The lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries for repairing the large soft tissue defects on the foot and ankle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Xin ¹ , ZOU Yonggen ¹ , TANG Lin ¹ , LIU Anming ¹ , ZHANG Renquan ² ,  CHEN Zenggang ²

1. Department of Burn and Plastic Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Orthopedics, People’s Hospital of Chongqing Banan District, Chongqing, 401320, P.R.China;

Corresponding author：

CHEN Zenggang, Email: chenzghand@163.com

Keywords：

Superficial inferior epigastric arteries; lower abdominal conjoined flap; foot and ankle; soft tissue defect

DOI：

10.7507/1002-1892.202106040

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Objective To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries (SIEA) for repairing the large soft tissue defects on the foot and ankle. Methods The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females; the age ranged from 25 to 62 years, with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases, cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels, tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement (the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm, with an average of 6.0 cm; the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. Results One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair; the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. Conclusion The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.

Citation： ZHOU Xin, ZOU Yonggen, TANG Lin, LIU Anming, ZHANG Renquan, CHEN Zenggang. The lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries for repairing the large soft tissue defects on the foot and ankle. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(11): 1467-1471. doi: 10.7507/1002-1892.202106040 Copy

1.	Antia NH, Buch VI. Transfer of an abdominal dermo-fat graft by direct anastomosis of blood vessels. Br J Plast Surg, 1971, 24(1): 15-19.
2.	Koshima I. Short pedicle superficial inferior epigastric artery adiposal flap: new anatomical findings and the use of this flap for reconstruction of facial contour. Plast Reconstr Surg, 2005, 116(4): 1091-1097.
3.	Koshima I, Nanba Y, Tsutsui T, et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg, 2004, 113(1): 233-240.
4.	Miyamoto S, Arikawa M, Kagaya Y. The use of lower abdominal perforator flaps in soft-tissue reconstruction after sarcoma resection. Microsurgery, 2020, 40(3): 353-360.
5.	Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg, 2008, 121(5): 1642-1649.
6.	Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.
7.	Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
8.	Hallock GG. Simplified nomenclature for compound flaps. Plast Reconstr Surg, 2000, 105(4): 1465-1470.
9.	Woodworth BA, Gillespie MB, Day T, et al. Muscle-sparing abdominal free flaps in head and neck reconstruction. Head Neck, 2006, 28(9): 802-807.
10.	Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
11.	Rozen WM, Chubb D, Grinsell D, et al. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery, 2010, 30(5): 386-391.
12.	Ye X, Rozen WM, Alonso-Burgos A, et al. “Choke” vessels between vascular territories of the abdominal wall: literature review and rare case of Leriche’s syndrome. Clin Anat, 2012, 25(8): 998-1004.
13.	Kita Y, Fukunaga Y, Arikawa M, et al. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg, 2020, 73(5): 870-875.
14.	Satake T, Muto M, Kou S, et al. Contralateral unaffected breast augmentation using zone Ⅳ as a SIEA flap during unilateral DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2019, 72(9): 1537-1547.
15.	Matsumine H, Sakurai H, Nakajima Y, et al. Use of a bipedicled thin groin flap in reconstruction of postburn anterior neck contracture. Plast Reconstr Surg, 2008, 122(3): 782-785.
16.	Yoshimatsu H, Hayashi A, Karakawa R, et al. Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk. Microsurgery, 2020, 40(6): 649-655.
17.	刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损. 中国修复重建外科杂志, 2021, 35(7): 886-890.
18.	Wang D, Gao T, Liu L, et al. Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue. Br J Oral Maxillofac Surg, 2020, 58(8): 992-996.
19.	Berner JE, Nikkhah D, Zhao J, et al. The versatility of the superficial circumflex iliac artery perforator flap: A single surgeon’s 16-year experience for limb reconstruction and a systematic review. J Reconstr Microsurg, 2020, 36(2): 93-103.
20.	Koshima I, Yamamoto H, Moriguchi T, et al. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the “mosaic” flap principle. Ann Plast Surg, 1994, 32(3): 321-327.

1. Antia NH, Buch VI. Transfer of an abdominal dermo-fat graft by direct anastomosis of blood vessels. Br J Plast Surg, 1971, 24(1): 15-19.
2. Koshima I. Short pedicle superficial inferior epigastric artery adiposal flap: new anatomical findings and the use of this flap for reconstruction of facial contour. Plast Reconstr Surg, 2005, 116(4): 1091-1097.
3. Koshima I, Nanba Y, Tsutsui T, et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg, 2004, 113(1): 233-240.
4. Miyamoto S, Arikawa M, Kagaya Y. The use of lower abdominal perforator flaps in soft-tissue reconstruction after sarcoma resection. Microsurgery, 2020, 40(3): 353-360.
5. Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg, 2008, 121(5): 1642-1649.
6. Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.
7. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
8. Hallock GG. Simplified nomenclature for compound flaps. Plast Reconstr Surg, 2000, 105(4): 1465-1470.
9. Woodworth BA, Gillespie MB, Day T, et al. Muscle-sparing abdominal free flaps in head and neck reconstruction. Head Neck, 2006, 28(9): 802-807.
10. Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
11. Rozen WM, Chubb D, Grinsell D, et al. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery, 2010, 30(5): 386-391.
12. Ye X, Rozen WM, Alonso-Burgos A, et al. “Choke” vessels between vascular territories of the abdominal wall: literature review and rare case of Leriche’s syndrome. Clin Anat, 2012, 25(8): 998-1004.
13. Kita Y, Fukunaga Y, Arikawa M, et al. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg, 2020, 73(5): 870-875.
14. Satake T, Muto M, Kou S, et al. Contralateral unaffected breast augmentation using zone Ⅳ as a SIEA flap during unilateral DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2019, 72(9): 1537-1547.
15. Matsumine H, Sakurai H, Nakajima Y, et al. Use of a bipedicled thin groin flap in reconstruction of postburn anterior neck contracture. Plast Reconstr Surg, 2008, 122(3): 782-785.
16. Yoshimatsu H, Hayashi A, Karakawa R, et al. Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk. Microsurgery, 2020, 40(6): 649-655.
17. 刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损. 中国修复重建外科杂志, 2021, 35(7): 886-890.
18. Wang D, Gao T, Liu L, et al. Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue. Br J Oral Maxillofac Surg, 2020, 58(8): 992-996.
19. Berner JE, Nikkhah D, Zhao J, et al. The versatility of the superficial circumflex iliac artery perforator flap: A single surgeon’s 16-year experience for limb reconstruction and a systematic review. J Reconstr Microsurg, 2020, 36(2): 93-103.
20. Koshima I, Yamamoto H, Moriguchi T, et al. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the “mosaic” flap principle. Ann Plast Surg, 1994, 32(3): 321-327.

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The lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries for repairing the large soft tissue defects on the foot and ankle

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