Pedicled perforator-based flaps: Risk factor analysis, outcomes evaluation and decisional algorithm based on 130 consecutive reconstructions.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
06
05
2019
revised:
29
01
2020
accepted:
27
03
2020
pubmed:
17
4
2020
medline:
29
7
2021
entrez:
17
4
2020
Statut:
ppublish
Résumé
Pedicled perforator flaps are widely used for soft tissue reconstruction, but evidence in literature about risk factors associated with complications is still controvert. The aim of this study is to evaluate risk factors and outcomes associated with pedicled perforator-based flaps harvested at different anatomical sites. Seventy-one propeller and 59 V-Y advancement flaps were performed to reconstruct defects of the face (24 cases), trunk (47 cases), and extremities (59 cases). Mean defect and flap area were 32.43 and 43.2 cm Overall flap complications rate was 23.07%. Coronary heart disease was an independent risk factor for flap complications (p = .010), while hypertension was associated with a lower complication rate (p = .010). The increasing degree of pedicle rotation had a significant impact on the development of flap vascular complications (p = .008). Mean patients' aesthetic and functional ratings were 4.23 of 5 and 4.37 of 5, respectively. We found a positive correlation between both coronary heart disease and increasing degree of pedicle rotation and complications. Other factors tested were not significantly associated with complications. Patients were overall satisfied with both the aesthetic and functional outcomes of the procedure. The decisional algorithm hereby suggested yields a 93.1% overall success rate and we believe it could be of help to plastic surgeons approaching soft tissue defects.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
545-552Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Bekara, F., Herlin, C., Mojallal, A., Sinna, R., Ayestaray, B., Letois, F., … Chaput, B. (2016). A systematic review and meta-analysis of perforator-Pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plastic and Reconstructive Surgery, 137(1), 314-331. https://doi.org/10.1097/PRS.0000000000001891
Blondeel, P. N., Van Landuyt, K. H., Monstrey, S. J., Hamdi, M., Matton, G. E., Allen, R. J., … Wei, F. C. (2003). The “gent” consensus on perforator flap terminology: Preliminary definitions. Plastic and Reconstructive Surgery, 112(5), 1378-1383.
Bravo, F. G., & Schwarze, H. P. (2009). Free-style local perforator flaps: Concept and classification system. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(5), 602-608.
Brunetti, B., Campa, S., Tenna, S., Pallara, T., & Persichetti, P. (2015). Free style perforator flaps: An innovative approach to soft tissue reconstruction. Dermatologic Therapy, 28(4), 226-229.
Brunetti, B., Poccia, I., Tenna, S., Campa, S., & Persichetti, P. (2015). Transversally oriented pedicled perforator flaps: A reliable alternative for lower leg reconstruction. Microsurgery, 35(7), 541-545. https://doi.org/10.1002/micr.22465
Brunetti, B., Tenna, S., Aveta, A., Segreto, F., & Persichetti, P. (2012). Angular artery perforator flap for reconstruction of nasal sidewall and medial canthal defects. Plastic and Reconstructive Surgery, 130(4), 627e-628e.
Brunetti, B., Tenna, S., Aveta, A., Segreto, F., & Persichetti, P. (2013). Free style local perforator flaps: Versatility of the V-Y design to reconstruct soft tissues defects in the skin cancer population. Plastic and Reconstructive Surgery, 132, 451-460.
Brunetti, B., Tenna, S., Poccia, I., & Persichetti, P. (2017). Propeller flaps with reduced rotational angles: Clinical experience on 40 consecutive reconstructions performed at different anatomical sites. Annals of Plastic Surgery, 78(2), 202-207. https://doi.org/10.1097/SAP.0000000000000830
D'Arpa, S., Cordova, A., Pignatti, M., & Moschella, F. (2011). Freestyle pedicled perforator flaps: Safety, prevention of complications, and management based on 85 consecutive cases. Plastic and Reconstructive Surgery, 128(4), 892-906.
Geddes, C. R., Morris, S. F., & Neligan, P. C. (2003). Perforator flaps: Evolution, classification, and applications. Annals of Plastic Surgery, 50(1), 90-99.
Jakubietz, R. G., Schmidt, K., Zahn, R. K., Waschke, J., Zeplin, P. H., Meffert, R. H., & Jakubietz, M. G. (2012). Subfascial directionality of perforators of the distal lower extremity: An anatomic study regarding selection of perforators for 180-degree propeller flaps. Annals of Plastic Surgery, 69(3), 307-311.
Lecours, C., Saint-Cyr, M., Wong, C., Bernier, C., Mailhot, E., Tardif, M., & Chollet, A. (2010). Freestyle pedicle perforator flaps: Clinical results and vascular anatomy. Plastic and Reconstructive Surgery, 126(5), 1589-1603.
Minabe, T., & Harii, K. (2007). Dorsal intercostal artery perforator flap: Anatomical study and clinical applications. Plastic and Reconstructive Surgery, 120(3), 681-689.
Niranjan, N. S., Price, R. D., & Govilkar, P. (2000). Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects. British Journal of Plastic Surgery, 53(8), 679-689.
Persichetti, P., Brunetti, B., Aveta, A., & Segreto, F. (2013). Reverse flow medial sural artery perforator flap: Pedicle extension for distal lower limb defects. Annals of Plastic Surgery, 70(2), 246-247.
Persichetti, P., Brunetti, B., Cagli, B., & Tenna, S. (2012). Chest wall reconstruction with the perforator-plus thoracoabdominal flap. Plastic and Reconstructive Surgery, 130(3), 488e-489e.
Ramakrishnan, V. V. (2006). Perforator flaps. Journal of Plastic, Reconstructive & Aesthetic Surgery, 59(6), 569-570.
Saint-Cyr, M., Wong, C., Schaverien, M., Mojallal, A., & Rohrich, R. J. (2009). The perforasome theory: Vascular anatomy and clinical implications. Plastic and Reconstructive Surgery, 124(5), 1529-1544.
Schaverien, M., & Saint-Cyr, M. (2008). Perforators of the lower leg: Analysis of perforator locations and clinical application for pedicled perforator flaps. Plastic and Reconstructive Surgery, 122(1), 161-170.
Sharma, R. K., Mehrotra, S., & Nanda, V. (2005). The perforator "plus" flap: A simple nomenclature for locoregional perforator-based flaps. Plastic and Reconstructive Surgery, 116(6), 1838-1839.
Taylor, G. I., & Palmer, J. H. (1987). The vascular territories (angiosomes) of the body: Experimental study and clinical applications. British Journal of Plastic Surgery, 40(2), 113-141.
Teo, T. C. (2010). The propeller flap concept. Clinics in Plastic Surgery, 37(4), 615-626.
Wallace, C. G., Kao, H. K., Jeng, S. F., & Wei, F. C. (2009). Free-style flaps: A further step forward for perforator flap surgery. Plastic and Reconstructive Surgery, 124(6), e419-e426.
Wong, C. H., Cui, F., Tan, B. K., Liu, Z., Lee, H. P., Lu, C., … Song, C. (2007 Dec). Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Annals of Plastic Surgery, 59(6), 672-678.
Yildirim, S., Taylan, G., & Aköz, T. (2007). Freestyle perforator-based V-Y advancement flap for reconstruction of soft tissue defects at various anatomic regions. Annals of Plastic Surgery, 58(5), 501-506.