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Chinese Neurosurgical Journal 2022年第3期8卷 209-214页

作者： Yao Wu Zhaoliang Li Dehong Yang Tao Wu Ailin Chen Chungang Dai Qing Zhu Second Affiliated Hospital of Soochow University Sanxiang Road 1055Suzhou 215004China

Background:Aneurysm of basilar perforator was rarely reported in the literature.It is difficult to treat due to its small size and deep-seated location.Excessive treatment may cause complications that resulted from ischemic events of parent perforators.Therefore,it is important to make clinical strategy for such patients to improve the prognosis.Case presentation:One case,who presented as spontaneous subarachnoid hemorrhage,despite the negative result in computed tomography angiography firstly,was diagnosed angiographically as a ruptured aneurysm of the basilar perforator.A good clinical outcome of the case was achieved during the follow-up after conservative observation for 2 months,as well as the disappearance of previous lesion from angiography.Conclusions:Aneurysm located at perforator of basilar trunk was rare and difficult to treat.Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects.

关键词： Basilar trunk Intracranial aneurysm perforator

perforator-based flaps for the treatment of burn scar contractures: a review

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Burns & Trauma 2017年第1期5卷 9-16页

作者： C.M.Stekelenburg R.E.Marck P.D.H.M.Verhaegen K.W.Marck P.P.M.van Zuijlen Burn Center and Department of Plastic Reconstructiveand Hand SurgeryRed Cross HospitalVondellaan 131942 LE BeverwijkThe Netherlands Department of Plastic Reconstructiveand Hand SurgeryUniversity Medical CenterUtrechtThe Netherlands Department of Plastic Reconstructiveand Hand SurgeryAcademical Medical CenterAmsterdamThe Netherlands Department of Plastic Reconstructiveand Hand SurgeryMOVE Research InstituteVU University Medical CenterAmsterdamThe Netherlands Department of Plastic Reconstructiveand Hand SurgeryIsalaZwolleThe Netherlands Department of Plastic Surgery Medisch Centrum LeeuwardenLeeuwardenThe Netherlands.

Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising;however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial;ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.

关键词： Burn Scar Contracture perforator flap

Dorsal hand reconstruction with radial artery perforator-based adipofascial flap

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Plastic and Aesthetic Research 2020年第5期7卷 15-25页

作者： Sho Yamakawa Kenji Hayashida Division of Plastic and Reconstructive Surgery Shimane University HospitalIzumoShimane 693-8501Japan

Reconstruction of dorsal hand soft tissue defects after severe injury is challenging for surgeons.Depending on the degree of defect,extensor tendon reconstruction may also be necessary.Various reconstruction methods are commonly performed to cover dorsal hand defects,such as skin grafting and distant,free,or local flaps.Among them,free vascularized flap transplantation is an ideal procedure because the major vessels that feed the local flap may have been damaged,and the affected limb can be reconstructed using a flow-through method.Although free flap surgery has advanced,few surgeons can choose this option due to its technical difficulty and uncertainty.On the other hand,distant flaps have been commonly used for the reconstruction of dorsal hand defects,and local flaps,such as reverse forearm flaps and retrograde posterior interosseous flaps,do not require microvascular anastomosis.However,they have some problems;distant flaps require at least two surgeries,reverse forearm flaps sacrifice major vessels and leave a scar at the donor site,and retrograde posterior interosseous flaps require meticulous dissection of the vascular pedicle.The radial artery perforator-based adipofascial flap is a versatile flap that is safe and easy to elevate without sacrificing the radial artery.In addition,elevating it as an adipofascial flap enables surgeons to avoid an unacceptable donor scar.We present two cases,demonstrating the usefulness of this pedicled perforator flap.

关键词： perforator dorsal hand reconstruction adipofascial flap hand replantation color Doppler ultrasonography

Adipo Fascio Cutaneous perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of perforators &Its Clinical Applications in Head &Neck Reconstruction

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International Journal of Otolaryngology and Head & Neck Surgery 2018年第5期7卷 268-286页

作者： Ehtaih Sham Jaumie A. Masia Thyagaraj Jayaram Reddy Department of Plastic Craniofacial & Reconstructive Surgery Hospital Sant Pau University Autonoma De Barcelona Barcelona Spain Department of Plastic & Reconstructive Surgery Vydehi Institute of Medical Sciences Bangalore India

Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.15%) & were not clinically significant. 104 perforators were greater than 0.5 mm in diameter (46.84%) & were clinically significant. 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on prox

关键词： Vascular Anatomy Angio Computed Tomography perforator Flap Radial Artery Reconstruction Vascularization

Free Anterolateral Thigh perforator Flap for Head and Neck Cancer Resection in a Nonagenarian

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Modern Plastic Surgery 2012年第1期2卷 1-4页

作者： Frank Lin Damien Grinsell 不详

With an aging population, free flap reconstruction for head and neck cancer ablation in the elderly is becoming more commonplace. In nonagenarians, however, such major operations are still rarely offered due to its physiological demands. We report the first case of successful resection and reconstruction of head and neck cancer with a free perforator flap in a 96 year old patient. We feel that with careful patient and flap selection, careful preoperative workup and close collaboration between treating teams, age alone should not preclude patients from receiving the best possible curative treatment and reconstruction in head and neck cancers. Even in nonagenarians, perforator free flaps, such as the anterolateral thigh flap, can be used safely to achieve good functional and aesthetic outcomes.

关键词： Nonagenarian Elderly Microsurgery perforator Flap Head and Neck

Safety of Single Vein Anastomosis versus Double Venous Anastomosis in ALT perforator Flap in Foot and Leg Reconstruction

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Modern Plastic Surgery 2019年第4期9卷 65-73页

作者： Mohamed Abdelaal Ahmed Gaber Plastic Surgery Department Sohag University Hospital Sohag University Sohag Egypt

Introduction: Single or double venous anastomosis in free flap in general and ALT, in particular, is still a matter of debate between micro vascular surgeons. In this study, we will present our experience in single vein anastomosis versus double venous anastomosis in ALT perforator flap used in leg and foot reconstruction as regarding flap outcome, complications, operation time and the need for re-exploration. Patient and Methods: We retrospectively evaluate 60 patients with post traumatic foot and leg defects in the period between January 2014 and January 2018 where free ALT flap was done. The patients were divided into two groups, Group 1 where single vein anastomosis was done and Group 2 where double venous anastomosis was done;we utilize the deep venous system for the anastomosis in all cases. Results: Complete flap survival noticed in 56 cases (93.3%), defect size ranged from 70 to 200 cm (mean 126.35 ± 33.78). There was no difference between the 2 groups as regarding Flap survival, hospital stay, flap complications, donner site morbidity and vascular insufficiency. There is statistically significant difference between both groups as regarding Ischemia time, Operation time, and overall re-exploration rate. Conclusions: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is as safe and feasible as the two veins anastomoses.

关键词： Single Vein perforator Flap Foot Reconstruction

Numerical Simulation on New perforator

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Defence Technology（防务技术） 2011年第4期7卷 253-256页

作者：姚志华王志军李德战付盟 School of Mechatronic Engineering North University of China Airport Service Technology Test Center of Air Force

To study a new shaped charge of perforator, the jet formation and penetration processes in concrete targets are simulated numerically by using LS-DYNA finite element analysis software. The results show that the cylindrical liner can form jet and most materials on top of liner form the tip of jet, while the others form the tail of jet. The jet has a better continuity, and the ratio of cumulative jet length to the liner diameter can reach to 7.56. Furthermore, the ratio of bore diameter to the liner diameter is from 0.36 and 1, and the ratio of penetration depth to the liner diameter can be up to 5.5.

关键词： explosion of mechanics cylindrical liner jet perforator numerical simulation

Surgical treatment algorithms for post-burn contractures

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Burns & Trauma 2017年第1期5卷 1-8页

作者： Kenji Hayashida Sadanori Akita Division of Plastic and Reconstructive Surgery Department of DermatologyFaculty of MedicineShimane University Hospital89-1Enya-choIzumoShimane693-0021Japan Department of Plastic Surgery Wound Repair andRegenerationFukuoka UniversityFukuokaJapan.

Burn contractures produce restrictions in motion and unacceptable aesthetic results, frequently with persistent wounds. Proper planning and tissue selection are essential to minimize donor site morbidity optimizing outcomes. The principle of burn reconstructive surgery requires that the defects after release should be replaced with donor tissues which have matching texture and color as well as enough pliability. Autologous skin grafting or flap surgeries meet these criteria to replace scar tissues and resurface the subsequent to post-released scar defects. Despite the benefits, the use of flaps is often limited in burn patients for many reasons. If a surgeon intends to release completely and reconstruct in one-stage operation, a large defect may result in large donor site morbidity, necessitating flap surgery including free flap surgery. A lot of different methods and procedures are available for resurfacing the defects, and these are reviewed. In this article, algorithms for the release of burn contractures and reconstructive methods are presented. These treatment algorithms should aid in achieving significant improvement in both joint motions and aesthetic deformities.

关键词： BurnContracture Algorithm Donor site morbidity perforator flap Surgical treatment

Distally based perforator sural flaps for foot and ankle reconstruction

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World Journal of Orthopedics 2015年第3期6卷 322-330页

作者： Shi-Min Chang Xiao-Hua Li Yu-Dong Gu Department of Orthopedic Surgery Yangpu Hospital Tongji University School of Medicine Department of Hand Surgery Huashan Hospital Fudan University Key Laboratory of Hand Reconstruction Ministry of Health Shanghai Key Laboratory of Peripheral Nerve and Microsurgery

Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chainlinked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

关键词： Fasciocutaneous flap Distally based flap Foot and ankle perforator flap Neurocutaneous flap Sural flap Propeller flap

perforator vascular anatomy and clinical application of the anteromedial thigh flap for head and neck Reconstruction

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Perforator vascular anatomy and clinical application of the ...