und 2008 wurden bei 31 Patienten Defekte nach Trauma oder Tumorresektion mittels lokalen Perforans-Lappenplastiken gedeckt, die in zwei unterschiedlichen Techniken gehoben wurden: „gestielte fasziokutane” und „Transpositions-fasziokutane bzw. kutane” Perforans-Lappenplastiken. In allen Fällen konnte eine vollständige Defektdeckung mit einem unauffälligen Hebedefekt erreicht werden. Oberflächliche oder partielle Lappenverluste wurden bei „gestielten fasziokutanen” Lappenplastiken in zwei Fällen beobachtet. In einem Fall war eine sekundäre Operation nötig. Bei allen 9 Patienten mit einer Transpositions-Perforans-Lappenplastik wurde präoperativ eine Doppler Untersuchung durchgeführt, die nur in einem Fall keine zuverlässige Lokalisation des Perforans-Gefäßes ermöglichte. Lokale Perforans-Lappenplastiken ermöglichen die Defektdeckung bei mittelgroßen Defekten der oberen Extremität. Sie können verhältnismäßig einfach gehoben werden, haben eine hohe Erfolgsrate und haben ästhetisch günstige Ergebnisse ohne funktionellen Hebedefekt. Die präoperative Doppler Sonographie erleichtert zuverlässig die intraoperative Indentifikation und Präparation der Perforans-Gefäße.

Key words

local perforator flap - free style flap - propeller flap - upper extremity - reconstruction - hand reconstruction

Schlüsselwörter

lokalen Perforans-Lappenplastiken - Free-style Lappernplastiken - propeller Lappernplastiken - obere Extremität - Rekonstruktion - Handrekonstruktion

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