【Abstract】 Objective To investigate the method and effectiveness of expanded delto-pectoral and abdominalperforator flaps in repairing large defects of the face and upper limb after scar excision. Methods Between August 2000 and February 2011, 25 patients with large scars on face and upper l imb were treated. There were 14 males and 11 females with an average ageof 27 years (range, 7-36 years). Scars causes were burn and scald in 25 cases with a disease duration of 6 months to 7 years (mean, 4.5 years). The hypertrophic scars located at face in 15 cases, and at upper limb and hand in 10 cases. The soft tissue expanders (300-500 mL in volume) were implanted in the delto-pectoral zone and abdominal region in one-stage operation. In two-stage operation, after scars were resected, defects (9 cm × 7 cm to 17 cm × 8 cm) were repaired with the delto-pectoralperforator flaps (17 cm × 7 cm to 20 cm × 8 cm) in 15 facial scar cases and with the deep inferior epigastric artery perforator flaps (10 cm × 9 cm to 25 cm × 14 cm) in 10 upper limb and hand scar cases. The donor sites were sutured directly. Results Partial necrosis of the flaps occurred in 2 cases after operation, then the flap survived after expectant treatment. The other flaps and skin grafts survived successfully, and the incisions healed by first intention. Ten patients were followed up 6 months to 4 years. Theappearance, texture, and color of the flaps were similar to those at the donor site. Conclusion It is an effective method to use the delto-pectoral perforator flap and the deep inferior epigastric artery perforator flap for repairing soft tissue defects of the face and upper limb after scar excision.
OBJECTIVE: To provide an ideal method for repairing the circular cicatricial contracture of thigh. METHODS: Deep inferior epigastric perforator (DIEP) island flaps was elevated based only on the deep inferior epigastric artery and vein and transferred to cover the thigh wound after scar had been resected. RESULTS: Four DIEP island flaps was applied clinically and all flaps survived. The size of the flaps ranged from (8 cm x 28 cm) to (11 cm x 32 cm). Venous return and edema had been obviously improved postoperatively. There was no abdominal weakness and hernia in the donor sites. CONCLUSION: DIEP flap not only retains the advantages of TRAM flap such as good blood supply and rich tissue volume, but also preserves the integrity of the rectus abdominis muscle. DIEP island flap is a good material for repair of the circular cicatricial contracture of the thigh.
ObjectiveTo summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.MethodsThe clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.ResultsAll DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.ConclusionIt is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.