Free tissue transfer has revolutionized tissue reconstruction. Microvascular operation techniques using free tissue transfer make it possible to precisely restore various defects and deformities. There are various surgical flaps available for this surgery, such as muscle flaps, musculocutaneous flaps, or fasciocutaneous flaps. The development of perforator flaps enables multi-component reconstruction with reduced donor site morbidity. Successful reconstruction must be approached with the goals of not only providing stable coverage, but most importantly, of restoring function. Therefore, the selection of flaps is dependent on the recipient site characteristics and the functional and aesthetic results at both the recipient and donor sites. With the high success rate of free flaps and the popularization of the perforator flap, microvascular surgery has played a major role in various reconstructive fields.
Congenital Abnormalities ; Free Tissue Flaps ; Humans ; Microsurgery* ; Myocutaneous Flap ; Perforator Flap* ; Surgical Flaps ; Tissue Donors

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.
Angiography ; Extremities ; Free Tissue Flaps ; Humans ; Leg ; Lower Extremity* ; Myocutaneous Flap ; Necrosis ; Perforator Flap ; Skin ; Surgical Flaps ; Thigh ; Tibial Arteries ; Tissue Donors ; Wounds and Injuries

The reconstruction of recurrent pressure sores is challenging due to a limited set of treatment options and a high risk of flap loss. Successful treatment requires scrupulous surgical planning and a multidisciplinary approach. Although the tensor fascia lata flap is regarded as the standard treatment of choice-it provides sufficient tissue bulk for a deep trochanteric sore defect-plastic surgeons must always consider the potential of recurrence and accordingly save the second-best tissues. With the various applications of anterolateral thigh (ALT) flaps in the reconstructive field, we report two cases wherein an alternative technique was applied, whereby pedicled ALT fasciocutaneous island flaps were used to cover recurrent trochanteric pressure sores. The postoperative course was uneventful without any complications. The flap provided a sound aesthetic result without causing a dog-ear formation or damaging the lower-leg contour. This flap was used as an alternative to myocutaneous flaps, as it can cover a large trochanteric defect, recurrence is minimized, and the local musculature and lower-leg contour are preserved.
Fascia Lata ; Femur* ; Myocutaneous Flap ; Perforator Flap ; Pressure Ulcer* ; Recurrence ; Surgical Flaps ; Thigh*

Skin and soft tissue defects around the knee joints are often accompanied by popliteal artery injury, patellar ligament injury, patellar fracture, and other deep tissue damage or exposure, making them challenging to repair. The principle is to repair the wound, reconstruct anatomical structure of the knee joint, and recover the knee joint function. At present the reconstruction with skin flap or myocutaneous flap is our priority. Local flap or myocutaneous flap can be used for repairing minor defects around the knee joints. Repairing with perforator flap, fascia flap, and free flap are main alternatives for covering larger and complex defects around the knee joints. During the treatment, a joint effort is mandatory, not only to repair the wound, but also to reconstruct vasculature, fix fracture, repair ligament, and finally recover the knee joint function. Therefore, the importance of multidisciplinary cooperation must be emphasized. Moreover, along with the development of new technologies, new methods, and new materials, perforator flap plays an important role in repairing skin and soft tissue defects around the knee joints.
Free Tissue Flaps ; Humans ; Knee Injuries ; surgery ; Knee Joint ; Myocutaneous Flap ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Treatment Outcome ; Wound Healing

BACKGROUND: The aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects. METHODS: A comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller) flaps used for lower extremity reconstruction were excluded from meta-analysis. RESULTS: From the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3%) comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed. CONCLUSIONS: Pedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body.
Free Tissue Flaps ; Humans ; Lower Extremity ; Perforator Flap ; Pressure Ulcer ; Retrospective Studies ; Surgical Flaps ; Ulcer

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.
Free Tissue Flaps ; Hyperemia ; Lower Extremity ; Microsurgery ; Perforator Flap ; Surgical Flaps ; Thigh ; Veins

The reconstruction of deep soft tissue defect such as pressure sore has difficult problems. Myocutaneous flaps have been used commonly as the best coverage method for pressure sore. But, they have several drawbacks such as sacrifice of functional muscle, high morbidity of the donor sites and bulkiness at the recipient site. The concepts of perforator flap has recently developed and widely used to overcome these disadvantages. Between March 2005 to July 2006, we have treated 9 patients who had pressure sore using perforator based fasciocutaneous island rotation flap. Preoperative unidirectional Doppler was used in all cases. Mean number of perforator vessels was 3.8 and flap sizes were from 7x5 cm to 14x13 cm. Rotation angles of flap were from 90 degree to 180 degree. In all cases, donor sites were closed primarily. All flap survived completely and postoperative complications were wound dehiscence in 1 case, wound infection in 3 cases. The mean postoperative follow up period was 15.7 months and recurrence was not reported. We could decrease donor site morbidity and cover wound sites easily by using flap rotation and get robust blood supply without sacrifice of functional muscle. Fasciocutaneous perforator island rotation flap would be very useful for various pressure sore treatment.
Follow-Up Studies ; Humans ; Myocutaneous Flap ; Perforator Flap ; Postoperative Complications ; Pressure Ulcer* ; Recurrence ; Surgical Flaps ; Tissue Donors ; Wound Infection ; Wounds and Injuries

Reconstruction of extensive soft tissue defect of the head and neck after or resection or injury has improved with advances in surgical techniques. Traditional local flap techniques are not easy to reconstruct the extensive soft tissue defects and irradiated or contaminated recipient beds. Then musculocutaneous flaps such as pectoralis major flap, trapezius flap, latissimus dorsi flap and sternocleidomastoid flap have been performed. These musculocutaneous flaps are effective in resurfacing the neck and lower face, for example, mandibular area but difficult to reconstruct the upper face and scalp and the result is poor. Other alternative flap used to cover this area is free flap, but this flap has many limitation too and therefore reconstructive surgeons have attempted to develop new flaps. There are three distinct musculocutaneous flaps, the superior, the lateral island, and the lower island flaps, that can be harvested from the trapezius muscle that are used in head and neck reconstruction. The lower trapezius musculocutaneous flap provides a long paddle of thin, pliable skin and muscle and offers the long are of rotation and thus the greater versatility of the three types of trapezius flaps. But this lower trapezius musculocutaneous flap has may problems to reconstruct the upper part of face and scalp by traditional method and has used mainly to resurface the neck and lower face. Thus, authors modified the procedure of lower trapezius flap and tried to reconstruct the upper part of face and scalp. The modification is that during the dissection, the trapezius muscle must be totally mobilized and the dorsal scapular artery must be preserved. By this procedure, blood flow can circulate effectively to the distal portion of flap and then modified flap has greater are of rotation and reliably reach higher portion of face and scalp. The operative results me that among the eight cases performed by modified lower trapezius musculocutaneouas flap, seven were reconstructed successfully, and remaining one presented partial flap necrosis and secondary procedure was needed. The functional defecits of donor site were minimal in all cases.
Arteries ; Free Tissue Flaps ; Head ; Humans ; Myocutaneous Flap* ; Neck ; Necrosis ; Scalp ; Skin ; Superficial Back Muscles* ; Surgical Flaps ; Tissue Donors

Since the use of the rectus abdominis myocutaneous flap was first reported by Mathes and Bostwick in 1977, its clinical utility both as an pedicled flap and a free flap has broadened reconstructive surgery. But there is a risk of postoperative abdominal hernia formation and bulkiness due to the volume of the rectus muscle and subcutaneous fatty tissue, it is pointed out as a disadvantage in the recipient site where a thin flap is required. To overcome these problems, Koshima (1989), and Itoth (1993) described the modification of this flap which contained little or no muscle or fascia. In our department , we performed deep inferior epigastric artery free skin flap in soft tissue reconstruction in three patients: we dissected one or two muscle perforator from the rectus muscle, removed the deep fatty layer, so we could elevate a thin flap. The results were good, so we are willing to describe the operative technique and its usefulness.
Adipose Tissue ; Epigastric Arteries* ; Fascia ; Free Tissue Flaps ; Hernia, Abdominal ; Humans ; Myocutaneous Flap ; Rectus Abdominis ; Skin* ; Surgical Flaps

BACKGROUND: Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area. METHODS: Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft. RESULTS: Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 cm2, with a range of 18 to 135 cm2. There were no major complications. No patients had any newly developed functional deficit of the lower leg. CONCLUSIONS: We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure.
Arteries ; Demography ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Leg ; Perforator Flap ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin ; Surgical Flaps