CLINICAL APPLICATION AND EXPERIENCE IN RECONSTRUCTION OF SOFT TISSUE DEFECTS FOLLOWING MALIGNANT TUMOR REMOVAL OF LIMBS USING PERFORATOR PROPELLER FLAPS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHUShan ¹ ,  LIUYuanbo ¹ , YUShengji ² , ZANGMengqing ¹ , ZHAOZhenguo ² , XULibin ² , ZHANGXinxin ² , CHENBo ¹ , DINGQiang ¹

1. No. 11 Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, 100144, P. R. China;
2. Department of Bone Cancer, Cancer Hospital, Chinese Academy of Medical Sciences;

Corresponding?author：

LIUYuanbo, Email: ybpumc@sina.com

Keywords：

Perforator flap; Propeller flap; Malignant tumor of limb; Defect repair

DOI：

10.7507/1002-1892.20160017

Video：

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Objective To explore the feasibility and technical essentials of soft tissue defect reconstruction following malignant tumor removal of limbs using perforator propeller flaps. Method Between July 2008 and July 2015, 19 patients with malignant limb tumor underwent defect reconstruction following tumor removal using the perforator propeller flaps. There were 13 males and 6 females with an average age of 53.4 years (range, 20-82 years). The disease duration ranged from 1 to 420 months (mean, 82 months). The tumors located at the thigh in 10 cases, at the leg in 2 cases, at the arm in 1 case, at the forearm in 1 case, around the knee in 2 cases, and around the elbow joint in 3 cases. Totally 23 flaps (from 8 cm×3 cm to 30 cm×13 cm in size) were used to reconstruct defects (from 4 cm×4 cm to 24 cm×16 cm in size). The potential source arteries included the femoral artery (n=2) , profunda femoral artery (n=3) , superficial circumflex iliac artery (n=1) , lateral circumflex femoral artery (n=6) , superior lateral genicular artery (n=2) , peroneal artery (n=2) , anterior tibial artery (n=1) , brachial artery (n=4) , and radial artery (n=1) . The remaining one was a free style perforator flap. Results Partial distal flap necrosis occurred in 3 cases after surgery with rotation angles of 180, 150, and 100° respectively, which were reconstructed after debridement using a free-style perforator flap in 1 case and using free skin grafting in the other 2 cases. The other 20 flaps survived completely after surgery. Primary healing of incisions was obtained at the donor and recipient sites. There was no severe complication such as infection, hematoma, and total flap failure. All patients were followed up 3 months to 5 years (mean, 19 months). One patient with malignant melanoma around the elbow joint had tumor recurrence, and underwent secondary tumor resection. The appearance, texture, and color of the flaps were similar to those at the recipient site. Conclusions For patients with malignant tumor of the limb, the perforator propeller flap can be an alternative option for soft tissue defect reconstruction after tumor resection, with the advantages of relatively simple operation and remaining the main vessels.

Citation： ZHUShan, LIUYuanbo, YUShengji, ZANGMengqing, ZHAOZhenguo, XULibin, ZHANGXinxin, CHENBo, DINGQiang. CLINICAL APPLICATION AND EXPERIENCE IN RECONSTRUCTION OF SOFT TISSUE DEFECTS FOLLOWING MALIGNANT TUMOR REMOVAL OF LIMBS USING PERFORATOR PROPELLER FLAPS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 82-86. doi: 10.7507/1002-1892.20160017 Copy

1.	Jemal A, Tiwari RC, Murray T, et al. Cancer statistics, 2004. CA Cancer J Clin, 2004, 54(1) :8-29.
2.	Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg, 1991, 44(1) :53-54.
3.	Hallock GG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or tranchanteric pressure sores. Ann Plast Surg, 2006, 56(5) :540-542.
4.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6) :645-648.
5.	Pignatti M, Ogawa R, Hallock GG, et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg, 2011, 127(2) :716-722.
6.	Taylor GI, Palmar JH. The vascular territories (angiosomes) of the body:experimental study and clinical applications. Br J Plast Surg, 1987, 40(2) :113-141.
7.	Lecours C, Saint-Cyer M, Wong C, et al. Freestyle pedicle perforator flaps:clinical results and vascular anatomy. Plast Reconstr Surg, 2010, 126(5) :1589-1603.
8.	D'Arpa S, Toia F, Pirrello R, et al. Propeller flaps:a review of indications, technique, and results. Biomed Res Int, 2014, 2014:986829.
9.	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(4) :892-906.
10.	Gir P, Cheng A, Oni G, et al. Pedicled-perforator (propeller) flaps in lower extremity defects:a systematic review. J Reconstr Microsurg, 2012, 28(9) :595-601.
11.	Georgescu AV. Propeller perforator flaps in distal lower leg:evolution and clinical applications. Arch Plast Surg, 2012, 39(2) :94-105.
12.	Innocenti M, Menichini G, Baldrighi C, et al. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction? Clin Orthop Relat Res, 2014, 472(7) :2276-2286.
13.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory:vascular anatomy and clinical applications. Plast Reconstr Surg, 2009, 124(5) :1529-1544.
14.	Chang CH, Lim SY, Pyon JK, et al. The influence of pedicle length on the viability of twisted perforator flaps in rats. J Reconstr Microsurg, 2009, 25(9) :533-538.
15.	Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinations of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6) :672-678.
16.	Zhang J, Zang M, Yu S, et al. Reconstruction of forearm soft tissue defects with radial artery perforator-pedicled propeller flaps. J Plast Reconstr Aesthet Surg, 2015, 68(1) :125-126.
17.	Ono S, Sebastin SJ, Yazaki N, et al. Clinical application of perforator-based propeller flaps in upper limb tissue reconstruction. J Hand Surg (Am), 2011, 36(5) :853-863.
18.	Stekenburg CM, Sonneveld PM, Bouman MB, et al. The hand held Doppler device for the detection of perforators in reconstructive surgery:what you hear is not always what you get. Burns, 2014, 40(8) :1702-1706.
19.	Hocao?lu E, Elbey H, Salmaslio?lu A, et al. Improving the accuracy of easily accessible 5-MHz handheld Doppler examination in perforator flap planning. Plast Reconstr Surg, 2013,131(1) :130e-132e.
20.	Mun GH, Jeon BJ. An efficient method to increase specificity of acoustic Doppler sonography for planning a perforator flap:perforator compression test. Plast Reconstr Surg, 2006, 118(1) :296-297.
21.	Gurtner GC, Jones GE, Neligan PC, et al. Intraoperative laser angiography using the SPY system:review of the literature and recommendations for use. Ann Surg Innov Res, 2013, 7(1) :1.
22.	Kanuri A, Liu AS, Guo L. Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plast Reconstr Surg, 2014, 133(4) :448e-454e.

1. Jemal A, Tiwari RC, Murray T, et al. Cancer statistics, 2004. CA Cancer J Clin, 2004, 54(1) :8-29.
2. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg, 1991, 44(1) :53-54.
3. Hallock GG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or tranchanteric pressure sores. Ann Plast Surg, 2006, 56(5) :540-542.
4. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6) :645-648.
5. Pignatti M, Ogawa R, Hallock GG, et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg, 2011, 127(2) :716-722.
6. Taylor GI, Palmar JH. The vascular territories (angiosomes) of the body:experimental study and clinical applications. Br J Plast Surg, 1987, 40(2) :113-141.
7. Lecours C, Saint-Cyer M, Wong C, et al. Freestyle pedicle perforator flaps:clinical results and vascular anatomy. Plast Reconstr Surg, 2010, 126(5) :1589-1603.
8. D'Arpa S, Toia F, Pirrello R, et al. Propeller flaps:a review of indications, technique, and results. Biomed Res Int, 2014, 2014:986829.
9. 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(4) :892-906.
10. Gir P, Cheng A, Oni G, et al. Pedicled-perforator (propeller) flaps in lower extremity defects:a systematic review. J Reconstr Microsurg, 2012, 28(9) :595-601.
11. Georgescu AV. Propeller perforator flaps in distal lower leg:evolution and clinical applications. Arch Plast Surg, 2012, 39(2) :94-105.
12. Innocenti M, Menichini G, Baldrighi C, et al. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction? Clin Orthop Relat Res, 2014, 472(7) :2276-2286.
13. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory:vascular anatomy and clinical applications. Plast Reconstr Surg, 2009, 124(5) :1529-1544.
14. Chang CH, Lim SY, Pyon JK, et al. The influence of pedicle length on the viability of twisted perforator flaps in rats. J Reconstr Microsurg, 2009, 25(9) :533-538.
15. Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinations of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6) :672-678.
16. Zhang J, Zang M, Yu S, et al. Reconstruction of forearm soft tissue defects with radial artery perforator-pedicled propeller flaps. J Plast Reconstr Aesthet Surg, 2015, 68(1) :125-126.
17. Ono S, Sebastin SJ, Yazaki N, et al. Clinical application of perforator-based propeller flaps in upper limb tissue reconstruction. J Hand Surg (Am), 2011, 36(5) :853-863.
18. Stekenburg CM, Sonneveld PM, Bouman MB, et al. The hand held Doppler device for the detection of perforators in reconstructive surgery:what you hear is not always what you get. Burns, 2014, 40(8) :1702-1706.
19. Hocao?lu E, Elbey H, Salmaslio?lu A, et al. Improving the accuracy of easily accessible 5-MHz handheld Doppler examination in perforator flap planning. Plast Reconstr Surg, 2013,131(1) :130e-132e.
20. Mun GH, Jeon BJ. An efficient method to increase specificity of acoustic Doppler sonography for planning a perforator flap:perforator compression test. Plast Reconstr Surg, 2006, 118(1) :296-297.
21. Gurtner GC, Jones GE, Neligan PC, et al. Intraoperative laser angiography using the SPY system:review of the literature and recommendations for use. Ann Surg Innov Res, 2013, 7(1) :1.
22. Kanuri A, Liu AS, Guo L. Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plast Reconstr Surg, 2014, 133(4) :448e-454e.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION AND EXPERIENCE IN RECONSTRUCTION OF SOFT TISSUE DEFECTS FOLLOWING MALIGNANT TUMOR REMOVAL OF LIMBS USING PERFORATOR PROPELLER FLAPS

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