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Reconstruction of soft tissue defect of the extremity with the perforator flap from inguinal region

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Chinese Medical Journal 2009年第23期122卷 2861-2864页

作者： HUANG Dong WANG Hai-wen WANG Hong-gang WU Wei-zhi ZHAO Cheng-yi Department of Orthopedics No. 2 People's Hospital of GuangdongProvince Guangzhou Guangdong 510317 China Department of Orthopedics Hand Surgery Hospital of Xin JiangNan Guangzhou Guangdong 510228 China Department of Orthopaedics & Microsurgery First AffiliatedHospital of Sun Yat-sen University Guangzhou Guangdong510080 China Department of Orthopaedics Zhongshan City People's HospitalZhongshan Guangdong 528403 China

Background The perforator flap has become a very useful reconstructive means of soft tissue defect of extremities. The perforator flap from the inguinal region has advantages that include the ability to cover a large area with little donor site morbidity and provision of suitable thickness for reconstruction. Methods From July 1, 2005 to June 30, 2007, 10 patients with various types of soft tissue defect underwent reconstruction with 10 perforator flaps from the inguinal region. Six flaps were applied to the upper extremities and four flaps to the lower extremities. The dimensions of the transferred flaps ranged from 7-30 cm in length and 4-10 cm in width. Results The postoperative course of all 10 flaps was uneventful and all flaps survived. Distal small partial necrosis was observed in one case due to arterial insufficiency of the distal part of the flap. All patients were satisfied with the functional and esthetic resurfacing outcome. Conclusion Use of perforator flap from the inguinal region could overcome the disadvantages of the traditional free groin flap, and represents a safe and useful tool for coverage of soft tissue defects.

关键词： soft tissue defect reconstruction perforator flap

Imaging for thinned perforator flap harvest:current status and future perspectives

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Burns & Trauma 2021年第1期9卷 36-46页

作者： Yi Min Khoong Xin Huang Shuchen Gu Tao Zan Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai200011China

With advances in anatomical knowledge and technology,increased interest has been directed towards reconstruction with enhanced aesthetic and functional outcomes.A myriad of thinned perforator flap harvest approaches have been developed for this purpose;however,concerns about jeopardizing their vascularity *** ensure optimum reconstructive outcome without hampering the flap’s microcirculation,it is important to make good use of the existing advanced imaging modalities that can provide clear visualization of perforator branches,particularly in the adipose layer,and an accurate assessment of flap ***,this review will highlight the imaging modalities that have been utilized for harvesting a thinned perforator flap from these two perspectives,along with future insights into creating both functionally and aesthetically satisfying,yet simultaneously safe,thinned perforator flaps for the best reconstructive outcomes for patients.

关键词： perforator flap Imaging Surgical guidance Preoperative imaging Intraoperative guidance flap perfusion flap thinning Thinned flap

Pharmacologic blockade of HIF-1α degradation improves choke vessel dilatation and flap survival in a multi territory perforator flap

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Pharmacologic blockade of HIF-1α degradation improves choke...

Pharmacologic blockade of HIF-1α degradation improves choke vessel dilatation and flap survival in a multi territory perforator flap

2016年浙江省骨科学学术年会

作者：陶先耀高伟阳王珑丁健封晓亮

Background Roxadustat(FG-4592) is a specific hypoxia-inducible factor la(HIF-la) prolyl hydroxylase *** investigated the effects of the Pharmacological delay with FG-4592 on the survival and choke vessels of a multi-territory perforator flap in *** In total,144 rats were divided into four groups(n = 36 each):FG-4592 alone,FG-4592 plus aminoguanidine(AG),AG alone,and no *** postoperative day 7,the surviving flap area was calculated as a percentage of total flap dimensions using DP2-BSW *** 12 hours post-surgery,in the second choke zone of the flap,the diameter of macrovascular and microvascular vessels were respectively calculated by angiography and histology,nitric oxide(NO) content was measured by NO concentration assay kits,and protein levels of HIFla and iNOS were assessed by Western *** Doppler imaging was used to evaluate flap perfusion at the second choke zone at 12 h and 7 days after *** The protein levels of HIF-la were significantly higher in FG-4592 and FG-4592 plus AG *** flap survival area,the diameter of macrovascular and microvascular vessels,the protein levels of iNOS,NO content and perfusion were significantly greater in rats given FG-4592 compared with the other three groups,All of these measures were significantly lower in AG-treated *** also found that the vasodilatory effect of FG-4592 was attenuated by *** FG-4592 pre-treatment may improve flap survival and dilate the choke vessels in a multiterritory perforator flap.

关键词： perforator flap choke vessels pharmacological delay hypoxia-inducible factor inducible nitric oxide synthase

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Pharmacologic blockade of HIF-1α degradation improves choke...

Application of peroneal artery perforator flap in reconstruction for soft tissue defects after oral cancer ablation

2016年浙江省手外科暨显微外科学学术年会

作者：陶先耀高伟阳王珑丁健封晓亮温州医科大学附属第二医院

Background Roxadustat(FG-4592) is a specific hypoxia-inducible factor 1α(HIF-1α) prolyl hydroxylase *** investigated the effects of the Pharmacological delay with FG-4592 on the survival and choke vessels of a multi-territory perforator flap in *** In total,144 rats were divided into four groups(n = 36 each):FG-4592 alone,FG-4592 plus aminoguanidine(AG),AG alone,and no *** postoperative day 7,the surviving flap area was calculated as a percentage of total flap dimensions using DP2-BSW *** 12 hours post-surgery,in the second choke zone of the flap,the diameter of macrovascular and microvascular vessels were respectively calculated by angiography and histology,nitric oxide(NO) content was measured by NO concentration assay kits,and protein levels of HIF-1α and iNOS were assessed by Western *** Doppler imaging was used to evaluate flap perfusion at the second choke zone at 12 h and 7 days after *** The protein levels of HIF-1α were significantly higher in FG-4592 and FG-4592 plus AG *** flap survival area,the diameter of macrovascular and microvascular vessels,the protein levels of iNOS,NO content and perfusion were significantly greater in rats given FG-4592 compared with the other three groups,All of these measures were significantly lower in AG-treated *** also found that the vasodilatory effect of FG-4592 was attenuated by *** FG-4592 pre-treatment may improve flap survival and dilate the choke vessels in a multiterritory perforator flap.

关键词： perforator flap choke vessels pharmacological delay hypoxia-inducible factor inducible nitric oxide synthase

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Application of peroneal artery perforator flap in reconstruc...

Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

2019第一届全国口腔颌面-头颈肿瘤学术大会——聚合引领、协同发展

作者：杨向明 WEI Jianhua LEI Delin School of Stomatology Air Force Military Medical University

Free flaps play key roles in reconstruction oral soft tissue defects. Nowadays, reconstruction require more precise, functional and less donor sites compromise. Upon employment of perforator flaps in recent years, more choices and less trauma to donor sites became possible. While forearm flap used to be workhorse in oral defects reconstruction, there were some drawbacks for the flap. The ALT flap has some advantage compared with forearm flap except for its bulkiness. The peroneal artery perforator flap owns benefit of forearm and ALT in reconstruction of oral tongue, floor of mouth and buccal defects. We summarize the perforator flap in this article, it is a good alternative for forearm and ALT in oral defects reconstruction.

关键词： defects perforator flap OSCC reconstruction peroneal artery

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World Journal of Clinical Cases 2024年第4期12卷 828-834页

作者： Jae Hyung Jeon Kyung Wook Kim Hong Bae Jeon Department of Plastic and Reconstructive Surgery Dankook University HospitalCheonan 31116ChungnamSouth Korea Department of Orthopaedic Surgery Dankook University HospitalDankook University College of MedicineCheonan 31116ChungnamSouth Korea Department of Plastic and Reconstructive Surgery Dankook University HospitalDankook University College of MedicineCheonan 31116ChungnamSouth Korea

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue ***,some drawbacks include restricted flap size,partial flap loss,and donor-site *** address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue *** SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was *** week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound *** debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the *** weeks later,the flap was detached from the abdomen,and the abdominal defect was directly ***,the second stage of Masquelet technique was performed at the fracture site at week ***,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or *** site osteosynthesis was achieved without *** Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

关键词： Forearm injury Open fracture reduction perforator flap Deep inferior epigastric artery perforators Case report

Clinical applications of paraumbilical perforator flaps in multiple angiosomes for the reconstruction of the upper limbs

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Chinese Journal Of Plastic and Reconstructive Surgery 2022年第1期4卷 1-5页

作者： Xiaojun Liu Rui Zhao Xinyuan Jin Lei Liu Guoliang Shen Department of Burn and Plastic Surgery The First Affiliated Hospital of Soochow UniversitySuzhou 215006JiangsuChina Department of Burn and Plastic Surgery North District of Suzhou Municipal HospitalSuzhou 215008JiangsuChina

Background:Repair of extensive deep wounds in the forelimb remains challenging for *** objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper ***:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were *** injuries included damage to the fingers,dorsal skin of the hands,wrist,or *** tendons or bones were exposed after *** some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue ***:All flaps survived and healed *** a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional ***:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.

关键词： Angiosome perforator flap Upper limb Reconstruction

Limb preservation with suprafascial and thin perforator flaps: salvaging osteomyelitis, Charcot collapse and critical limb ischemia

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Plastic and Aesthetic Research 2019年第8期6卷 13-23页

作者： Shawn Diamond Andres F.Doval Benjamin Scott Matthew L.Iorio Division of Plastic and Reconstructive Surgery Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215USA Division of Plastic and Reconstructive Surgery University of Colorado Anschutz Medical CenterAuroraCO 80045USA.

AIM: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine patient and flap related outcomes in advanced lower extremity disease. Methods: The authors conducted a retrospective review of fasciocutaneous free flaps of variable thickness for lower extremity salvage. Osteomyelitis and non-osteomyelitis patients were compared according to our primary outcome measures: functional ambulation, bone healing and complications to flap and patient. Subgroups with critical limb ischemia, Charcot collapse and diabetic foot were analyzed separately. Results: Fifty-nine patients underwent free flap reconstruction: osteomyelitis (n = 20, 34%), Charcot collapse (n = 22, 37%), and/or critical limb ischemia (n = 12, 20%). All patients underwent anterolateral thigh flaps tailored for defect-specific thicknesses: 17 superthin, 25 suprafascial, 17 subfascial. There were no significant differences between groups in terms of partial and complete flap loss (P = 1.000 and P = 0.108). Ninety-one percent of patients were ambulatory at follow up. Eighty-tive percent of individuals with osteomyelitis cleared their infection demonstrating radiographic bone healing. Two patients developed recalcitrant deep space infections ultimately requiring amputation. Subgroup analysis did not show any differences in flap related complications within the diabetic Charcot population. In multivariate regression, preoperative revascularization was independently associated with failure of limb salvage. ;Conclusion: Primarily thinned perforator flaps performed well in the setting of lower extremity limb salvage, critical limbischemia, osteomyelitis, and the Charcot foot - expanding their role in the armamentarium for lower extremity care.

关键词： perforator flap diabetic foot limb salvage

The evolution of lower extremity reconstruction

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Plastic and Aesthetic Research 2022年第1期9卷 182-195页

作者： Brogan G.A.Evans David L.Colen Division of Plastic and Reconstructive Surgery Department of SurgeryYale School of MedicineNew HavenCT 06510USA

Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past *** advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of *** introduction of antibiotics improved surgical debridement and local reconstructive options,enhancing the viability of lower extremities with simple and proximal *** the advent of microvascular surgery,free tissue transfer techniques provided a means to reconstruct more distal and complex *** these surgical techniques have continued to evolve,so too have indications for reconstruction,patient management and post-operative care-now with a greater emphasis on patient quality of life and limb *** purpose of this article is to outline the evolution of lower extremity reconstruction,and how the standard of practice has changed over time.

关键词： Lower extremity lower extremity reconstruction limb salvage free flap perforator flap vascularized bone flap orthoplastic surgery