Repair of limb wounds with free profunda artery perforator flap in posteromedial femoral region_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIU Yujie , DING Xiaoheng , JIAO Hongsheng , REN Shengquan , WANG Zhengdan

The Hand Surgery Center of PLA, the 971th Hospital of Chinese PLA, Qingdao Shandong, 266071, P.R.China;

Corresponding author：

LIU Yujie, Email: liuyj2046@126.com

Keywords：

Profunda artery perforator flap; extremity wound; repair

DOI：

10.7507/1002-1892.201901069

Video：

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Objective To explore the effectiveness of free profounda artery perforator flap (PAPF) in the posteromedial femoral region for the treatment of traumatic skin defects of limbs.Methods Between March 2015 and April 2017, 11 cases of traumatic limb skin defect with deep tissue exposure were treated with free PAPF in posteromedial femoral region. There were 7 males and 4 females, with an average age of 39 years (range, 26-54 years). There were 4 cases of upper limb skin defect and 7 cases of lower limb skin defect. The causes of injury included 6 cases of traffic accident injury, 3 cases of machine crush injury, and 2 cases of crush injury. The size of wounds ranged from 11 cm×7 cm to 18 cm×11 cm. The time from post-traumatic admission to flap repair were 4-9 days (mean, 7.3 days). The size of free PAPF ranged from 15 cm×9 cm to 22 cm×13 cm. The donor site of 8 cases were closed directly; 3 cases could not be closed directly, and skin grafting was used to cover the wound.Results The time of skin flap harvest was 40-90 minutes (mean, 47 minutes). All flaps and skin grafts survived and the wounds healed by first intention. All the 11 patients were followed up 6-19 months (mean, 12 months). The skin flaps were soft in texture, similar in color to the skin around the injured limbs, without obvious pigmentation and hair overgrowth. Three of them underwent second-stage skin flap thinning. At last follow-up, the limb function of all patients recovered well. Longitudinal scar could be seen in the donor site of the flap, and the location was concealed. All patients did not complain that scar of the donor site affected their sexual life during the follow-up.Conclusion Free PAPF can achieve satisfactory results in repairing skin defects of extremities. The flaps have the advantages including constant perforator branches, simple operation, and concealed donor site.

Citation： LIU Yujie, DING Xiaoheng, JIAO Hongsheng, REN Shengquan, WANG Zhengdan. Repair of limb wounds with free profunda artery perforator flap in posteromedial femoral region. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(5): 590-594. doi: 10.7507/1002-1892.201901069 Copy

1.	Allen RJ, Haddock NT, Ahn CY, et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg, 2012, 129(1): 16e-23e.
2.	宋达疆, 李赞, 周晓, 等. 不同形式游离股深动脉蒂嵌合穿支肌皮瓣修复舌癌术后缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(6): 696-701.
3.	Teotia SS, Cho MJ, Haddock NT. Salvaging breast reconstruction: profunda artery perforator flaps using thoracodorsal vessels. Plast Reconstr Surg Glob Open, 2018, 6(9): e1837.
4.	卿黎明, 贺继强, 唐举玉, 等. 基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究. 中国临床解剖学杂志, 2016, 34(1): 12-15.
5.	DeLong MR, Hughes DB, Bond JE, et al. A detailed evaluation of the anatomical variations of the profunda artery perforator flap using computed tomographic angiograms. Plast Reconstr Surg, 2014, 134(2): 186e-192e.
6.	Angrigiani C, Grilli D, Thorne CH. The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg, 2001, 107(7): 1725-1731.
7.	贺继强. 股深动脉穿动脉穿支皮瓣的解剖及临床应用进展. 中国临床解剖学杂志, 2017, 35(4): 475-477.
8.	刘温悦, 穆兰花, 张寒, 等. 股深动脉穿支皮瓣应用于乳房再造的解剖学研究. 中国临床解剖学杂志, 2014, 32(4): 384-386.
9.	Mohan AT, Zhu L, Sur YJ, et al. Application of posterior thigh three-dimensional profunda artery perforator perforasomes in refining next-generation flap designs: transverse, vertical, and S-shaped profunda artery perforator flaps. Plast Reconstr Surg, 2017, 139(4): 834e-845e.
10.	Wu JC, Huang JJ, Tsao CK, et al. Comparison of posteromedial thigh profunda artery perforator flap and anterolateral thigh perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2016, 137(1): 257-266.
11.	王剑利, 王根, 赵刚, 等. 游离股后侧穿支动脉皮瓣的解剖学研究及临床应用. 中华显微外科杂志, 2013, 36(1): 7-10.
12.	穆籣, 彭喆, 毕晔, 等. 双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习. 中华显微外科杂志, 2016, 39(6): 555-558.
13.	Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap: a new option for autologous breast reconstruction—a cadaveric and computer tomography angiogram study. J Reconstr Microsurg, 2012, 28(6): 381-386.
14.	Hunsinger V, Lhuaire M, Haddad K, et al. Medium- and large-sized autologous breast reconstruction using a fleur-de-lys profunda femoris artery perforator flap design: a report comparing results with the horizontal profunda femoris artery perforator flap. J Reconstr Microsurg, 2019, 35(1): 8-14.
15.	Haddock NT, Greaney P, Otterburn D, et al. Predicting perforator location on preoperative imaging for the profunda artery perforator flap. Microsurgery, 2012, 32(7): 507-511.
16.	宋达疆, 李赞, 周晓, 等. 股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用. 中国修复重建外科杂志, 2017, 31(1): 52-56.
17.	Rozen WM, Donahoe S, Wilson JL. The profunda femoris artery " fourth perforator” island flap: a new perforator flap in lower-limb reconstruction. J Reconstr Microsurg, 2011, 27(4): 273-276.
18.	Ahmadzadeh R, Bergeron L, Tang M, et al. The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg, 2007, 119(1): 194-202.

1. Allen RJ, Haddock NT, Ahn CY, et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg, 2012, 129(1): 16e-23e.
2. 宋达疆, 李赞, 周晓, 等. 不同形式游离股深动脉蒂嵌合穿支肌皮瓣修复舌癌术后缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(6): 696-701.
3. Teotia SS, Cho MJ, Haddock NT. Salvaging breast reconstruction: profunda artery perforator flaps using thoracodorsal vessels. Plast Reconstr Surg Glob Open, 2018, 6(9): e1837.
4. 卿黎明, 贺继强, 唐举玉, 等. 基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究. 中国临床解剖学杂志, 2016, 34(1): 12-15.
5. DeLong MR, Hughes DB, Bond JE, et al. A detailed evaluation of the anatomical variations of the profunda artery perforator flap using computed tomographic angiograms. Plast Reconstr Surg, 2014, 134(2): 186e-192e.
6. Angrigiani C, Grilli D, Thorne CH. The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg, 2001, 107(7): 1725-1731.
7. 贺继强. 股深动脉穿动脉穿支皮瓣的解剖及临床应用进展. 中国临床解剖学杂志, 2017, 35(4): 475-477.
8. 刘温悦, 穆兰花, 张寒, 等. 股深动脉穿支皮瓣应用于乳房再造的解剖学研究. 中国临床解剖学杂志, 2014, 32(4): 384-386.
9. Mohan AT, Zhu L, Sur YJ, et al. Application of posterior thigh three-dimensional profunda artery perforator perforasomes in refining next-generation flap designs: transverse, vertical, and S-shaped profunda artery perforator flaps. Plast Reconstr Surg, 2017, 139(4): 834e-845e.
10. Wu JC, Huang JJ, Tsao CK, et al. Comparison of posteromedial thigh profunda artery perforator flap and anterolateral thigh perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2016, 137(1): 257-266.
11. 王剑利, 王根, 赵刚, 等. 游离股后侧穿支动脉皮瓣的解剖学研究及临床应用. 中华显微外科杂志, 2013, 36(1): 7-10.
12. 穆籣, 彭喆, 毕晔, 等. 双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习. 中华显微外科杂志, 2016, 39(6): 555-558.
13. Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap: a new option for autologous breast reconstruction—a cadaveric and computer tomography angiogram study. J Reconstr Microsurg, 2012, 28(6): 381-386.
14. Hunsinger V, Lhuaire M, Haddad K, et al. Medium- and large-sized autologous breast reconstruction using a fleur-de-lys profunda femoris artery perforator flap design: a report comparing results with the horizontal profunda femoris artery perforator flap. J Reconstr Microsurg, 2019, 35(1): 8-14.
15. Haddock NT, Greaney P, Otterburn D, et al. Predicting perforator location on preoperative imaging for the profunda artery perforator flap. Microsurgery, 2012, 32(7): 507-511.
16. 宋达疆, 李赞, 周晓, 等. 股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用. 中国修复重建外科杂志, 2017, 31(1): 52-56.
17. Rozen WM, Donahoe S, Wilson JL. The profunda femoris artery " fourth perforator” island flap: a new perforator flap in lower-limb reconstruction. J Reconstr Microsurg, 2011, 27(4): 273-276.
18. Ahmadzadeh R, Bergeron L, Tang M, et al. The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg, 2007, 119(1): 194-202.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of limb wounds with free profunda artery perforator flap in posteromedial femoral region

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