Background: Upper extremity soft tissue reconstruction is an extensive topic as a multitude of options exist for diverse soft tissue defects involving shoulder, arm, elbow, forearm, wrist, and hand. Many of the times flap cover is necessary for resurfacing exposed critical structures like tendons, neurovascular structures, bone and to provide supple tissue over joints. Pedicled and perforator flaps are seen in last years as a good choice to restore length, sensitivity and function of the injured upper limb.
The aim of this paper is to give an overview of the definitions of as well as to present our experience regarding pedicled and perforator flaps.
Materials and methods: A retrospective analysis of 15 trauma patients who underwent pedicled and perforator flaps during the 2012-2016 timeframe period was made. The patients were divided according to their type of injury, as well as the types of flasp that were used.
Results: We have performed in total: 7 Foucher’s flaps, 4 Posterior Interosseous Artery flaps, 1 Radial Recurrent Artery flap, 1 Quaba flap, 1 SDMA flap. We had only two cases of partial necrosis of the flaps and all the others survived completely.
Conclusions: Every single flap elevated successfully is linked with a meticulous surgical technique. We should take a special care in pedicle positioning because pedicle strangling was the most important negative factor in our two flap partial necrosis. Understanding the mistakes will help us to improve our surgical techniques day after day.
Blondeel PN, VanLanduyt, Monstry SJ, et al.The Gent consensus on perforator flap terminology:preliminary definitions.PRS 112:1378-1383: discussion 1384-1377,2003.
Cormack GC, Lamberty BG. Fascio-cutaneous vessels.Their distribution on the trunk and limbs, and their clinikcal application in tissue transfer.Anat Clin 6:121-131,1984.
Hallock GG.Doppler sonografy and color duplex imaging for planning a perforator flap. Clin Plast Surg 30:347,2003.
Massia J, Clavero Ja, Larranga Jr, et al. Multidetector-row CT in the planning of abdominal perforator flaps.J Plast Recon Aesthet Surg 59:594.2006.
Geddes CR, Morris SF, Neligan PC.Perforator flaps: evolution, classification and applications. Ann Plast Surg 50: 90, 2003.
Hwang K,Lee WJ,Jung CY, et al.Cutaneous perforators of the upper arm and clinical applications. J Reconstr Microsurg 21:463-469,2005.
The Functional Complex Anatomy of the Elbow: Jospt, www.jospt.org/doi/pdf/10.2519/jospt.1922.214.171.1249,by M Stroyan - 1993
Prantl L, Scherml S, Schwarce H, et al.A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects. J Plast Reconstr Aesthet Surg 61:546-551,2008.
Agir H,Sen C, Alagoz S, et al.Distally based posterior interosseous flap:primary role in soft tissue reconstruction of the hand. Ann Plast Surg 59:291-296,2007.
Cavadas PC,Ibanez J, Landin L, et al.Use of the reversed posterior interosseous flap in staged reconstruction of mutilating hand injuries before toe transfers.PRS 122:1823-1826,2008.
Chang SC,Chen SL,Chen TM, et al.Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg 53:449-454,2004.
Eski M, Nisanci M, Sergenzer M.Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap.Burns 33:65-71,2007.
Zhang X, He Y, Shao X, et al.First dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defects. J Hand Surg Am 34:1467-1473,2009.
Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making: Chinese Journal of Traumatology Volume 21, Issue 6, December 2018, Pages 338-351
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.