Strategy of harvesting extended thoracodorsal artery perforator flaps for resurfacing the large soft-tissue defects of extremities
| Autor: | Su-Zhen Wu, Lee-Wei Chen, Cheng-Ta Lin |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Thoracodorsal artery Soft Tissue Injuries Vascular disease business.industry Significant difference Angiography Soft tissue Arteries Color doppler Plastic Surgery Procedures medicine.disease Predictive value Surgery Upper Extremity medicine.artery medicine Humans Vascular thrombosis business Perforator Flap Perforator flaps Aged |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery. 75:1064-1072 |
| ISSN: | 1748-6815 |
| DOI: | 10.1016/j.bjps.2021.11.035 |
| Popis: | Background The authors presented their strategy to harvest extended thoracodorsal artery perforator flaps for resurfacing the large soft-tissue defects of extremities. Materials and Methods Thirty-three free extended thoracodorsal artery perforator flaps were harvested in thirty-three patients. The mean flap size was 145.2 cm2. The maximal flap length and width were 30 cm and 10 cm. The color Doppler sonography was used for preoperative assessment of perforators. Indocyanine green angiography was used for intraoperative assessment of flap viability in three patients. Results The vascular thrombosis, donor-site scar widening, delayed recipient-site wound healing were not significantly related to the patient and flap characteristics. Flap tip or partial necrosis was significantly related to age and peripheral vascular disease. True positive rate, false negative rate, and positive predictive value of color Doppler sonography for perforator identification were not different significantly between attending surgeon and residents. In the distance discrepancy of color Doppler sonography, significant difference was found based on the classifications of perforator size, perforator type, and sonographic operator. The indocyanine green angiography identified a hypoperfused distal area in a 30 cm long flap. Conclusion The color Doppler sonography locates the thoracodorsal artery perforators more precisely when scanned by experienced hands, in larger size or septocutaneous perforators. Using reliable and more perforators, applying muscle-sparing technique, considering suprafascial course of perforator and proper flap orientation are helpful in harvesting extended thoracodorsal artery perforator flaps. Indocyanine green angiography is an option for assessing flap viability, especially in elders and patients with peripheral vascular diseases. |
| Databáze: | OpenAIRE |
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