The application of jigsaw puzzle flap based on free-style perforator to repair the defect on the groin and adjacent organs after tumor extended resection
10.3760/cma.j.cn114453-20200303-00099
- VernacularTitle:自由穿支血管组合皮瓣修复腹股沟及邻近部位恶性肿瘤扩大切除后皮肤软组织缺损
- Author:
Daojiang YU
1
;
Lu AN
;
Jianghuiwen LU
;
Xiaoming CHEN
;
Yulong WANG
;
Wenxing SU
Author Information
1. 成都医学院第二附属医院整形外科，成都 610051
- Keywords:
Surgical flaps;
Malignancy;
Groin;
Defect;
Repair;
Perforator flap
- From:
Chinese Journal of Plastic Surgery
2022;38(2):169-175
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application value of jigsaw puzzle flap based on free-style perforator in repairing the defect on groin and adjacent organ after tumor extended resection.Methods:From December 2013 to August 2019, the data was focused on the patients who underwent soft tissue defect repair of groin and adjacent areas in the Second Affiliated Hospital of Chengdu Medical College. After the defect was predetermined preoperatively, portable ultrasound Doppler was used to map multiple perforators adjacent to the defect. The large defect was divided into several small parts, based on the location of perforators, the intensity of the Doppler, the safety size of flap that can be perfused by a single free-style perforator, and the donor sites can be closed primarily. Each component part corresponds to a free-style perforator flap. The perforator vessels were reversely dissected, and small flaps of V-Y advancement, rotation and propeller pedicled with perforator vessels were formed (appropriate modification of flaps can be made according to actual anatomical perforator vessels). All flaps were transferred to the defect site and reassembled according to the preoperative design (film simulation) to repair the large wound or deep space after the extended resection of the tumor in the groin and adjacent organs. Meanwhile, the donor site was closed and sutured primarily. The color, temperature, capillary reaction of the skin flap were observed during the first 3 days after procedure, and appearance and function after repair were observed after long-term follow-up.Results:A total of 31 patients were enrolled, including 18 males and 13 females. The ages of the patients ranged from 48 to 82 years with an average of 66 years. The defect area of skin and soft tissue was 8.0 cm×10.0 cm-15.5 cm×20.0 cm, with an average of 12.0 cm×15.0 cm. A total of 65 flaps were harvested, including 32 propeller flaps, 18 rotating flaps and 15 V-Y advancement flaps. There were 3 cases with 3 flaps and 28 cases with 2 flaps. The average skin flap area was 12.0 cm×20.0 cm-5.0 cm×10.0 cm, with an average of 8.0 cm×13.0 cm, and the diameter of the pedicle perforator vessel was 0.5 mm-4.0 mm. The color, temperature and capillary reaction of the skin flap were normal during the first 3 days after operation. Too much tension resulted in congestion of the flap in one case and poor wound healing. The wound was treated with dressing change, and healed in two weeks. The patients were followed up for 3 months to 5 years, with an average of 1.5 years. 30 patients survived primarily. The postoperative appearance was good.Conclusions:The combination of multiple small free-style perforator flaps can repair the large skin and soft tissue defects of malignant tumors after extensive resection on the groin and its adjacent area, and the donor site can be closed primarily. This method is easy to operate and avoids micro anastomosis and skin grafting. It is a kind of repair approach for clinical reference.
