Pre-expanded perforator flaps:
Gespeichert in:
| Weitere Verfasser: | , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pennsylvania
Elsevier
[2017]
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| Schriftenreihe: | Clinics in plastic surgery
volume 44, number 1 (January 2017) |
| Online-Zugang: | Inhaltsverzeichnis Inhaltsverzeichnis |
| Beschreibung: | xiv, 187 Seiten Illustrationen |
| ISBN: | 9780323482684 |
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Datensatz im Suchindex
| _version_ | 1804177756458582016 |
|---|---|
| adam_text | Titel: Pre-expanded perforator flaps
Autor: Pu, Lee L. Q
Jahr: 2017
Pre-expanded Perforator Flaps
Contents
Preface: Pre-expanded Perforator Flaps xiii
Lee L.Q. Pu and Chunmei Wang
An Overview of Pre-expanded Perforator Flaps: Part 1, Current Concepts 1
Chunmei Wang, Sifen Yang, Jing Zhang, Lun Yan, Ping Song, Hiko Hyakusoku, and
Lee L.Q. Pu
Pre-expanded perforator flaps, a combination of tissue expansion with perforator
flaps, are emerging as another landmark of plastic surgery. This flap inherits the
characteristics of both perforator flaps and expanded flaps, making it a highly
versatile option in reconstructive surgery. However, the definition of the pre-
expanded perforator flap and the impact of pre-expansion on the superficial
angio-architecture remain controversial. In this article, the authors review current
concepts including the mechanism of expansion and the resultant changes in the
angio-architecture. The authors also review the previous studies and classifications
of pre-expanded perforator flaps.
An Overview of Pre-expanded Perforator Flaps: Part 2, Clinical Applications 13
Chunmei Wang, Jing Zhang, Hiko Hyakusoku, Ping Song, and Lee L.Q. Pu
Pre-expanded perforator flaps have several advantages over their traditional coun-
terparts owing to the thin, more pliable nature, larger size, and minimum morbidity of
the donor site. Recently, plastic surgeons have begun to use pre-expanded perfo-
rator flaps to reconstruct defects of almost the entire body, including the cervicofa-
cial region, axilla, trunk, and extremities resulting from scar, congenital melanocytic
nevi, hemangiomas, and neurofibromas. Such a versatile flap is especially appro-
priate for face and neck resurfacing, which requires more optimal functional and
cosmetic outcomes.
Imaging Studies for Preoperative Planning of Perforator Flaps: An Overview 21
Shimpei Ono, Hiromitsu Hayashi, Hiroyuki Ohi, and Rei Ogawa
The vascular anatomy of perforators varies between individuals; thus, accurate pre-
operative assessment of perforators is essential for safely planning perforator flaps.
Perforator computed tomographic angiography (P-CTA) with multidetector-row
computed tomography (MDCT) is one of the best available methods to precisely
reveal the 3-dimensional anatomic details of perforators. The aim of this article is
to describe the authors experience using P-CTA with MDCT for detecting the perfo-
rating vessel preoperatively and a step-by-step approach to harvest perforator flaps
based on this technique. This article also provides a comprehensive review of liter-
ature on other preoperative assessment tools of perforators.
Pre-expanded Super-Thin Skin Perforator Flaps 31
Chunmei Wang, Sifen Yang, and Lee L.Q. Pu
Patients with severe postburn scar contractures underwent reconstruction of skin
defects after scar excision with pre-expanded super-thin skin perforator flaps sup-
plied primarily by perforators via the bridging effect from the branches of the adja-
cent arteries as 2-stage procedures. Pre-expansion is an innovative technique and
viii
Contents
may improve the anastomoses between subdermal vascular plexuses and extend
the supplying area of these vessels to the flap. Such a flap becomes super thin,
but with a prefabricated blood supply it can be used for reconstruction of skin de-
fects of the face, neck, or other body part with improved functional and cosmetic
outcomes.
Pre-expanded Transverse Cervical Artery Perforator Flap 41
Huifeng Song and Jiake Chai
The face and neck are important areas for function and appearance. High-quality
skin flaps should be used to reconstruct defects in the cervicofacial region. This
article introduces the pre-expanded transverse cervical artery perforator flap, which
can be used for cervicofacial reconstruction after burns, trauma, and tumor resec-
tion with excellent results. This perforator flap is one of the best options for cervico-
facial reconstruction in terms of color and texture match, and has fewer flap
complications. With regard to the expanded flap, the donor site can be sutured
directly leaving only an inconspicuous linear scar.
Pre-expanded Supraclavicular Artery Perforator Flap 49
Norbert Pallua and Bong-Sung Kim
The supraclavicular artery perforator (SAP) flap is a versatile flap for the reconstruc-
tion of head and neck defects. Recently, the authors have modified the SAP flap by
using an anterior branch of the transverse cervical artery. The anterior SAP flap al-
lows the harvest of a tissue island in the deltopectoral fossa, which is even thinner,
is more pliable, and shows a superior color match to the face and neck compared
with the original SAP flap. Pre-expansion increases flap size considerably, enabling
the coverage of extended defects without the need of microsurgery.
Pre-expanded Internal Mammary Artery Perforator Flap 65
Stacy Wong, James D. Goggin, Nicholas D. Webster, and Michel H. Saint-Cyr
Internal mammary artery (IMA)-based pedicled perforator flaps can be used to
reconstruct defects of the neck and anterior chest wall. Pre-expansion causes a
possible delay phenomenon, improves flap survival, and decreases donor site
morbidity. It also increases the area that can be covered. Pre-expanding can allow
for perforator flaps that require a shorter arc of rotation. The pre-expanded internal
mammary artery perforator (IMAP) flap is an excellent option for patients who have
undergone multiple failed reconstructions and require large amounts of soft tissue
while lacking other donor sites.
Pre-expanded Intercostal Perforator Super-Thin Skin Flap 73
Yunjun Liao, Yong Luo, Feng Lu, Hiko Hyakusoku, Jianhua Gao, and Ping Jiang
Video content accompanies this article at http://www.plasticsurgery.thedinics.com.
This article introduces pre-expanded super-thin intercostal perforator flaps, partic-
ularly the flap that has a perforator from the first to second intercostal spaces.
The key techniques, advantages and disadvantages, and complications and man-
agement of this flap are described. At present, the thinnest possible flap is achieved
by thinning the pre-expanded flap that has a perforator from the first to second inter-
costal spaces. It is used to reconstruct large defects on the face and neck, thus
restoring function and cosmetic appearance.
Contents ix
Pre-expanded Thoracodorsal Artery Perforator Flap 91
Yalcin Kulahci, Cihan Sahin, Huseyin Karagoz, and Fatih Zor
The size of the thoracodorsal artery perforator (TDAP) flap or pedicle, in general, may
be found to be inadequate. Pre-expansion of the flap before harvest can be a solu-
tion to increase the size of the TDAP flap in such instances. The pre-expanded TDAP
flap can be used to reconstruct large-sized defects with the advantage of primary
closure of the donor site. This article presents details on the surgical technique
and provides discussion of the authors experiences.
Pre-expanded Paraumbilical Perforator Flap 99
Yuanbo Liu, Mengqing Zang, Shan Zhu, Bo Chen, and Qiang Ding
The paraumbilical perforator flap is the first and the most famous perforator flap.
Pre-expansion increases the flap dimension and reduces the flap thickness and
donor site morbidities, making the paraumbilical perforator flap a more effective op-
tion for upper extremity reconstruction. Pre-expanded pedicled paraumbilical perfo-
rator flaps can achieve excellent function and aesthetic outcomes in patients with
extensive scar contracture and giant melanocytic nevi in the upper extremity.
Although this technique requires multiple procures, each operation is relatively sim-
ple and has a low complication rate, when properly planned and performed.
Pre-expanded Deep Inferior Epigastric Perforator Flap 109
Sharon E. Monsivais, Nicholas D. Webster, Stacy Wong, and Michel H. Saint-Cyr
The deep inferior epigastric perforator (DIEP) flap can be used to cover large defects
of the proximal lower extremity, abdominal wall, perineum, vulva, and buttock. Pre-
expanding DIEP flaps cause a possible delay phenomenon improving vascularity,
decrease donor site morbidity, and increase the area that can be covered. Pre-
expansion requires staged procedures, has risk of extrusion and infection, causes
temporary contour deformity during the expansion process, and requires a longer
course. Pre-expanded DIEP flaps can be a useful flap with proper patient selection
and planning.
Pre-expanded Brachial Artery Perforator Flap 117
Yuanbo Liu, Mengqing Zang, Maolin Tang, Shan Zhu, Jianhua Zhang, and Yu Zhou
The medial upper arm flap is a time-honored yet ignored technique. It may be revi-
talized by combining the techniques of tissue expansion and perforator flap surgery.
Pre-expansion increases flap dimension, remodels flap vasculature, and reduces
donor site morbidities, making the medial arm flap a more effective option for various
defect reconstructions. A pre-expanded brachial artery perforator flap achieves
excellent functional and aesthetic outcomes in patients with soft tissue defects on
the head and neck, axilla, chest wall, and upper extremity. Although this technique
requires multiple procedures, each operation is relatively simple and has a low
complication rate when properly performed.
Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty 129
Salvatore D Arpa, Britt Colebunders, Filip Stillaert, and Stan Monstrey
The anterolateral thigh (ALT) perforator flap for phalloplasty is gaining popularity
because it avoids the well-known scars of the radial forearm flap. However, scars
X
Contents
are not eliminated, just moved to a different location, the thigh, that can for some pa-
tients be of great sexual value. Preexpansion of the ALT flap allows primary donor
site closure, thus avoiding not only the unsightly appearance of a skin grafted ALT
donor site, but also the skin graft donor site scar. Preoperative perforator location
by means of computed tomography angiography allows safe expander placement
through 2 small remote incisions.
Pre-expanded Free Perforator Flaps 143
Emre Hocaoglu
Video content accompanies this article at http://www.plasticsurgery.thedinics.com.
Pre-expanded perforator flaps are the most recent technical way to shape tissue for
exact needs. Reconstruction with pre-expanded free perforator flaps has proven
successful in terms of obtaining more extensive, more pliable, and thinner flaps
that have increased vascularity, and also causing less donor site morbidity. In this
article the author s experience with the clinical application of such flaps and the rele-
vant published literature are reviewed.
Pre-expanded Bipedided Supratrochlear Perforator Flap for Simultaneous
Reconstruction of the Nasal and Upper Lip Defects 153
Shaoqing Feng, Zheng Zhang, Wenjing Xi, Davide Lazzeri, Yong Fang, and Yi Xin Zhang
The double S principle should be followed for facial reconstruction: the similarity
of the donor site to the defect area and the reconstruction should be based on the
different subunits of the face. In this article the pre-expanded, bipedicled supratro-
chlear perforator flap method is described, which is used for the resurfacing of both
nasal and upper lip defects. This method can provide 2 independent flaps with
sufficient tissue from 1 single donor site, resurfacing the nasal and upper lip units
separately and providing an unparalleled color and texture match and ideal recon-
structive result.
Pre-expanded, Prefabricated Monoblock Perforator Flap for Total Facial Resurfacing 163
Tao Zan, Yashan Gao, Haizhou Li, Bin Gu, Feng Xie, and Qingfeng Li
In this article, we present the pre-expanded, prefabricated supercharged cervico-
thoracic monoblock perforator flap for total or subtotal facial resurfacing. This tech-
nique can be a reliable reconstruction option for extensive facial skin defect with
undamaged muscles and deep structures, which could provide excellent aesthetic
and functional outcomes with acceptable complications. Our approach may replace
a conventional skin-only face allotransplantation in selected patients.
Pre-expanded and Prefabricated Abdominal Superthin Skin Perforator Flap for Total
Hand Resurfacing 171
Chunmei Wang, Junyi Zhang, Sifen Yang, Ping Song, Lun Yang, and Lee L.Q. Pu
Reconstruction of the postburn hand remains a challenge for surgeons. For
cosmetic and functional requirements, the desired flap should be thin enough to
ensure the flexibility of the hand. Conventional perforator flaps serve as a viable op-
tion when reconstructing the postburn hand to regain functionality. However, limita-
tions include the discrepancy in tissue thickness and the difficulty with donor site
Contents xi
closure. Thus, a pre-expanded superthin skin perforator flap can be an ideal choice
for postburn hand reconstruction, with the trade-off being a longer treatment course
(3-4 months), but with results that satisfy both patients and their surgeons.
Future Perspectives of Pre-expanded Perforator Flaps 179
Lee L.Q. Pu and Chunmei Wang
Although clinical application of a pre-expanded perforator flap is primarily focused
on face and neck reconstructions, such a flap has also been used to reconstruct de-
fects in the trunk, extremities, or hands. With better understanding of the improved
blood supply to the flap and the mechanism on the préfabrication of blood supply
within the flap, the pre-expanded perforator flap will definitely play a more important
role in reconstructive surgery and can be used in selected patients by many plastic
surgeons worldwide with good reconstructive and cosmetic outcomes.
Index
185
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| spelling | Pre-expanded perforator flaps editors Lee L.Q. Pu, Chunmei Wang Philadelphia, Pennsylvania Elsevier [2017] xiv, 187 Seiten Illustrationen txt rdacontent n rdamedia nc rdacarrier Clinics in plastic surgery volume 44, number 1 (January 2017) Clinics review articles Pu, Lee L. Q. (DE-588)1074268792 edt Wang, Chunmei (DE-588)1137969148 edt Clinics in plastic surgery volume 44, number 1 (January 2017) (DE-604)BV000003656 44,1 http://digitool.hbz-nrw.de:1801/webclient/DeliveryManager?pid=7279729&custom_att_2=simple_viewer Pre-expanded perforator flaps Inhaltsverzeichnis HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=029845620&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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