ABSTRACT
Objective:To investigate the clinical effect of free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods for repairing soft tissue defects of limbs.Methods:A retrospective cohort study was used to analyze the data of 60 patients with soft tissue defects of limbs treated in Ningbo No.6 Hospital from March 2017 to March 2020, including 38 males and 22 females, aged 21-57 years［(35.6±3.1)years］. The wounds were located on the upper limb in 33 patients and the lower limb wound in 27 patients. The defect area was 4.5 cm × 2.0 cm-17.0 cm × 8.0 cm. All patients received debridement and vacuum sealing drainage (VSD) in stage I, and free superficial iliac circumflex artery perforator flap transplantation in stage II. The flap area was 4.9 cm × 2.6 cm-17.0 cm × 8.0 cm. According to the different anastomotic vessels, the superficial iliac circumflex artery was anastomosed end-to- side to the radial artery in 25 patients, the ulnar artery in 8, the dorsalis pedis artery in 18 and the anterior tibial artery in 9. Flap healing and healing time were detected. Texture and appearance of the flap were observed at the last follow-up. The appearance of the donor area was evaluated by Vancouver scar scale (VSS), and the satisfaction rate of appearance of the recipient area was measured by numerical score.Results:All patients were followed up for 5-15 months［(7.1±1.3)points］. All flaps survived successfully after operation, including arterial crisis in 4 patients, among which 2 had flap perforator anastomosed with the radial artery, 1 with the ulnar artery and 1 with the dorsalis pedis artery. There was no significant difference in flap crisis after end-to-side arterial anastomosis in different recipient areas ( P>0.05). For patients with flap perforator anastomosed with the radial artery, the ulnar artery, the dorsalis pedis artery and the anterior tibial artery, the flap healing time was 15(14, 16)days, 15(14, 16)days, 14.5(14，16)days and 14(14，15.5)days, respectively (all P>0.05). The flaps showed sufficient elasticity and soft texture at the last follow-up. For patients with flap perforator anastomosed with the radial artery, the ulnar artery, the dorsalis pedis artery and the anterior tibial artery, the VSS of the donor area was (10.2±1.5)points, (10.9±1.6)points, (9.4±1.5)points and (9.8±1.5)points at the last follow-up (all P>0.05), and the satisfaction rate of appearance of the recipient area was 9 (8, 10)points, 9(8, 9)points, 9(8, 9)points and 8(8, 9.5)points at the last follow-up ( P>0.05), showing that all patients were satisfied with the appearance of the wound. Conclusions:The transplantation of free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods is safe and reliable in repairing soft tissue defects of limbs with advantages of low occurrence of postoperative vascular crisis, good flap survival, no influence on flap healing by different anastomotic vessels, hidden donor area with small scar and satisfactory appearance of the recipient area. It can be used as one of the common vascular repair methods for free tissue flap transplantation.
ABSTRACT
Objective@#To investigate the feasibility and clinic outcome of the turbocharging technique in repairing large defect with free perforator flap.@*Methods@#From January 2017 to December 2018, 6 patients with defect of over length or large size were repaired with free perforator flaps, anterolateral thigh(ALT) flap in 3 cases and deep inferior epigastric artery perforator(DIEP) flap in 3 cases in Department of Hand Surgery, Ningbo No.6 Hospital. There were 4 males and 2 females, aged from 29 to 54 years old, with an average age of 41 years old.It was found that the size of the flap beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle. The turbocharging technique was applied in the operation. The distal perforator of the flap was anastomosed with the proximal pedicle branch. The flap size ranged from 20 cm×8 cm to 25 cm×12 cm. The donor sites were closed directly for 3 cases and skin grafting for 3 cases.@*Results@#All the flaps survived successfully, no distal necrosis occurred. The patients were followed up for 3 to 12 months, with an average of 9 months. All flaps survived well with satisfactory appearance and pliable texture. The healing of skin graft was satisfactory in 3 cases in donor site. No graft skin contracture occurred. The donor sites closed directly in 3 cases had linear scar in donor site, no obvious contracture occurred. The flap sensation returned to S2-S3.@*Conclusions@#If the size of the flap is super long or large, beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle, the application of turbocharging technique can avoid partial necrosis of the flap and improve the survival rate of the flap, which is an ideal alternative.