Thanh bên bài viết
Số lượt xem chi tiết bài báo: 10
Freestyle pedicled perforator flaps for the reconstruction of lower extremity defects
Nội dung chính của bài viết
Tóm tắt
Background: Lower limb soft tissue defects present unique challenges due to the region's anatomical and functional characteristics. Freestyle pedicled perforator flaps (FPPFs) represent a local skin flap that utilizes adjacent identified perforators, regardless of their source vessel, to cover soft tissue defects. This study evaluated the outcomes of using freestyle perforator flaps to reconstruct lower limb soft tissue defects.
Subjects and methods: A prospective study was conducted on 41 patients with 41 lower limb soft tissue defects treated using FPPFs at the Hue University of Medicine and Pharmacy Hospital from March 2022 to September 2024. Data collected included defect characteristics, surgical techniques, and postoperative outcomes. Flap designs included peninsular, advancement/Keystone, and propeller flaps, selected based on defect location and size. Outcomes were evaluated during hospitalization and long-term follow-up.
Results: The mean defect size was 27.3 ± 13.2 cm², with infection being the most common cause (73.2%). Among the 41 flaps performed, 87.8% achieved complete survival, and 97.6% maintained optimal outcomes at 6 months, including functional mobility and aesthetic satisfaction. Complications occurred in 12.2% of cases, primarily marginal or distal flap necrosis, but none resulted in total flap loss. Donor site closure was achieved with direct suturing in 90.2% of cases, while skin grafting was needed in 9.8%.
Conclusion: FPPFs are reliable for lower limb defect reconstruction with their flexibility and donor site preservation. The modified techniques demonstrated high survival rates, aesthetic compatibility, and improved postoperative quality of life. Further research is needed to minimize venous congestion risks and optimize outcomes.
Chi tiết bài viết
Từ khóa
: Perforator flaps, lower limb, soft tissue defects, Freestyle Pedicled perforator flap
Tài liệu tham khảo
2. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113-141.
3. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42(6):645-648.
4. D’Arpa S, Cordova A, Pignatti M, et al. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg 2011; 128: 892-906.
5. Brunetti B, Tenna S, Aveta A, et al. Freestyle local perforator flaps: versatility of the V-Y design to reconstruct soft-tissue defects in the skin cancer population. Plast Reconstr Surg 2013; 132: 451-460.
6. Zeiderman MR, Pu LLQ. Freestyle Free Perforator Flaps in Lower Extremity Reconstruction. Clin Plast Surg 2021; 48: 215-223.
7. Song P, Pu LLQ. Perforator-Plus Flaps in Lower Extremity Reconstruction. Clin Plast Surg 2021; 48: 183-192.
8. Gunnarsson GL, Jackson IT, Westvik TS, Thomsen JB. The freestyle pedicle perforator flap: a new favorite for the reconstruction of moderate-sized defects of the torso and extremities. Eur J Plast Surg. 2015; 38(1):31-36.
9. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995; 16(5):535-538.
10. Abdelfattah U, Power HA, Song S, Min K, Suh HP, Hong JP. Algorithm for Free Perforator Flap Selection in Lower Extremity Reconstruction Based on 563 Cases. Plast Reconstr Surg. 2019;144(5):1202-1213.
11. Bekara F, Herlin C, Mojallal A, et al. A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects: Identification of Risk Factors for Complications. Plast Reconstr Surg. 2016;137(1):314-331.
12. Gir P, Cheng A, Oni G, Mojallal A, Saint-Cyr M. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review. J Reconstr Microsurg. 2012;28(9):595-601.
13. Tripathee S, Basnet SJ, Lamichhane A, Hariani L. How Safe Is Reverse Sural Flap?: A Systematic Review. Eplasty. 2022;22:e18.
14. Lee KJ, Lee SH, Kim MB, Lee YH. Adipofascial fold-down flaps based on the posterior tibial artery perforator to cover the medial foot and ankle defects. J Plast Reconstr Aesthet Surg. 2016;69(12):e229-e237.
15. AlMugaren FM, Pak CJ, Suh HP, Hong JP. Best Local Flaps for Lower Extremity Reconstruction. Plast Reconstr Surg Glob Open. 2020;8(4):e2774.
16. Mendieta M, Cabrera R, Siu A, Altamirano R, Gutierrez S. Perforator Propeller Flaps for the Coverage of Middle and Distal Leg Soft-tissue Defects. Plast Reconstr Surg Glob Open. 2018;6(5):e1759..
17. Huang J, Yu N, Long X, Wang X. A systematic review of the keystone design perforator island flap in lower extremity defects. Medicine (Baltimore). 2017;96(21):e6842.
18. Hallock GG. The keystone island perforator flap: An "ideal" local soft tissue flap for the lower extremity. Orthoplastic Surg 2024; 17: 23-29.
19. Lecours C, Saint-Cyr M, Wong C, et al. Freestyle pedicle perforator flaps: clinical results and vascular anatomy. Plast Reconstr Surg. 2010; 126(5):1589-1603..
20. Qian Y, Li G, Zang H, et al. A Systematic Review and Meta-analysis of Freestyle Flaps: Risk Analysis of Complications. Plast Reconstr Surg Glob Open. 2018; 6(2):e1651.