scholarly journals Vein-Supercharged Peroneal Artery Perforator Propeller Flap for Achilles Soft Tissue Coverage

1970 ◽  
Vol 2 (2) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Laureen Supit
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Peroneal Artery ◽  
Soft Tissue Coverage ◽  
Aesthetic Result ◽  
Propeller Flap ◽  
Split Thickness Skin Grafting ◽  
Artery Perforator

Background: Wounds on the distal third of the lower extremity are reconstructively challenging, as there is lack of spare local tissue to design local flaps from. The perceived alternative is to perform free flaps to cover for these defects. Drawbacks include the need for specific training to perform microsurgery, longer time required, and the probable bulkiness when donor is obtained from certain areas. The perforator propeller flap is a local island fasciocutaneous flap, designed with 2 blades of skin island of unequal length extending from each side of the perforator. As the flap is rotated, the longer blade will cover the defect. Patient and Method: A case of soft tissue defect on the achilles is reported, with successful defect closure by utilizing a peronal artery perforator based fasciocutaneous propeller flap with 180 degree rotation and vein supercharge to facilitate backflow. Secondary defect required split-thickness skin grafting. Result: After surgery, muscles of the lower limb started to swell and get compromised. We removed some stitches to allow soft tissue expansion underneath the flap. after the release, flap perfusion improved. Stitches were left open for 3 days, then closure of flap edges by placing gradual traction sutures which were tightened daily. By the 7th day, flap edges was re-approximated and the skin grafts took well. Summary: The ability of the propeller flap to rotate makes this flap highly useful and versatile for the reconstruction of distal lower limb defects. Flap dimension can be enhanced when distal part of the flap is supercharged to neighboring recipient vessels. Another advantage is the close vicinity of donor, giving better aesthetic result.6

scholarly journals A Study of Clinical Applications of Perforator-Based Propeller Flaps in Leg Reconstructive Surgery: A Single-Center Experience of 40 Cases

2019 ◽  
Vol 19 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Shahab Faria Shahabuddin ◽  
Mohammed Fahud Khurram
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Soft Tissue Defect ◽  
Surgical Reconstruction ◽  
Flap Necrosis ◽  
Aesthetic Result ◽  
Propeller Flap ◽  
Degloving Injury ◽  
Group I ◽  
Group Ii

Soft tissue management in lower limb poses a considerable challenge to a reconstructive plastic surgeon. Perforator-based propeller flaps can cover large wounds without sacrificing a major vascular axis and allows reconstruction using nearby similar tissues, thereby following the principle of replace like with like. This study was undertaken with the objective to look for the results of propeller flap in lower limb reconstruction and how the results can be improved. This was a retrospective study on 40 patients who underwent the reconstruction of soft tissue defects of lower limb with propeller flap. All the relevant data were collected and analyzed. Patients with soft tissue defect anywhere in the leg were included, but patients who had history of degloving injury, peripheral vascular disease, and diabetes mellitus were excluded. All these patients were divided in 2 groups according to the angle of rotation of propeller flap. Group I had 20 patients in which the flap was rotated by 150° to 180°. Group II had 20 patients, and the flap was rotated by 90° to 150°. Postoperatively, the first 2 cases in Group I showed total flap congestion and had complete necrosis, which were debrided and an alternate method was used to reconstruct. Thereafter, no patient had total flap necrosis. Minor complications were seen in 3 patients who showed transient venous congestion of the flap. Group II had no flap necrosis except for mild dehiscence, which was managed by secondary suturing. In most cases, the aesthetic result was acceptable and patients were completely satisfied. When parameters of the defect are suitable for treatment with a propeller-based local flap, this technique may be considered as the first option for surgical reconstruction. Proper planning, location of perforator with preoperative and intraoperative audio Doppler, and use of magnification would make this procedure more successful and definitely decrease the use of long-duration microvascular surgery.

Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

2020 ◽  
pp. 000348942094678
Author(s):  
Chen Lin ◽  
Akina Tamaki ◽  
Enver Ozer
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Single Mode ◽  
Soft Tissue Defect ◽  
Peroneal Artery ◽  
Soft Tissue Coverage ◽  
Large Defect ◽  
Skin Paddle ◽  
Lower Lip ◽  
Fibula Free Flap

Objective: Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap. Methods: Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment. Results: The fibula free flap was split into proximal (80 cm2) and distal (120 cm2) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip. Conclusions: The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap – one of the largest reported in the literature – as a single mode of reconstruction.

scholarly journals Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

2017 ◽  
Vol 45 (3) ◽  
pp. 1074-1089 ◽  
Author(s):  
Lifeng Shen ◽  
Yiyang Liu ◽  
Chun Zhang ◽  
Qiaofeng Guo ◽  
Wenhua Huang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Lower Leg ◽  
Soft Tissue Defect ◽  
Venous Congestion ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Propeller Flap ◽  
Perforator Vessel ◽  
Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects

2011 ◽  
Vol 64 (3) ◽  
pp. 386-393 ◽  
Author(s):  
Ting-Chen Lu ◽  
Cheng-Hung Lin ◽  
Chih-Hung Lin ◽  
Yu-Te Lin ◽  
Ruei-Feng Chen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Leg ◽  
Peroneal Artery ◽  
Soft Tissue Coverage ◽  
Perforator Flaps ◽  
Artery Perforator

Modified Anterior Tibial Artery Perforator-Pedicled Propeller Flap for Soft-Tissue Coverage of the Ankle and Heel

2020 ◽  
Vol 44 (7) ◽  
pp. 2237-2242 ◽  
Author(s):  
Jian Lin ◽  
Feng Zhou ◽  
Yi-Dan Sun ◽  
Ya-Shan Gao ◽  
Hai-Zhou Li ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Anterior Tibial Artery ◽  
Soft Tissue Coverage ◽  
Tibial Artery ◽  
Propeller Flap ◽  
Anterior Tibial ◽  
Artery Perforator

Distally Based Peroneal Artery Perforator-Plus Fasciocutaneous Flap to Reconstruct Soft Tissue Defect Combined With Chronic Osteomyelitis in the Lateral Malleolus

2020 ◽  
pp. 153473462095678
Author(s):  
Zhaobiao Luo ◽  
Zhonggen Dong ◽  
Jiangdong Ni ◽  
Jianwei Wei ◽  
Ping Peng ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Chronic Osteomyelitis ◽  
Soft Tissue Defect ◽  
Lateral Malleolus ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Distally Based ◽  
Artery Perforator ◽  
Tissue Defects

Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used to reconstruct soft tissue defects of the lower extremity. Treatment for soft tissue defect combined with chronic osteomyelitis in the lateral malleolus has rarely been reported. The aim of this study was to elaborate the superiority of the DPAPF flap and provide referential experience for using the DPAPF flap in this situation. Between June 2010 and December 2017, soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus were reconstructed with DPAPF flaps in 17 patients. After thorough debridement, the defect was repaired with the DPAPF flap, and patients subsequently followed an antibiotic regimen for 6 weeks. Follow-up periods for all patients were at least 24 months. The reconstruction outcomes and the satisfaction of the 17 patients were evaluated. Of the 17 flaps, 16 survived uneventfully, except one occurrence of partial necrosis. No infection occurred in the follow-up period. In the study, 17 patients except one were satisfied with flap appearance. All the patients were satisfied with the reconstruction outcomes. In a one-stage procedure, the use of DPAPF flaps is ideal for reconstructing soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus.

Clinical Application of the Peroneal Artery Perforator Flap for Reconstruction of Lateral Malleolus Defects

2021 ◽  
pp. 153473462110158
Author(s):  
Yu-Jen Shih ◽  
Yen-Chun Wang ◽  
Chin-Ta Lin ◽  
Shun-Cheng Chang ◽  
Yuan-Sheng Tzeng ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Skin Grafting ◽  
Lateral Malleolus ◽  
Peroneal Artery ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Ankle Joints ◽  
The Mean ◽  
Artery Perforator

The reconstruction of defects of the lateral malleolus involving the exposed fibular bone or tendon is challenging. This study aimed to evaluate the clinical application of the peroneal artery perforator flap with or without split-thickness skin grafting for soft tissue reconstruction of the bony defect of the lateral malleolus of the ankle joints. Reconstruction using a peroneal artery perforator flap with or without split-thickness skin grafting was performed for 15 patients (10 men, 5 women) between January 2007 and December 2018. The mean age was 53.7 years, and the mean size of the flaps was 40 cm2. The flaps were elevated in the form of a perforator flap, and split-thickness skin grafting was performed over the flaps and adjoining raw areas. The flaps survived in all cases; however, partial necrosis was observed in 3 cases. In cases of small-sized defects of the lateral malleolus of the ankle joints where a flap is required for the exposed bone or tendon, reconstruction using the peroneal artery perforator flap is advantageous, since the morbidity rate of the donor site is low and soft tissue is reconstructed.

Laparoscopic Greater Omentum Harvesting with Split-Thickness Skin Grafting for Sternal Wound Dehiscence

2006 ◽  
Vol 72 (9) ◽  
pp. 829-832
Author(s):  
Barnard A. Barragan ◽  
Ari O. Halldorsson ◽  
Mitchell S. Wachtel ◽  
Eldo E. Frezza
Keyword(s):  
Soft Tissue ◽  
Wound Dehiscence ◽  
Skin Grafting ◽  
Soft Tissue Defect ◽  
Omental Flap ◽  
Greater Omentum ◽  
Soft Tissue Coverage ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Sternal Wound Dehiscence

Sternal wound dehiscence is a serious complication occasionally requiring soft tissue coverage. The greater omentum typically has been used as a last resort because of the underlying morbidity from a laparotomy. We present a case in which a laparoscopically created omental flap with subsequent split-thickness skin grafting was used to correct a large soft tissue defect that occurred after sternal wound dehiscence developed. A nonambulatory 49-year-old man who underwent coronary artery bypass grafting developed sternal wound dehiscence. Because a large soft tissue defect developed after multiple debridements, soft tissue coverage was required. A laparoscopically harvested omental flap spared this man's upper extremity musculature and provided a soft tissue bed for split-thickness skin grafting. This case helps to establish the role of laparoscopically harvested omentum. If the results suggested by this case are confirmed in a large series, omental flaps should be considered as options of first choice in the management of sternal wound dehiscence.

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