ObjectiveTo explore the feasibility and technical essentials of soft tissue defect reconstruction following malignant tumor removal of limbs using perforator propeller flaps. MethodBetween July 2008 and July 2015, 19 patients with malignant limb tumor underwent defect reconstruction following tumor removal using the perforator propeller flaps. There were 13 males and 6 females with an average age of 53.4 years (range, 20-82 years). The disease duration ranged from 1 to 420 months (mean, 82 months). The tumors located at the thigh in 10 cases, at the leg in 2 cases, at the arm in 1 case, at the forearm in 1 case, around the knee in 2 cases, and around the elbow joint in 3 cases. Totally 23 flaps (from 8 cm×3 cm to 30 cm×13 cm in size) were used to reconstruct defects (from 4 cm×4 cm to 24 cm×16 cm in size). The potential source arteries included the femoral artery (n=2) , profunda femoral artery (n=3) , superficial circumflex iliac artery (n=1) , lateral circumflex femoral artery (n=6) , superior lateral genicular artery (n=2) , peroneal artery (n=2) , anterior tibial artery (n=1) , brachial artery (n=4) , and radial artery (n=1) . The remaining one was a free style perforator flap. ResultsPartial distal flap necrosis occurred in 3 cases after surgery with rotation angles of 180, 150, and 100° respectively, which were reconstructed after debridement using a free-style perforator flap in 1 case and using free skin grafting in the other 2 cases. The other 20 flaps survived completely after surgery. Primary healing of incisions was obtained at the donor and recipient sites. There was no severe complication such as infection, hematoma, and total flap failure. All patients were followed up 3 months to 5 years (mean, 19 months). One patient with malignant melanoma around the elbow joint had tumor recurrence, and underwent secondary tumor resection. The appearance, texture, and color of the flaps were similar to those at the recipient site. ConclusionsFor patients with malignant tumor of the limb, the perforator propeller flap can be an alternative option for soft tissue defect reconstruction after tumor resection, with the advantages of relatively simple operation and remaining the main vessels.
ObjectiveTo study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.MethodsBetween March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained.ResultsThe origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements (P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.ConclusionThe digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.
ObjectiveTo explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh.MethodsBetween 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.ResultsThe 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.ConclusionBased 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.
Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=−11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. ConclusionThe perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.