Posterior intercostal artery perforator flap for posterior trunk reconstruction: Perforator mapping with high-resolution ultrasound and clinical application.
Back
High resolution ultrasound
Perforator flap
Posterior intercostal artery
Propeller flap
Reconstruction
Journal
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
19
06
2016
revised:
04
11
2018
accepted:
09
12
2018
pubmed:
24
12
2018
medline:
27
12
2019
entrez:
23
12
2018
Statut:
ppublish
Résumé
Pedicled perforator flaps have progressively been used for reconstructive purposes of the anterior trunk. However, reports regarding perforator flaps for local reconstruction of the posterior trunk are sparse. The aim of this study was to investigate the vascular basis of perforator flaps based on the posterior intercostal arteries and to highlight the clinical versatility of these flaps for local posterior trunk reconstruction. The posterior intercostal artery perforators (PICAP) between the 4th and 12th intercostal space were investigated using high resolution ultrasound in ten healthy volunteers. The location, diameter, suprafascial length and course of the individual perforators was measured. PICAP flaps were used in a series of ten cases for defect reconstruction of the posterior trunk to demonstrate their clinical versatility. A total number of 100 perforators was investigated. The mean diameter was 0,7 ± 0,24 mm with an average length until arborisation of 0,8 ± 0,8 cm. Perforators were located at 2,4 ± 1,8 cm from the midline on average. Only 16% of all measured perforators were identified as major perforators (diameter ≥ 1 mm). In ten patients (mean age at surgery 61,7 years, f:m = 3:7) a PICAP flap was used for defect reconstruction at the back with a mean follow-up of 2,9 years. Flap dimensions ranged from 7 × 3 to 16 × 7 cm. In three cases, a complication was observed (one seroma, one hematoma, one marginal tip necrosis). In the present study, a reliable vascular basis of the posterior intercostal artery perforator flap could be demonstrated. Clinically these flaps replace "like with like" and may be transposed in a propeller - or V to Y - fashion. The donor site can be closed primarily in most cases, thus resulting in a favorable donor side morbidity.
Sections du résumé
BACKGROUND
BACKGROUND
Pedicled perforator flaps have progressively been used for reconstructive purposes of the anterior trunk. However, reports regarding perforator flaps for local reconstruction of the posterior trunk are sparse. The aim of this study was to investigate the vascular basis of perforator flaps based on the posterior intercostal arteries and to highlight the clinical versatility of these flaps for local posterior trunk reconstruction.
METHODS
METHODS
The posterior intercostal artery perforators (PICAP) between the 4th and 12th intercostal space were investigated using high resolution ultrasound in ten healthy volunteers. The location, diameter, suprafascial length and course of the individual perforators was measured. PICAP flaps were used in a series of ten cases for defect reconstruction of the posterior trunk to demonstrate their clinical versatility.
RESULTS
RESULTS
A total number of 100 perforators was investigated. The mean diameter was 0,7 ± 0,24 mm with an average length until arborisation of 0,8 ± 0,8 cm. Perforators were located at 2,4 ± 1,8 cm from the midline on average. Only 16% of all measured perforators were identified as major perforators (diameter ≥ 1 mm). In ten patients (mean age at surgery 61,7 years, f:m = 3:7) a PICAP flap was used for defect reconstruction at the back with a mean follow-up of 2,9 years. Flap dimensions ranged from 7 × 3 to 16 × 7 cm. In three cases, a complication was observed (one seroma, one hematoma, one marginal tip necrosis).
CONCLUSION
CONCLUSIONS
In the present study, a reliable vascular basis of the posterior intercostal artery perforator flap could be demonstrated. Clinically these flaps replace "like with like" and may be transposed in a propeller - or V to Y - fashion. The donor site can be closed primarily in most cases, thus resulting in a favorable donor side morbidity.
Identifiants
pubmed: 30578046
pii: S1748-6815(18)30444-3
doi: 10.1016/j.bjps.2018.12.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
737-743Informations de copyright
Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.