OBJECTIVE: To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. METHODS: A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. RESULTS: Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. CONCLUSION Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.
Male ; Female ; Humans ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Temporal Arteries/surgery* ; Indocyanine Green ; Forehead/surgery* ; Retrospective Studies ; Skin Transplantation ; Angiography ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome

OBJECTIVE: To review the research progress of the principle and clinical application of keloid core excision technique. METHODS: The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed. RESULTS: Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies. CONCLUSION The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.
Humans ; Keloid/pathology* ; Recurrence ; Surgical Flaps/pathology* ; Plastic Surgery Procedures ; Treatment Outcome

Objective:To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods:The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed. Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection. Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap. Donor sites at the back were directly sutured. The survival of flaps, the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results:A total of 13 patients, aged from 5 to 36 years (median age, 14 years), were included, including 8 males and 5 females. Twelve of the 13 cases were post-burn scar, including facial scars in 5 cases, cervical scar in 1 case and faciocervical scar in 6 cases. One case of scar was caused by radiotherapy for facial hemangioma. The size of defects after scar resection and release ranged from 12.0 cm × 8.0 cm to 24.5 cm × 8.0 cm. The operation was successfully completed in all cases. Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps, measuring 23.0 cm × 7.0 cm to 27.0 cm ×14.0 cm, were used as the first flap; five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps, measuring 18.0 cm × 7.0 cm to 25.0 cm × 10.0 cm, were used as the second flap. One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma. Other flaps survived without complications and the incisions were healed in one stage. Patients were followed up for 1 to 48 months, with a median follow-up of 13 months. The color, texture, and thickness of flaps were similar to those of the recipient site. All patients were satisfied with the cosmetic result of recipient sites and donor sites.Conclusion:The sequential flap transfer technique could improve the reconstructive ability of pre-expanded medial arm flap and supraclavicular artery perforator plus flap in surgical treatment of extensive faciocervical scar, minimize the donor site morbidities, assist the closure of donor site and improve the overall outcomes.

Objective:To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods:The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed. Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection. Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap. Donor sites at the back were directly sutured. The survival of flaps, the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results:A total of 13 patients, aged from 5 to 36 years (median age, 14 years), were included, including 8 males and 5 females. Twelve of the 13 cases were post-burn scar, including facial scars in 5 cases, cervical scar in 1 case and faciocervical scar in 6 cases. One case of scar was caused by radiotherapy for facial hemangioma. The size of defects after scar resection and release ranged from 12.0 cm × 8.0 cm to 24.5 cm × 8.0 cm. The operation was successfully completed in all cases. Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps, measuring 23.0 cm × 7.0 cm to 27.0 cm ×14.0 cm, were used as the first flap; five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps, measuring 18.0 cm × 7.0 cm to 25.0 cm × 10.0 cm, were used as the second flap. One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma. Other flaps survived without complications and the incisions were healed in one stage. Patients were followed up for 1 to 48 months, with a median follow-up of 13 months. The color, texture, and thickness of flaps were similar to those of the recipient site. All patients were satisfied with the cosmetic result of recipient sites and donor sites.Conclusion:The sequential flap transfer technique could improve the reconstructive ability of pre-expanded medial arm flap and supraclavicular artery perforator plus flap in surgical treatment of extensive faciocervical scar, minimize the donor site morbidities, assist the closure of donor site and improve the overall outcomes.

Objective:To explore the feasibility and technical tips of donor-site reconstruction of the latissimus dorsi myocutaneous flap using the perforator propeller flap technique.Methods:Between July 2012 and January 2019, a total of 24 patients, including 9 males and 15 females, underwent reconstructions of defects in various locations using the latissimus dorsi myocutaneous flap. The average patient age was 43.6 years (range, 4-81 years). Before surgery, perforators adjacent to the latissimus dorsi muscle were explored using an ultrasound Doppler probe and marked on the skin. A latissimus dorsi myocutaneous flap was elevated according to the resultant defect following the removal of the lesion and transferred to reconstruct the defect. The donor-site defects were reconstructed using one, dual, or even triple perforator propeller flap.Results:All the 24 myocutaneous flaps survived completely. The dimension and width of the myocutaneous flaps ranged from 16 cm × 11 cm to 33 cm × 17 cm and 9 cm to 20 cm, respectively. The donor-site defects of the myocutaneous flap were all closed by perforator propeller flaps including 22 pedicled flaps and 2 free flaps. The defect was reconstructed by one perforator propeller flap in 12 patients, two flaps in 11, and three flaps in the remaining one patient. There were 36 posterior intercostal artery perforator propeller flaps and one freestyle perforator propeller flap. The size, pedicle length, and rotation angle of the propeller flaps were 13 cm × 5 cm to 23 cm × 14 cm, 3 cm to 6 cm, and 90 to 180 degrees, respectively. All the donor sites of the perforator propeller flaps were closed primarily. Total necrosis of the propeller flap occurred in one patient and small-sized distal flap necrosis in another one. The remaining propeller flaps survived completely. All patients were followed up for one to 38 months and the mean follow-up time was 7 months. Tumor recurrence was noticed in four patients. All patients were satisfied with the final functional and aesthetic outcomes.Conclusions:Using the perforator propeller flaps could guarantee not only harvesting a wide latissimus dorsi myocutaneous flap, but also primary donor-site closure of the myocutaneous flap, and therefore greatly improve the versatility and capability of the latissimus dorsi myocutaneous in defect reconstruction.

Objective:To explore the indications and technical tips of defect reconstruction in the elbow and upper arm using the radial collateral artery perforator (RCAP) propeller flap.Methods:From October 2016 to December 2019, 6 patients underwent defect reconstruction using the RCAP propeller flaps. All patients were female, aged from 5 to 66 years, with an average of 31 years. All of the defects were repaired with radial collateral artery perforator propeller flap. Before the surgery, the RCAP was thoroughly explored using the hand-held ultrasound Doppler and marked on the skin. According to the size, shape and location of the defect, a RCAP propeller flap was elevated based on the chosen RCAP, rotated in a certain degree with the perforating point as the rotation point. The large paddle was used to repair the defect of the upper extremity, and the small paddle was used to assist in closing the donor site. The donor sites were sutured directly or repaired with free skin graft. Capillary filling test or indocyanine green SPY fluorescence imaging system was used to evaluate the blood supply of the flap immediately. The effect was observed.Results:The defect size ranged from 6.0 cm × 3.0 cm to 10.0 cm × 7.0 cm. The flap size ranged from 6.0 cm × 3.5 cm to 20.0 cm × 8.0 cm. All perforators were septocutaneous perforators. The pedicle of the pedicle ranged from 2.5 cm to 5.0 cm and the mean length was 3.6 cm. The flaps were rotated 180° in 5 patients, and 150° in one patient. The donor sites were sutured directly in 5 patients and repaired with free skin graft in one patient. Five flaps survived completely without any major complications. Wound infection occurred in one flap, which healed after debridement. All donor sites were closed primarily, except one which was covered by free skin grafting. All patients were followed up for 3 months to 3 years and the average follow-up time was 2.4 years. The appearance and texture of the flap were good, and the motion of elbow joint was normal. All patients were satisfied with the functional and aesthetic outcomes of the upper extremities. Tumor recurrence was not noticed in the oncologic patients.Conclusions:For selected patients, the RCAP propeller flap could be an alternative option for soft-tissue defect reconstruction in the upper extremity.

Since the first description by Hyakusoku in 1991, perforator propeller flaps have become one of the most commonly used method for defect reconstruction across the entire human body. We briefly reviewed the history, definition, nomenclature, and classification of perforator propeller flaps, and the corresponding surgical techniques were introduced in detail as well by reviewing our clinical cases. The clinical applications of the perforator propeller flaps were reviewed thoroughly by describing its use in different anatomic regions including the head and neck, trunk, extremities, buttock, and perineum respectively. Both the advantages and drawbacks of the flaps, common complications, and its prevention were also analyzed. Problems that we often encountered in the application of perforator propeller flaps and its current research status were analyzed and summarized. Although the perforator propeller flaps have been increasingly widely used, there still exist some important issues that deserve more concern and need to be solved, including precise perforator localization, accurate definition of perforators, correlations between the rotation angle of the flap, vascular patency and pedicle length. Though with the aforementioned problems, we believe that, like the tissue expansion and microsurgical flap transfer technique, the perforator propeller flap technique will ultimately become a conventional and important method for defect and organ reconstruction.

Objective:To explore the feasibility and technical tips of donor-site reconstruction of the latissimus dorsi myocutaneous flap using the perforator propeller flap technique.Methods:Between July 2012 and January 2019, a total of 24 patients, including 9 males and 15 females, underwent reconstructions of defects in various locations using the latissimus dorsi myocutaneous flap. The average patient age was 43.6 years (range, 4-81 years). Before surgery, perforators adjacent to the latissimus dorsi muscle were explored using an ultrasound Doppler probe and marked on the skin. A latissimus dorsi myocutaneous flap was elevated according to the resultant defect following the removal of the lesion and transferred to reconstruct the defect. The donor-site defects were reconstructed using one, dual, or even triple perforator propeller flap.Results:All the 24 myocutaneous flaps survived completely. The dimension and width of the myocutaneous flaps ranged from 16 cm × 11 cm to 33 cm × 17 cm and 9 cm to 20 cm, respectively. The donor-site defects of the myocutaneous flap were all closed by perforator propeller flaps including 22 pedicled flaps and 2 free flaps. The defect was reconstructed by one perforator propeller flap in 12 patients, two flaps in 11, and three flaps in the remaining one patient. There were 36 posterior intercostal artery perforator propeller flaps and one freestyle perforator propeller flap. The size, pedicle length, and rotation angle of the propeller flaps were 13 cm × 5 cm to 23 cm × 14 cm, 3 cm to 6 cm, and 90 to 180 degrees, respectively. All the donor sites of the perforator propeller flaps were closed primarily. Total necrosis of the propeller flap occurred in one patient and small-sized distal flap necrosis in another one. The remaining propeller flaps survived completely. All patients were followed up for one to 38 months and the mean follow-up time was 7 months. Tumor recurrence was noticed in four patients. All patients were satisfied with the final functional and aesthetic outcomes.Conclusions:Using the perforator propeller flaps could guarantee not only harvesting a wide latissimus dorsi myocutaneous flap, but also primary donor-site closure of the myocutaneous flap, and therefore greatly improve the versatility and capability of the latissimus dorsi myocutaneous in defect reconstruction.

Objective:To explore the indications and technical tips of defect reconstruction in the elbow and upper arm using the radial collateral artery perforator (RCAP) propeller flap.Methods:From October 2016 to December 2019, 6 patients underwent defect reconstruction using the RCAP propeller flaps. All patients were female, aged from 5 to 66 years, with an average of 31 years. All of the defects were repaired with radial collateral artery perforator propeller flap. Before the surgery, the RCAP was thoroughly explored using the hand-held ultrasound Doppler and marked on the skin. According to the size, shape and location of the defect, a RCAP propeller flap was elevated based on the chosen RCAP, rotated in a certain degree with the perforating point as the rotation point. The large paddle was used to repair the defect of the upper extremity, and the small paddle was used to assist in closing the donor site. The donor sites were sutured directly or repaired with free skin graft. Capillary filling test or indocyanine green SPY fluorescence imaging system was used to evaluate the blood supply of the flap immediately. The effect was observed.Results:The defect size ranged from 6.0 cm × 3.0 cm to 10.0 cm × 7.0 cm. The flap size ranged from 6.0 cm × 3.5 cm to 20.0 cm × 8.0 cm. All perforators were septocutaneous perforators. The pedicle of the pedicle ranged from 2.5 cm to 5.0 cm and the mean length was 3.6 cm. The flaps were rotated 180° in 5 patients, and 150° in one patient. The donor sites were sutured directly in 5 patients and repaired with free skin graft in one patient. Five flaps survived completely without any major complications. Wound infection occurred in one flap, which healed after debridement. All donor sites were closed primarily, except one which was covered by free skin grafting. All patients were followed up for 3 months to 3 years and the average follow-up time was 2.4 years. The appearance and texture of the flap were good, and the motion of elbow joint was normal. All patients were satisfied with the functional and aesthetic outcomes of the upper extremities. Tumor recurrence was not noticed in the oncologic patients.Conclusions:For selected patients, the RCAP propeller flap could be an alternative option for soft-tissue defect reconstruction in the upper extremity.

Since the first description by Hyakusoku in 1991, perforator propeller flaps have become one of the most commonly used method for defect reconstruction across the entire human body. We briefly reviewed the history, definition, nomenclature, and classification of perforator propeller flaps, and the corresponding surgical techniques were introduced in detail as well by reviewing our clinical cases. The clinical applications of the perforator propeller flaps were reviewed thoroughly by describing its use in different anatomic regions including the head and neck, trunk, extremities, buttock, and perineum respectively. Both the advantages and drawbacks of the flaps, common complications, and its prevention were also analyzed. Problems that we often encountered in the application of perforator propeller flaps and its current research status were analyzed and summarized. Although the perforator propeller flaps have been increasingly widely used, there still exist some important issues that deserve more concern and need to be solved, including precise perforator localization, accurate definition of perforators, correlations between the rotation angle of the flap, vascular patency and pedicle length. Though with the aforementioned problems, we believe that, like the tissue expansion and microsurgical flap transfer technique, the perforator propeller flap technique will ultimately become a conventional and important method for defect and organ reconstruction.