Application of free-style perforator flap for soft tissue defect of knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YU Daojiang ^1,2 , SUN Wei ¹ , WU Lijun ¹ , YU Wenyuan ¹ , CAO Shikun ¹ , CAI Weichao ¹ , ZHAO Tianlan ¹

1. Department of Plastic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215004, P.R.China;
2. Department of Burn and Plastic Surgery, the Second Affiliated Hospital of Chengdu Medical College, Chengdu Sichuan, 610051, P.R.China;

Corresponding?author：

YU Daojiang, Email: ydj51087@163.com

Keywords：

Knee; free-style perforator flap; soft tissue defect; wound repair

DOI：

10.7507/1002-1892.201904121

Video：

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Objective To investigate the effectiveness of free-style perforator flap in repairing the soft tissue defect of knee.Methods Between December 2011 and October 2017, 13 patients with the soft tissue defects of knees were repaired with the free-style perforator flaps. There were 9 males and 4 females, with an average age of 40 years (range, 14-65 years). The injuries were caused by traffic accident in 7 cases, crushing in 4 cases, and falling from height in 2 cases. The soft tissue defects in 9 cases formed after 2 weeks-2 months (mean, 1 month) of lower extremity fractures fixation. The other 4 cases were urgently admitted to the hospital after injury, and the time from injury to admission was 0.5-18.0 hours (mean, 8 hours). The size of soft tissue defect ranged from 3 cm×2 cm to 12 cm×8 cm after debridement. Nine propeller flaps, 6 rotating flaps, and 2 V-Y advanced flaps were used; and 9 cases were repaired by single flap and 4 cases were repaired by combined flaps. The size of flap ranged from 7.5 cm×2.5 cm to 20.0 cm×6.0 cm. The donor sites were sutured directly.Results The flaps survived smoothly and incisions healed by first intention in 12 cases. The congestion occurred in 1 case, which obtained delayed healing after symptomatic treatment. All incisions at donor sites healed by first intention. All patients were followed up 3-24 months with an average of 6 months. The shape and motions of knee were satisfactory.Conclusion The free-style perforator flap can maximize the utilization of the donor area around the knee wound, with reliable blood supply, small trauma, and easy operation. It is an ideal flap for the soft tissue defect of knee.

Citation： YU Daojiang, SUN Wei, WU Lijun, YU Wenyuan, CAO Shikun, CAI Weichao, ZHAO Tianlan. Application of free-style perforator flap for soft tissue defect of knee. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1424-1428. doi: 10.7507/1002-1892.201904121 Copy

1.	張功林, 甄平, 陳克明, 等. 延遲逆行股前外側帶蒂皮瓣修復膝部軟組織缺損 16 例臨床隨訪. 中華顯微外科雜志, 2016, 39(3): 230-233.
2.	蔡喜雨, 董帥, 朱征威, 等. 逆行轉移股前外側皮瓣修復膝部及小腿近端創面 12 例. 中華顯微外科雜志, 2016, 39(4): 402-404.
3.	Mardini S, Tsai FC, Wei FC. The thigh as a model for free-style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
4.	Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
5.	Qian Y, Li G, Zang H, et al. A systematic review and meta-analysis of free-style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open, 2018, 6(2): e1651.
6.	Usami S, Inami K, Hirase Y. Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept. J Plast Reconstr Aesthet Surg, 2018, 71(6): 863-869.
7.	Yu D, Cao S, Zhang S. The application of a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit for large facial defects. J Craniofac Surg, 2019, 30(5): 1529-1532.
8.	余道江, 趙天蘭, 徐又佳, 等. 負壓封閉引流技術在狹長窄蒂皮瓣中的應用. 中華整形外科雜志, 2013, 29(1): 62-65.
9.	周建生, 葉永杰, 苗華. 膝周血管的應用解剖與骨腫瘤保肢術受區血管的選擇. 解剖與臨床, 2004, 9(3): 137-141.
10.	Wallace CG, Kao HK, Jeng SF, et al. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg, 2009, 124(6Suppl): e419-426.
11.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
12.	Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg, 2009, 123(4): 132e-145e.
13.	Sinna R, Boloorchi A, Mahajan AL, et al. What should define a " perforator flap”. Plast Reconstr Surg, 2010, 126(6): 2258-2263.
14.	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.
15.	Aydin MA, Mavili ME. Examining microcirculation improves the angiosome theory in explaining the delay phenomenon in a rabbit model. J Reconstr Microsurg, 2003, 19(3): 187-194.
16.	何智靈, 高偉陽, 李俊杰, 等. 大鼠背部單一穿支蒂皮瓣的實驗研究. 中華整形外科雜志, 2014, 30(1): 40-44.
17.	陳潔, 蔣燦華, 尹乒, 等. 股前外側 free-style 穿支皮瓣在口腔頜面部缺損修復重建中的應用. 中華顯微外科雜志, 2015, 38(1): 20-24.
18.	余道江, 趙天蘭, 孫衛, 等. 自由式穿支皮瓣在鼻腫瘤切除后缺損修復中的應用. 中華醫學美學美容雜志, 2018, 24(4): 223-226.

1. 張功林, 甄平, 陳克明, 等. 延遲逆行股前外側帶蒂皮瓣修復膝部軟組織缺損 16 例臨床隨訪. 中華顯微外科雜志, 2016, 39(3): 230-233.
2. 蔡喜雨, 董帥, 朱征威, 等. 逆行轉移股前外側皮瓣修復膝部及小腿近端創面 12 例. 中華顯微外科雜志, 2016, 39(4): 402-404.
3. Mardini S, Tsai FC, Wei FC. The thigh as a model for free-style free flaps. Clin Plast Surg, 2003, 30(3): 473-480.
4. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
5. Qian Y, Li G, Zang H, et al. A systematic review and meta-analysis of free-style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open, 2018, 6(2): e1651.
6. Usami S, Inami K, Hirase Y. Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept. J Plast Reconstr Aesthet Surg, 2018, 71(6): 863-869.
7. Yu D, Cao S, Zhang S. The application of a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit for large facial defects. J Craniofac Surg, 2019, 30(5): 1529-1532.
8. 余道江, 趙天蘭, 徐又佳, 等. 負壓封閉引流技術在狹長窄蒂皮瓣中的應用. 中華整形外科雜志, 2013, 29(1): 62-65.
9. 周建生, 葉永杰, 苗華. 膝周血管的應用解剖與骨腫瘤保肢術受區血管的選擇. 解剖與臨床, 2004, 9(3): 137-141.
10. Wallace CG, Kao HK, Jeng SF, et al. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg, 2009, 124(6Suppl): e419-426.
11. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
12. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg, 2009, 123(4): 132e-145e.
13. Sinna R, Boloorchi A, Mahajan AL, et al. What should define a " perforator flap”. Plast Reconstr Surg, 2010, 126(6): 2258-2263.
14. 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.
15. Aydin MA, Mavili ME. Examining microcirculation improves the angiosome theory in explaining the delay phenomenon in a rabbit model. J Reconstr Microsurg, 2003, 19(3): 187-194.
16. 何智靈, 高偉陽, 李俊杰, 等. 大鼠背部單一穿支蒂皮瓣的實驗研究. 中華整形外科雜志, 2014, 30(1): 40-44.
17. 陳潔, 蔣燦華, 尹乒, 等. 股前外側 free-style 穿支皮瓣在口腔頜面部缺損修復重建中的應用. 中華顯微外科雜志, 2015, 38(1): 20-24.
18. 余道江, 趙天蘭, 孫衛, 等. 自由式穿支皮瓣在鼻腫瘤切除后缺損修復中的應用. 中華醫學美學美容雜志, 2018, 24(4): 223-226.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free-style perforator flap for soft tissue defect of knee

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