Clinical study on functional perforator flap with sensory reconstruction for repairing complex defects on limbs_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lin ¹ , HUANG Shuqing ² , ZHANG Jiaping ³ ,  ZHOU Xin ³

1. Department of Orthopedics, Jiangbei Campus, the First Affiliated Hospital of Army Medical University, Chongqing, 400020, P. R. China;
2. Department of Plastic and Cosmetic Surgery, the Second Hospital of Army Medical University, Chongqing, 400037, P. R. China;
3. Department of Plastic and Cosmetic Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, 400038, P. R. China;

Corresponding author：

ZHOU Xin, Email: Zhouxin1985@tmmu.edu.cn

Keywords：

Functional perforator flap; sensation reconstruction; functional repair; complex defects; limb

DOI：

10.7507/1002-1892.202505088

Video：

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Objective To investigate the clinical outcome of sensory reconstruction about the functional perforator flap for repairing the complex defects on the limbs. Methods A retrospective analysis was conducted on 21 patients with limb complex defects admitted betweenMarch 2018 and January 2023. There were 12 males and 9 females, with a median age of 36 years (range, 19-62 years). The wounds were on the upper limbs (hands) in 13 cases and the lower limbs (feet) in 8 cases. Five patients with tumor/scar, and the left defects after en-bloc resection of the tumor lesion and scar were repaired immediately. The remaining16 cases were acute/chronic wounds, undergoing the emergent debridement and vacuum sealing drainage placement, and the left defects were repaired with flaps during second-stage operation. The size of the defects ranged from 5.5 cm×4.5 cm to 17.0 cm×12.0 cm. The donor sites were located on the thoracic and back in 4 cases, the anterior lateral thigh in 6 cases, and the feet in 11 cases. All flaps were functional perforator flaps with sensory nerve. The donor sites were closed directly or repaired with skin grafting. At last follow-up, the sensation of flap and the muscle strength of recipient site were evaluated according to the British Medical Research Council (BMRC) sensory grading (S₀-S₄) and muscle strength grading (M₀-M₅) criteria. Results Twenty flaps survived completely without significant complications, and partial edge necrosis was observed in 1 flap, which was healed with the debridement and skin graft. The donor and recipient sites healed by first intention. All patients were followed up 10-18 months (mean, 12 months). At last follow-up, the flaps with satisfactory shape and soft texture were observed, and no abnormal hair growth or pigmentation occurred. The sensation of flap was evaluated as S₁ in 2 cases, S₂ in 7, S₃ in 9, and S₄ in 3. The muscle strength of recipient site was evaluated as M₂ in 4 cases, M₃ in 9, M₄ in 5, and M₅ in 3. Only linear scars were left at the donor site. Conclusion The functional perforator flap with sensory nerve is beneficial for early sensation reconstruction for repairing the complex defects on the limbs, and could reconstruct the functional subunit structure defect in one stage. The short-term functional follow-up results are satisfactory.

1.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
2.	唐举玉. 特殊形式穿支皮瓣及其衍生术式的分型与命名. 中华显微外科杂志, 2021, 44(3): 245-254.
3.	王欣, 潘佳栋. 功能性穿支皮瓣的概念与应用. 中华显微外科杂志, 2024, 47(6): 611-613.
4.	Huang Y, Tang L, Liu A, et al. Reconstruction of the severe Achilles tendon and soft-tissue loss with the bi-pedicled conjoined flap and vascularized fasciae latae: A consecutive case series of 15 patients. Injury, 2023, 54(4): 1210-1215.
5.	Shi J, Zhang Y, Zhang B, et al. Loop-neurorrhaphy technique for preventing bone resorption and preserving sensation in mandibular reconstruction. Plast Reconstr Surg, 2024, 154(5): 1004e-1014e.
6.	潘佳栋, 王欣, 尹善青, 等. 功能性胸背动脉穿支皮瓣嵌合背阔肌游离移植重建前臂复合组织缺损13例. 中华显微外科杂志, 2024, 47(3): 241-247.
7.	Yu J, Luo Z, Wu P, et al. Novel design of the chimeric deep inferior epigastric artery perforator flap that provides for three-dimensional reconstruction of composite tissue defects of the heel in children. Orthop Surg, 2021, 13(1): 216-224.
8.	Tang L, Zhou X, Huang S, et al. Reconstruction of the extensor tendon on the dorsal pedis with a chimeric skin-aponeurosis flap from the groin region. Injury, 2024, 55(8): 111660. doi: 10.1016/j.injury.2024.111660.
9.	唐林, 周鑫, 黄宇, 等. 以旋髂深动脉为蒂的髂骨肌皮瓣修复合并空腔的下肢复合缺损创面. 中国修复重建外科杂志, 2024, 38(9): 1105-1110.
10.	郑晓菊, 李海军, 王新宏, 等. 功能性股外侧肌浅区移植急诊重建创伤性动力肌肉缺损初步临床研究. 中华显微外科杂志, 2023, 46(1): 25-31.
11.	王增涛, 刘焕龙, 郝丽文, 等. 拇与手指再造新进展. 中华烧伤与创面修复杂志, 2025, 41(2): 109-119.
12.	Zhang A, Arbuiso S, Lu Wang M, et al. Sensation in neurotized deep inferior epigastric perforator flap breast reconstruction with different donor nerves: Comparing T₁₁ and T₁₂. Ann Plast Surg, 2025, 94(4S Suppl 2): S271-S275.
13.	Horen SR, Hamidian Jahromi A, Konofaos P. Direct neurotization: Past, present, and future considerations. Ann Plast Surg, 2022, 88(3): 308-312.
14.	Adidharma W, Khouri AN, Lee JC, et al. Sensory nerve regeneration and reinnervation in muscle following peripheral nerve injury. Muscle Nerve, 2022, 66(4): 384-396.
15.	麻荪香. 皮瓣移植感觉功能的重建及其评价. 组织工程与重建外科杂志, 2006, 2(2): 116-119.
16.	Abe Y, Nagasaka S, Yamashita Y, et al. Functional outcomes of reconstructive flap surgery for soft tissue sarcoma: Long-term outcomes of functional restoration using innervated muscle transplantation. J Plast Reconstr Aesthet Surg, 2024, 91: 312-321.
17.	Stevanovic M, Sharpe F. Functional free muscle transfer for upper extremity reconstruction. Plast Reconstr Surg, 2014, 134(2): 257e-274e.
18.	Ribuffo D, Cigna E, Gargano F, et al. The innervated anterolateral thigh flap: anatomical study and clinical implications. Plast Reconstr Surg, 2005, 115(2): 464-470.
19.	李有斌, 刘少华, 丁治红, 等. 带感觉神经的股前外侧穿支皮瓣修复足底软组织缺损九例. 中华显微外科杂志, 2021, 44(2): 194-197.
20.	周荣, 巨积辉, 唐林峰, 等. 带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果. 中华烧伤杂志, 2021, 37(5): 453-459.
21.	Tang L, Zhou X, Huang S, et al. Combined great toe dorsal nail-skin flap and medial plantar flap for reconstruction of degloved finger loss. Plast Reconstr Surg, 2024, 153(1): 143-152.
22.	Abdelrehem A, Shi J, Wang X, et al. Novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap. Head Neck, 2022, 44(1): 46-58.

1. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
2. 唐举玉. 特殊形式穿支皮瓣及其衍生术式的分型与命名. 中华显微外科杂志, 2021, 44(3): 245-254.
3. 王欣, 潘佳栋. 功能性穿支皮瓣的概念与应用. 中华显微外科杂志, 2024, 47(6): 611-613.
4. Huang Y, Tang L, Liu A, et al. Reconstruction of the severe Achilles tendon and soft-tissue loss with the bi-pedicled conjoined flap and vascularized fasciae latae: A consecutive case series of 15 patients. Injury, 2023, 54(4): 1210-1215.
5. Shi J, Zhang Y, Zhang B, et al. Loop-neurorrhaphy technique for preventing bone resorption and preserving sensation in mandibular reconstruction. Plast Reconstr Surg, 2024, 154(5): 1004e-1014e.
6. 潘佳栋, 王欣, 尹善青, 等. 功能性胸背动脉穿支皮瓣嵌合背阔肌游离移植重建前臂复合组织缺损13例. 中华显微外科杂志, 2024, 47(3): 241-247.
7. Yu J, Luo Z, Wu P, et al. Novel design of the chimeric deep inferior epigastric artery perforator flap that provides for three-dimensional reconstruction of composite tissue defects of the heel in children. Orthop Surg, 2021, 13(1): 216-224.
8. Tang L, Zhou X, Huang S, et al. Reconstruction of the extensor tendon on the dorsal pedis with a chimeric skin-aponeurosis flap from the groin region. Injury, 2024, 55(8): 111660. doi: 10.1016/j.injury.2024.111660.
9. 唐林, 周鑫, 黄宇, 等. 以旋髂深动脉为蒂的髂骨肌皮瓣修复合并空腔的下肢复合缺损创面. 中国修复重建外科杂志, 2024, 38(9): 1105-1110.
10. 郑晓菊, 李海军, 王新宏, 等. 功能性股外侧肌浅区移植急诊重建创伤性动力肌肉缺损初步临床研究. 中华显微外科杂志, 2023, 46(1): 25-31.
11. 王增涛, 刘焕龙, 郝丽文, 等. 拇与手指再造新进展. 中华烧伤与创面修复杂志, 2025, 41(2): 109-119.
12. Zhang A, Arbuiso S, Lu Wang M, et al. Sensation in neurotized deep inferior epigastric perforator flap breast reconstruction with different donor nerves: Comparing T₁₁ and T₁₂. Ann Plast Surg, 2025, 94(4S Suppl 2): S271-S275.
13. Horen SR, Hamidian Jahromi A, Konofaos P. Direct neurotization: Past, present, and future considerations. Ann Plast Surg, 2022, 88(3): 308-312.
14. Adidharma W, Khouri AN, Lee JC, et al. Sensory nerve regeneration and reinnervation in muscle following peripheral nerve injury. Muscle Nerve, 2022, 66(4): 384-396.
15. 麻荪香. 皮瓣移植感觉功能的重建及其评价. 组织工程与重建外科杂志, 2006, 2(2): 116-119.
16. Abe Y, Nagasaka S, Yamashita Y, et al. Functional outcomes of reconstructive flap surgery for soft tissue sarcoma: Long-term outcomes of functional restoration using innervated muscle transplantation. J Plast Reconstr Aesthet Surg, 2024, 91: 312-321.
17. Stevanovic M, Sharpe F. Functional free muscle transfer for upper extremity reconstruction. Plast Reconstr Surg, 2014, 134(2): 257e-274e.
18. Ribuffo D, Cigna E, Gargano F, et al. The innervated anterolateral thigh flap: anatomical study and clinical implications. Plast Reconstr Surg, 2005, 115(2): 464-470.
19. 李有斌, 刘少华, 丁治红, 等. 带感觉神经的股前外侧穿支皮瓣修复足底软组织缺损九例. 中华显微外科杂志, 2021, 44(2): 194-197.
20. 周荣, 巨积辉, 唐林峰, 等. 带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果. 中华烧伤杂志, 2021, 37(5): 453-459.
21. Tang L, Zhou X, Huang S, et al. Combined great toe dorsal nail-skin flap and medial plantar flap for reconstruction of degloved finger loss. Plast Reconstr Surg, 2024, 153(1): 143-152.
22. Abdelrehem A, Shi J, Wang X, et al. Novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap. Head Neck, 2022, 44(1): 46-58.

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