Jason K F Wong1, Nidal Deek2, Chung-Chen Hsu2, Hsin-Yu Chen2, Chih-Hung Lin2, Cheng-Hung Lin3. 1. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan; Plastic Surgery Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK. 2. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan. 3. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan; Center for Vascularized Composite Allotransplantation, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: lukechlin@gmail.com.
Abstract
BACKGROUND: The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects. PATIENTS AND METHODS: Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects. RESULTS: Flaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin grafting. Complications requiring secondary surgery occurred in 18% (11/61) of the cases. Six required secondary skin grafting (10%). One RF-ALT flap was converted into a free flap, one PAP required arterial supercharging, and three pedicled RF-ALT flaps required venous supercharging. Image analysis showed that these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The higher length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover. CONCLUSION: Image analysis can be used as a modality to assess the versatility of individual flaps in the reconstruction of lower limb defects.
BACKGROUND: The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects. PATIENTS AND METHODS: Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects. RESULTS: Flaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin grafting. Complications requiring secondary surgery occurred in 18% (11/61) of the cases. Six required secondary skin grafting (10%). One RF-ALT flap was converted into a free flap, one PAP required arterial supercharging, and three pedicled RF-ALT flaps required venous supercharging. Image analysis showed that these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The higher length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover. CONCLUSION: Image analysis can be used as a modality to assess the versatility of individual flaps in the reconstruction of lower limb defects.
Authors: Henry T de Berker; Urška Čebron; Daniel Bradley; Vinod Patel; Meklit Berhane; Fernando Almas; Gary Walton; Mekonen Eshete; Mark McGurk; Dominique Martin; Calum Honeyman Journal: Syst Rev Date: 2021-09-08
Authors: Rafael G Jakubietz; Danni F Jakubietz; Raymund E Horch; Joerg G Gruenert; Rainer H Meffert; Michael G Jakubietz Journal: Plast Reconstr Surg Glob Open Date: 2019-09-30