Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Yaojun , REN Zhongliang , XUE Jiajie , GUO Lei , GAO Dengwen , HAO Qingye , GAO Fucheng , YANG Jie

Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City, Yulin Shaanxi, 719000, P.R.China;

Corresponding?author：

WANG Yaojun, Email: doctwyj@163.com

Keywords：

Latissimus dorsi myocutaneous flap; posterior intercostal artery perforator flap; relaying flap; soft tissue defect; donor site

DOI：

10.7507/1002-1892.201803046

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ObjectiveTo investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer.MethodsBetween January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly.ResultsAll the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites.ConclusionThe latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.

Citation： WANG Yaojun, REN Zhongliang, XUE Jiajie, GUO Lei, GAO Dengwen, HAO Qingye, GAO Fucheng, YANG Jie. Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1187-1191. doi: 10.7507/1002-1892.201803046 Copy

1.	曹東升, 盛輝, 汪春蘭, 等. 應用帶少許肌袖的背闊肌肌皮瓣修復下肢軟組織缺損. 中國修復重建外科雜志, 2007, 21(11): 1206-1208.
2.	唐舉玉, 李康華, 劉俊, 等. 背闊肌皮瓣游離移植修復下肢巨大軟組織缺損. 中國修復重建外科雜志, 2006, 20(11): 1087-1089.
3.	Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
4.	劉志遠, 唐修俊, 王達利, 等. 背闊肌 Kiss 皮瓣修復上臂復合組織缺損及功能重建. 中國修復重建外科雜志, 2017, 31(9): 1106-1110.
5.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
6.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7.	唐舉玉, 卿黎明, 梁捷予, 等. 改良背闊肌皮瓣移植修復下肢巨大面積皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(3): 211-214.
8.	俞芳, 唐舉玉, 汪華僑, 等. 中國穿支皮瓣應用進入新時代—— 第七屆中國穿支皮瓣高峰論壇”在長沙召開. 中華顯微外科雜志, 2017, 40(6): 后插 5-后插 7.
9.	唐舉玉, 汪華僑, Hallock GG, 等. 關注皮瓣供區問題——減少皮瓣供區損害專家共識. 中華顯微外科雜志, 2018, 41(1): 3-5.
10.	常樹森, 何春念, 金文虎, 等. 股前外側皮瓣的供區并發癥. 中華顯微外科雜志, 2018, 41(1): 101-104.
11.	中華醫學會顯微外科學分會. MBCMA 股前外側皮瓣臨床實踐指南 (2016 征求意見稿). 中華顯微外科雜志, 2016, 39(4): 313-317.
12.	Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
13.	呂春柳, 李贊, 周曉, 等. 帶蒂背闊肌 Kiss 皮瓣修復腫瘤切除術后胸壁皮膚軟組織缺損的臨床研究. 中國修復重建外科雜志, 2016, 30(12): 1498-1501.
14.	金文虎, 魏在榮, 鄧呈亮, 等. 游離旋股外側動脈降支穿支組織瓣的臨床應用及對供區影響觀察. 中國修復重建外科雜志, 2015, 29(10): 1284-1287.
15.	滕云升, 梁高峰, 文波, 等. 股前穿支接力皮瓣修復游離股前外側皮瓣供區創面. 中華顯微外科雜志, 2017, 40(2): 126-129.
16.	宋達疆, 李贊, 周曉, 等. 股前內側接力穿支皮瓣修復游離股前外側穿支皮瓣供區的臨床應用. 中國修復重建外科雜志, 2017, 31(1): 52-56.
17.	周曉, 芮永軍, 薛明宇, 等. 以旋髂深動脈肌皮穿支為蒂的 V-Y 接力皮瓣修復腹部供區創面的臨床應用. 中華顯微外科雜志, 2015, 38(5): 421-424.
18.	周曉, 薛明宇, 許亞軍, 等. 以指動脈皮穿支蒂接力皮瓣修復指端皮膚軟組織缺損. 中華整形外科雜志, 2015, 31(6): 422-425.
19.	Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
20.	Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg, 1978, 61(5): 653-665.

1. 曹東升, 盛輝, 汪春蘭, 等. 應用帶少許肌袖的背闊肌肌皮瓣修復下肢軟組織缺損. 中國修復重建外科雜志, 2007, 21(11): 1206-1208.
2. 唐舉玉, 李康華, 劉俊, 等. 背闊肌皮瓣游離移植修復下肢巨大軟組織缺損. 中國修復重建外科雜志, 2006, 20(11): 1087-1089.
3. Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
4. 劉志遠, 唐修俊, 王達利, 等. 背闊肌 Kiss 皮瓣修復上臂復合組織缺損及功能重建. 中國修復重建外科雜志, 2017, 31(9): 1106-1110.
5. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
6. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7. 唐舉玉, 卿黎明, 梁捷予, 等. 改良背闊肌皮瓣移植修復下肢巨大面積皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(3): 211-214.
8. 俞芳, 唐舉玉, 汪華僑, 等. 中國穿支皮瓣應用進入新時代—— 第七屆中國穿支皮瓣高峰論壇”在長沙召開. 中華顯微外科雜志, 2017, 40(6): 后插 5-后插 7.
9. 唐舉玉, 汪華僑, Hallock GG, 等. 關注皮瓣供區問題——減少皮瓣供區損害專家共識. 中華顯微外科雜志, 2018, 41(1): 3-5.
10. 常樹森, 何春念, 金文虎, 等. 股前外側皮瓣的供區并發癥. 中華顯微外科雜志, 2018, 41(1): 101-104.
11. 中華醫學會顯微外科學分會. MBCMA 股前外側皮瓣臨床實踐指南 (2016 征求意見稿). 中華顯微外科雜志, 2016, 39(4): 313-317.
12. Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
13. 呂春柳, 李贊, 周曉, 等. 帶蒂背闊肌 Kiss 皮瓣修復腫瘤切除術后胸壁皮膚軟組織缺損的臨床研究. 中國修復重建外科雜志, 2016, 30(12): 1498-1501.
14. 金文虎, 魏在榮, 鄧呈亮, 等. 游離旋股外側動脈降支穿支組織瓣的臨床應用及對供區影響觀察. 中國修復重建外科雜志, 2015, 29(10): 1284-1287.
15. 滕云升, 梁高峰, 文波, 等. 股前穿支接力皮瓣修復游離股前外側皮瓣供區創面. 中華顯微外科雜志, 2017, 40(2): 126-129.
16. 宋達疆, 李贊, 周曉, 等. 股前內側接力穿支皮瓣修復游離股前外側穿支皮瓣供區的臨床應用. 中國修復重建外科雜志, 2017, 31(1): 52-56.
17. 周曉, 芮永軍, 薛明宇, 等. 以旋髂深動脈肌皮穿支為蒂的 V-Y 接力皮瓣修復腹部供區創面的臨床應用. 中華顯微外科雜志, 2015, 38(5): 421-424.
18. 周曉, 薛明宇, 許亞軍, 等. 以指動脈皮穿支蒂接力皮瓣修復指端皮膚軟組織缺損. 中華整形外科雜志, 2015, 31(6): 422-425.
19. Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
20. Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg, 1978, 61(5): 653-665.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer

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