The use of double free flaps with intra-flap anastomosis for complex defects reconstruction.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
03 Jul 2023
03 Jul 2023
Historique:
revised:
02
05
2023
received:
09
01
2023
accepted:
23
06
2023
medline:
4
7
2023
pubmed:
4
7
2023
entrez:
4
7
2023
Statut:
aheadofprint
Résumé
Over the years, the improvements in microsurgical field allowed the reconstruction of increasingly larger and more complex defects. In this context, we conceived linking more flaps with a single vascular supply. The double free flaps with intra-flap anastomosis offer a better match with recipient site requirements, still having a minimal donor and recipient site morbidity. In the present paper, we describe our experience with this procedure, focusing on its features and providing a collection of cases in different areas and clinical settings. Consecutive single-center case series with 16 patients who received defect reconstruction using double free flaps with intra-flap anastomosis between February 2019 and August 2021. The median age was 58 years old (range 39-77). Nine patients were men and seven were women. The defects were located throughout the body, including breast, head and neck, lower and upper limbs. In 12 cases, the cause of the defect was surgical removal of a tumor, while in four cases the cause was trauma. The main indication for this procedure was related to the need of covering a large defect, either in terms of volume or surface, resorting to only one vascular axis. A total of 32 flaps were harvested, including 10 different techniques. The flaps size ranged from 6 × 3 cm to 24 × 8 cm. Eleven patients completely healed without any complications. No flaps were lost. Three patients developed a minor wound dehiscence and one a wound infection treated conservatively with antibiotic therapy. One patient experienced both of these complications. The median follow up was 12 months and ranged between 6 and 24 months. At the final clinical evaluation, the reconstructive result was stable in all cases and all the patients had a complete resumption of their daily activities. Double free flaps reconstruction with intra-flap anastomosis represents a valid and reliable option for the coverage of complex defects in case of depleted recipient sites. This procedure allows us to transfer high amounts of tissue resorting to a single vascular axis. However, it represents a technical challenge and a highly experienced microsurgical team is required.
Sections du résumé
BACKGROUND
BACKGROUND
Over the years, the improvements in microsurgical field allowed the reconstruction of increasingly larger and more complex defects. In this context, we conceived linking more flaps with a single vascular supply. The double free flaps with intra-flap anastomosis offer a better match with recipient site requirements, still having a minimal donor and recipient site morbidity. In the present paper, we describe our experience with this procedure, focusing on its features and providing a collection of cases in different areas and clinical settings.
PATIENTS AND METHODS
METHODS
Consecutive single-center case series with 16 patients who received defect reconstruction using double free flaps with intra-flap anastomosis between February 2019 and August 2021. The median age was 58 years old (range 39-77). Nine patients were men and seven were women. The defects were located throughout the body, including breast, head and neck, lower and upper limbs. In 12 cases, the cause of the defect was surgical removal of a tumor, while in four cases the cause was trauma. The main indication for this procedure was related to the need of covering a large defect, either in terms of volume or surface, resorting to only one vascular axis.
RESULTS
RESULTS
A total of 32 flaps were harvested, including 10 different techniques. The flaps size ranged from 6 × 3 cm to 24 × 8 cm. Eleven patients completely healed without any complications. No flaps were lost. Three patients developed a minor wound dehiscence and one a wound infection treated conservatively with antibiotic therapy. One patient experienced both of these complications. The median follow up was 12 months and ranged between 6 and 24 months. At the final clinical evaluation, the reconstructive result was stable in all cases and all the patients had a complete resumption of their daily activities.
CONCLUSIONS
CONCLUSIONS
Double free flaps reconstruction with intra-flap anastomosis represents a valid and reliable option for the coverage of complex defects in case of depleted recipient sites. This procedure allows us to transfer high amounts of tissue resorting to a single vascular axis. However, it represents a technical challenge and a highly experienced microsurgical team is required.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Bauermeister, A. J., Zuriarrain, A., Newman, M., Earle, S. A., & Medina, M. A., 3rd. (2017). Impact of continuous two-team approach in autologous breast reconstruction. Journal of Reconstructive Microsurgery, 33(4), 298-304. https://doi.org/10.1055/s-0037-1598199
Chen, Y. C., Scaglioni, M. F., Huang, E. Y., & Kuo, Y. R. (2016). Utility of “open-Y” anastomosis technique in the use of superior thyroid artery as recipient vessel for head and neck reconstruction with free flap. Microsurgery, 36(5), 391-396. https://doi.org/10.1002/micr.22384
Fong, H. C., & Levin, L. S. (2019). Avoiding complications in microsurgery and strategies for flap take-back. Archives of Plastic Surgery, 46(5), 488-490. https://doi.org/10.5999/aps.2019.00059
Guillemaud, J. P., Seikaly, H., Cote, D. W. J., Barber, B. R., Rieger, J. M., Wolfaardt, J., Nesbitt, P., & Harris, J. R. (2009). Double free-flap reconstruction: Indications, challenges, and prospective functional outcomes. Archives of Otolaryngology-Head & Neck Surgery, 135(4), 406-410. https://doi.org/10.1001/archoto.2009.15
Hallock, G. G. (2011). The complete nomenclature for combined perforator flaps. Plastic and Reconstructive Surgery, 127(4), 1720-1729.
Hong, J. P., Park, C. J., & Suh, H. P. (2021). Importance of vascularity and selecting the recipient vessels of lower extremity reconstruction. Journal of Reconstructive Microsurgery, 37(1), 83-88. https://doi.org/10.1055/s-0040-1708835
Kim, J. H., Lee, C. R., Kwon, H. J., Oh, D. Y., Jun, Y. J., Rhie, J. W., & Moon, S. H. (2022). Two-team-approached free flap reconstruction for plantar malignant melanoma: An observational (STROBE-compliant) trial. Medicine (Baltimore), 101(30), e29442. https://doi.org/10.1097/MD.0000000000029442
Lee, G. K., Fox, P. M., Riboh, J., Hsu, C., Saber, S., Rubin, G. D., & Chang, J. (2013). Computed tomography angiography in microsurgery: Indications, clinical utility, and pitfalls. Eplasty, 7(13), e42.
Ludolph, I., Horch, R. E., Arkudas, A., & Schmitz, M. (2019). Enhancing safety in reconstructive microsurgery using intraoperative indocyanine green angiography. Frontiers in Surgery, 2(6), 39. https://doi.org/10.3389/fsurg.2019.00039
Mayo, J. L., Allen, R. J., & Sadeghi, A. (2015). Four-flap breast reconstruction: Bilateral stacked DIEP and PAP flaps. Plastic and Reconstructive Surgery. Global Open, 3(5), e383. https://doi.org/10.1097/GOX.0000000000000353
Nangole, W. F., Khainga, S., Aswani, J., Kahoro, L., & Vilembwa, A. (2015). Free flaps in a resource constrained environment: A five-year experience-outcomes and lessons learned. Plastic Surgery International, 2015, 194174. https://doi.org/10.1155/2015/194174
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. https://doi.org/10.1097/PRS.0b013e3181b98a6c
Scaglioni, M. F., Meroni, M., & Fritsche, E. (2021). Free tissue transfer with supermicrosurgical perforator-to-perforator (P-to-P) technique for tissue defect reconstruction around the body: Technical pearls and clinical experience. Journal of Plastic, Reconstructive & Aesthetic Surgery, 74(8), 1791-1800. https://doi.org/10.1016/j.bjps.2020.12.025
Scaglioni, M. F., Meroni, M., & Fritsche, E. (2022). Stacked profunda artery perforator flaps with intra-flap anastomosis for moderate to large breast autologous reconstruction. Microsurgery. [Online ahead of print]. https://doi.org/10.1002/micr.30974
Scaglioni, M. F., Meroni, M., Fuchs, B., Knobe, M., & Fritsche, E. (2022). The use of the chimeric conjoint flap technique for complex defects reconstruction throughout the body: Clinical experience with 28 cases. Microsurgery, 43, 109-118. https://doi.org/10.1002/micr.30936
Wei, F. C., Yazar, S., Lin, C. H., Cheng, M. H., Tsao, C. K., & Chiang, Y. C. (2005). Double free flaps in head and neck reconstruction. Clinics in Plastic Surgery, 32(3), 303-308.
Wei, F.-C., Jain, Vivek, M., Suominen, S., & Chen, H.-C. (2001). Confusion among perforator flaps: What is a true perforator flap? Plastic and Reconstructive Surgery, 107(3), 874-876.
Yamamoto, K., Moriguchi, H., & Torita Nagayama, H. (1993). Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: An introduction to the chimeric flap principle. Plastic and Reconstructive Surgery, 92(3), 411-420.
Yoshimatsu, H., Karakawa, R., Scaglioni, M. F., Fuse, Y., Tanakura, K., & Yano, T. (2021). Application of intraoperative indocyanine green angiography for detecting flap congestion in the use of free deep inferior epigastric perforator flaps for breast reconstruction. Microsurgery, 41(6), 522-526. https://doi.org/10.1002/micr.30734
Zhang, Y. X., Hayakawa, T. J., Levin, L. S., Hallock, G. G., & Lazzeri, D. (2016). The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plastic and Reconstructive Surgery, 137(3), 1018-1030. https://doi.org/10.1097/01.prs.0000479971.99309.21