Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yangjian ^1,2 , HUA Zuguang ² , WEI Peng ² , REN Tiantian ² , XU Yi ² ,  XU Youjia ¹

1. Department of Orthopaedics, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215004, P.R.China;
2. Department of Reparative and Reconstructive Surgery, Ningbo First Hospital, Ningbo Zhejiang, 315010, P.R.China;

Corresponding author：

XU Youjia, Email: xuyoujia@suda.edu.cn

Keywords：

Propeller flap; free-style perforator flap; malignant tumor; wound repair; thigh

DOI：

10.7507/1002-1892.202104052

Video：

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Objective To explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh.Methods Between December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade.Results The distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal.Conclusion Based on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.

Citation： WANG Yangjian, HUA Zuguang, WEI Peng, REN Tiantian, XU Yi, XU Youjia. Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1177-1181. doi: 10.7507/1002-1892.202104052 Copy

1.	刘元波, 王欣, 张世民, 等. “带蒂穿支皮瓣常见并发症原因分析与防治” 专家共识. 中华显微外科杂志, 2017, 40(2): 105-108.
2.	唐举玉, 汪华侨, 章一新, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
3.	韩婷璐, 臧梦青, 朱珊, 等. 以旋股外侧动脉不同分支来源的穿支为蒂的螺旋桨皮瓣手术设计和临床应用. 中华整形外科杂志, 2019, 35(9): 854-861.
4.	Iida T, Yoshimatsu H, Koshima I. Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Ann Plast Surg, 2017, 79(4): 385-389.
5.	Liu Y, Ding Q, Zang M, et al. Classification and application of the distally-based thigh flap based on the lateral circumflex femoral artery system. Ann Plast Surg, 2017, 78(5): 497-504.
6.	Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
7.	Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
8.	Chaput B, Bertheuil N, Grolleau JL, et al. Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: a prospective study. Mrcrosurgery, 2018, 38(2): 177-184.
9.	Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: a comparison. J Plast Reconstr Aesthet Surg, 2019, 72(2): 181-187.
10.	Falinower H, Herlin C, Laloze J, et al. Use of the propeller lumbar perforator flap: a series of 32 cases. Plast Reconstr Surg Glob Open, 2020, 8(1): e2522. doi: 10.1097/GOX.0000000000002522.
11.	周慧霞. 9例隆突性皮肤纤维肉瘤的临床病理特征分析. 实用癌症杂志, 2019, 34(6): 1044.
12.	Levine SM, Shapiro RL. Surgical treatment of malignant melanoma: practical guidelines. Dermatol Clin, 2012, 30(3): 487-501.
13.	陈林海, 林光豪, 魏鹏, 等. 体表软组织恶性肿瘤根治术后创面的一期显微修复. 中华显微外科杂志, 2018, 41(6): 529-533.
14.	Luz FB, Ferron C, Cardoso GP. Surgical treatment of basal cell carcinoma: an algorithm based on the literature. An Bras Dermatol, 2015, 90(3): 377-383.
15.	王扬剑, 李学渊, 王胜伟, 等. 术前多普勒定位的自由式穿支螺旋桨皮瓣设计. 同济大学学报 (医学版), 2016, 37(4): 109-114.
16.	徐毅, 王扬剑, 陈芝武, 等. 跨区带蒂腓动脉穿支皮瓣局部并发症血流动力学相关原因分析. 中华整形外科杂志, 2019, 35(12): 1221-1225.
17.	Blondeel PN, Morris SF, Hallock GG, et al. Perforator flaps: anatomy, technique and clinical applications. 2nd ed. St. Louis: Quality Medical Publishing (Missouri), 2013: 668-684.
18.	陈永中, 黄俊英, 薛兰, 等. 跨区皮瓣切取后choke血管管径的定量分析及MMP-2与MMP-9的表达. 中国临床解剖学杂志, 2017, 35(5): 526-531.
19.	李文波, 张超, 石杰, 等. 穿支皮瓣中choke vessels的新生过程研究及 “血管体” 概念. 中国组织工程研究, 2018, 22(8): 1261-1266.
20.	Cormack GC, Lamberty BG. Cadaver studies of correlation between vessel size and anatomical territory of cutaneous supply. Br J Plast Surg, 1986, 39(3): 300-306.
21.	唐茂林, 刘元波. 穿支皮瓣的解剖学研究进展. 中华整形外科杂志, 2018, 34(9): 785- 790.
22.	Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg, 1991, 44(1): 53-54.
23.	Pignatti M, Ogawa R, Hallock GG, et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg, 2011, 127(2): 716-722.
24.	赵书明, 刘亚明, 刘娜, 等. CT血管造影辅助下逆行股前外侧穿支皮瓣修复膝周或小腿近端皮肤及软组织缺损的临床效果. 中华烧伤杂志, 2021, 37(4): 356-362.

1. 刘元波, 王欣, 张世民, 等. “带蒂穿支皮瓣常见并发症原因分析与防治” 专家共识. 中华显微外科杂志, 2017, 40(2): 105-108.
2. 唐举玉, 汪华侨, 章一新, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
3. 韩婷璐, 臧梦青, 朱珊, 等. 以旋股外侧动脉不同分支来源的穿支为蒂的螺旋桨皮瓣手术设计和临床应用. 中华整形外科杂志, 2019, 35(9): 854-861.
4. Iida T, Yoshimatsu H, Koshima I. Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Ann Plast Surg, 2017, 79(4): 385-389.
5. Liu Y, Ding Q, Zang M, et al. Classification and application of the distally-based thigh flap based on the lateral circumflex femoral artery system. Ann Plast Surg, 2017, 78(5): 497-504.
6. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
7. Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
8. Chaput B, Bertheuil N, Grolleau JL, et al. Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: a prospective study. Mrcrosurgery, 2018, 38(2): 177-184.
9. Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: a comparison. J Plast Reconstr Aesthet Surg, 2019, 72(2): 181-187.
10. Falinower H, Herlin C, Laloze J, et al. Use of the propeller lumbar perforator flap: a series of 32 cases. Plast Reconstr Surg Glob Open, 2020, 8(1): e2522. doi: 10.1097/GOX.0000000000002522.
11. 周慧霞. 9例隆突性皮肤纤维肉瘤的临床病理特征分析. 实用癌症杂志, 2019, 34(6): 1044.
12. Levine SM, Shapiro RL. Surgical treatment of malignant melanoma: practical guidelines. Dermatol Clin, 2012, 30(3): 487-501.
13. 陈林海, 林光豪, 魏鹏, 等. 体表软组织恶性肿瘤根治术后创面的一期显微修复. 中华显微外科杂志, 2018, 41(6): 529-533.
14. Luz FB, Ferron C, Cardoso GP. Surgical treatment of basal cell carcinoma: an algorithm based on the literature. An Bras Dermatol, 2015, 90(3): 377-383.
15. 王扬剑, 李学渊, 王胜伟, 等. 术前多普勒定位的自由式穿支螺旋桨皮瓣设计. 同济大学学报 (医学版), 2016, 37(4): 109-114.
16. 徐毅, 王扬剑, 陈芝武, 等. 跨区带蒂腓动脉穿支皮瓣局部并发症血流动力学相关原因分析. 中华整形外科杂志, 2019, 35(12): 1221-1225.
17. Blondeel PN, Morris SF, Hallock GG, et al. Perforator flaps: anatomy, technique and clinical applications. 2nd ed. St. Louis: Quality Medical Publishing (Missouri), 2013: 668-684.
18. 陈永中, 黄俊英, 薛兰, 等. 跨区皮瓣切取后choke血管管径的定量分析及MMP-2与MMP-9的表达. 中国临床解剖学杂志, 2017, 35(5): 526-531.
19. 李文波, 张超, 石杰, 等. 穿支皮瓣中choke vessels的新生过程研究及 “血管体” 概念. 中国组织工程研究, 2018, 22(8): 1261-1266.
20. Cormack GC, Lamberty BG. Cadaver studies of correlation between vessel size and anatomical territory of cutaneous supply. Br J Plast Surg, 1986, 39(3): 300-306.
21. 唐茂林, 刘元波. 穿支皮瓣的解剖学研究进展. 中华整形外科杂志, 2018, 34(9): 785- 790.
22. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg, 1991, 44(1): 53-54.
23. Pignatti M, Ogawa R, Hallock GG, et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg, 2011, 127(2): 716-722.
24. 赵书明, 刘亚明, 刘娜, 等. CT血管造影辅助下逆行股前外侧穿支皮瓣修复膝周或小腿近端皮肤及软组织缺损的临床效果. 中华烧伤杂志, 2021, 37(4): 356-362.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh

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