Application of free-style perforator flap for soft tissue defect of knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YU Daojiang ^1,2 , SUN Wei ¹ , WU Lijun ¹ , YU Wenyuan ¹ , CAO Shikun ¹ , CAI Weichao ¹ , ZHAO Tianlan ¹

1. Department of Plastic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215004, P.R.China;
2. Department of Burn and Plastic Surgery, the Second Affiliated Hospital of Chengdu Medical College, Chengdu Sichuan, 610051, P.R.China;

Corresponding author：

YU Daojiang, Email: ydj51087@163.com

Keywords：

Knee; free-style perforator flap; soft tissue defect; wound repair

DOI：

10.7507/1002-1892.201904121

Video：

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Objective To investigate the effectiveness of free-style perforator flap in repairing the soft tissue defect of knee.Methods Between December 2011 and October 2017, 13 patients with the soft tissue defects of knees were repaired with the free-style perforator flaps. There were 9 males and 4 females, with an average age of 40 years (range, 14-65 years). The injuries were caused by traffic accident in 7 cases, crushing in 4 cases, and falling from height in 2 cases. The soft tissue defects in 9 cases formed after 2 weeks-2 months (mean, 1 month) of lower extremity fractures fixation. The other 4 cases were urgently admitted to the hospital after injury, and the time from injury to admission was 0.5-18.0 hours (mean, 8 hours). The size of soft tissue defect ranged from 3 cm×2 cm to 12 cm×8 cm after debridement. Nine propeller flaps, 6 rotating flaps, and 2 V-Y advanced flaps were used; and 9 cases were repaired by single flap and 4 cases were repaired by combined flaps. The size of flap ranged from 7.5 cm×2.5 cm to 20.0 cm×6.0 cm. The donor sites were sutured directly.Results The flaps survived smoothly and incisions healed by first intention in 12 cases. The congestion occurred in 1 case, which obtained delayed healing after symptomatic treatment. All incisions at donor sites healed by first intention. All patients were followed up 3-24 months with an average of 6 months. The shape and motions of knee were satisfactory.Conclusion The free-style perforator flap can maximize the utilization of the donor area around the knee wound, with reliable blood supply, small trauma, and easy operation. It is an ideal flap for the soft tissue defect of knee.

Citation： YU Daojiang, SUN Wei, WU Lijun, YU Wenyuan, CAO Shikun, CAI Weichao, ZHAO Tianlan. Application of free-style perforator flap for soft tissue defect of knee. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1424-1428. doi: 10.7507/1002-1892.201904121 Copy

1.	张功林, 甄平, 陈克明, 等. 延迟逆行股前外侧带蒂皮瓣修复膝部软组织缺损 16 例临床随访. 中华显微外科杂志, 2016, 39(3): 230-233.
2.	蔡喜雨, 董帅, 朱征威, 等. 逆行转移股前外侧皮瓣修复膝部及小腿近端创面 12 例. 中华显微外科杂志, 2016, 39(4): 402-404.
3.	Mardini S, Tsai FC, Wei FC. The thigh as a model for free-style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
4.	Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
5.	Qian Y, Li G, Zang H, et al. A systematic review and meta-analysis of free-style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open, 2018, 6(2): e1651.
6.	Usami S, Inami K, Hirase Y. Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept. J Plast Reconstr Aesthet Surg, 2018, 71(6): 863-869.
7.	Yu D, Cao S, Zhang S. The application of a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit for large facial defects. J Craniofac Surg, 2019, 30(5): 1529-1532.
8.	余道江, 赵天兰, 徐又佳, 等. 负压封闭引流技术在狭长窄蒂皮瓣中的应用. 中华整形外科杂志, 2013, 29(1): 62-65.
9.	周建生, 叶永杰, 苗华. 膝周血管的应用解剖与骨肿瘤保肢术受区血管的选择. 解剖与临床, 2004, 9(3): 137-141.
10.	Wallace CG, Kao HK, Jeng SF, et al. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg, 2009, 124(6Suppl): e419-426.
11.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
12.	Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg, 2009, 123(4): 132e-145e.
13.	Sinna R, Boloorchi A, Mahajan AL, et al. What should define a " perforator flap”. Plast Reconstr Surg, 2010, 126(6): 2258-2263.
14.	Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
15.	Aydin MA, Mavili ME. Examining microcirculation improves the angiosome theory in explaining the delay phenomenon in a rabbit model. J Reconstr Microsurg, 2003, 19(3): 187-194.
16.	何智灵, 高伟阳, 李俊杰, 等. 大鼠背部单一穿支蒂皮瓣的实验研究. 中华整形外科杂志, 2014, 30(1): 40-44.
17.	陈洁, 蒋灿华, 尹乒, 等. 股前外侧 free-style 穿支皮瓣在口腔颌面部缺损修复重建中的应用. 中华显微外科杂志, 2015, 38(1): 20-24.
18.	余道江, 赵天兰, 孙卫, 等. 自由式穿支皮瓣在鼻肿瘤切除后缺损修复中的应用. 中华医学美学美容杂志, 2018, 24(4): 223-226.

1. 张功林, 甄平, 陈克明, 等. 延迟逆行股前外侧带蒂皮瓣修复膝部软组织缺损 16 例临床随访. 中华显微外科杂志, 2016, 39(3): 230-233.
2. 蔡喜雨, 董帅, 朱征威, 等. 逆行转移股前外侧皮瓣修复膝部及小腿近端创面 12 例. 中华显微外科杂志, 2016, 39(4): 402-404.
3. Mardini S, Tsai FC, Wei FC. The thigh as a model for free-style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
4. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
5. Qian Y, Li G, Zang H, et al. A systematic review and meta-analysis of free-style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open, 2018, 6(2): e1651.
6. Usami S, Inami K, Hirase Y. Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept. J Plast Reconstr Aesthet Surg, 2018, 71(6): 863-869.
7. Yu D, Cao S, Zhang S. The application of a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit for large facial defects. J Craniofac Surg, 2019, 30(5): 1529-1532.
8. 余道江, 赵天兰, 徐又佳, 等. 负压封闭引流技术在狭长窄蒂皮瓣中的应用. 中华整形外科杂志, 2013, 29(1): 62-65.
9. 周建生, 叶永杰, 苗华. 膝周血管的应用解剖与骨肿瘤保肢术受区血管的选择. 解剖与临床, 2004, 9(3): 137-141.
10. Wallace CG, Kao HK, Jeng SF, et al. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg, 2009, 124(6Suppl): e419-426.
11. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
12. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg, 2009, 123(4): 132e-145e.
13. Sinna R, Boloorchi A, Mahajan AL, et al. What should define a " perforator flap”. Plast Reconstr Surg, 2010, 126(6): 2258-2263.
14. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
15. Aydin MA, Mavili ME. Examining microcirculation improves the angiosome theory in explaining the delay phenomenon in a rabbit model. J Reconstr Microsurg, 2003, 19(3): 187-194.
16. 何智灵, 高伟阳, 李俊杰, 等. 大鼠背部单一穿支蒂皮瓣的实验研究. 中华整形外科杂志, 2014, 30(1): 40-44.
17. 陈洁, 蒋灿华, 尹乒, 等. 股前外侧 free-style 穿支皮瓣在口腔颌面部缺损修复重建中的应用. 中华显微外科杂志, 2015, 38(1): 20-24.
18. 余道江, 赵天兰, 孙卫, 等. 自由式穿支皮瓣在鼻肿瘤切除后缺损修复中的应用. 中华医学美学美容杂志, 2018, 24(4): 223-226.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free-style perforator flap for soft tissue defect of knee

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