Clinical application of thoracodorsal artery perforator flap in repair of serious scar contracture of opisthenar_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAO Haitao , WANG Huaisheng , LIU Yong , ZHANG Yuting ,  LIU Xiaoxue ,  XU Xuewen

Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIU Xiaoxue, Email: liuxiaoxue0930@126.com; XU Xuewen, Email: xxw_0826@163.com

Keywords：

Thoracodorsal artery perforator flap; scar contracture; opisthenar; repair

DOI：

10.7507/1002-1892.201809091

Video：

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Objective To investigate the feasibility and effectiveness of thoracodorsal artery perforator (TDAP) flap for repairing serious scar contracture of the opisthenar. Methods Between March 2015 and June 2017, 7 cases of serious scar contracture of opisthenar were repaired with TDAP flaps. There were 5 males and 2 females with an average age of 31 years (range, 11-48 years). The time from injury to operation was 8-67 months, with an average of 42 months. After the relocation of the joint and release of the scar, the size of soft tissue defect ranged from 5 cm×4 cm to 10 cm×8 cm. The size of TDAP flap ranged from 5.5 cm×5.0 cm to 10.5 cm×9.0 cm. Results All flaps survived completely with primary healing at both donor site and recipient site. The flaps of 3 patients were bulky and underwent second-stage skin flap thinning at 3 months after operation. All 7 patients were followed up 6-32 months, with an average of 15 months. The skin flaps were soft and elastic. According to the upper limb function evaluation system recommended by Chinese Society of Hand Surgery, sensory function was classified as in 2 cases, in 1 case, in 3 cases, and in 1 case. The hand function was excellent in 2 cases, good in 4 cases, and fair in 1 case. There was no significant effect on shoulder movement. Conclusion The TDAP flap is an ideal method for serious scar contracture of opisthenar.

Citation： XIAO Haitao, WANG Huaisheng, LIU Yong, ZHANG Yuting, LIU Xiaoxue, XU Xuewen. Clinical application of thoracodorsal artery perforator flap in repair of serious scar contracture of opisthenar. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(6): 717-720. doi: 10.7507/1002-1892.201809091 Copy

1.	闫涛, 黎立, 乔为民, 等. 前臂骨间背侧动脉逆行岛状皮瓣修复手部创面. 中国修复重建外科杂志, 2011, 25(3): 377-378.
2.	White CP, Steve AK Jr, Buchel EW, et al. Reverse radial artery flap perforator anatomy and clinical applications. Ann Plast Surg, 2016, 77(3): 345-349.
3.	吴焱秋, 柴家科, 孙天俊, 等. 腹部携带皮瓣在瘢痕性爪形手畸形修复中的应用. 感染、炎症、修复, 2008, 9(3): 165-167.
4.	Azizeddin A, Choong PFM, Grinsell D. Reconstructive options for large back free flap donor sites. ANZ J Surg, 2018, 88(10): 1066-1070.
5.	张铁慧, 童致虹, 杨卫东, 等. 游离股前外侧皮瓣修复四肢软组织缺损. 中华显微外科杂志, 2006, 29(1): 9.
6.	王相, 张凯威, 毛根莲, 等. 端侧吻合动脉的游离上臂内侧皮瓣修复手背皮肤缺损. 中华手外科杂志, 2014, 30(1): 72-73.
7.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-134.
8.	Brown M, Chung KC. Postburn contractures of the hand. Hand Clin, 2017, 33(2): 317-331.
9.	Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg, 1995, 96(7): 1608-1614.
10.	尹路, 宫可同, 殷中罡, 等. 游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(3): 319-322.
11.	Thomas BP, Geddes CR, Tang M, et al. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg, 2005, 116(3): 818-822.
12.	李涛, 陈振兵, 翁雨雄, 等. T形血管吻合的游离胸背动脉穿支皮瓣的临床应用. 中华手外科杂志, 2015, 31(1): 56-60.
13.	Shaw RJ, Ho MW, Brown JS. Thoracodorsal artery perforator-scapular flap in oromandibular reconstruction with associated large facial skin defects. Br J Oral Maxillofac Surg, 2015, 53(6): 569-571.
14.	孙涛, 王晓峰, 周坚龙, 等. 胸背动脉穿支皮瓣修复手部皮肤软组织缺损35例. 中华显微外科杂志, 2016, 39(3): 221-224.
15.	庄加川, 张振伟, 李敏姣, 等. 胸背动脉穿支皮瓣修复手部皮肤缺损的临床应用. 中华手外科杂志, 2018, 34(3): 161-163.
16.	庞梦茹, 肖海涛, 王怀胜, 等. 应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析. 中国修复重建外科杂志, 2016, 30(3): 382-384.
17.	姚志浩, 黄馗, 罗世洪, 等. CT 血管造影辅助设计股前外侧(肌)皮瓣修复口腔颌面部软组织缺损. 中国修复重建外科杂志, 2017, 31(6): 702-708.
18.	Tashiro K, Yamashita S, Araki J, et al. Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators. J Plast Reconstr Aesthet Surg, 2016, 69(3): 346-350.
19.	Schwabegger AH, Harpf C, Rainer C. 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.

1. 闫涛, 黎立, 乔为民, 等. 前臂骨间背侧动脉逆行岛状皮瓣修复手部创面. 中国修复重建外科杂志, 2011, 25(3): 377-378.
2. White CP, Steve AK Jr, Buchel EW, et al. Reverse radial artery flap perforator anatomy and clinical applications. Ann Plast Surg, 2016, 77(3): 345-349.
3. 吴焱秋, 柴家科, 孙天俊, 等. 腹部携带皮瓣在瘢痕性爪形手畸形修复中的应用. 感染、炎症、修复, 2008, 9(3): 165-167.
4. Azizeddin A, Choong PFM, Grinsell D. Reconstructive options for large back free flap donor sites. ANZ J Surg, 2018, 88(10): 1066-1070.
5. 张铁慧, 童致虹, 杨卫东, 等. 游离股前外侧皮瓣修复四肢软组织缺损. 中华显微外科杂志, 2006, 29(1): 9.
6. 王相, 张凯威, 毛根莲, 等. 端侧吻合动脉的游离上臂内侧皮瓣修复手背皮肤缺损. 中华手外科杂志, 2014, 30(1): 72-73.
7. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-134.
8. Brown M, Chung KC. Postburn contractures of the hand. Hand Clin, 2017, 33(2): 317-331.
9. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg, 1995, 96(7): 1608-1614.
10. 尹路, 宫可同, 殷中罡, 等. 游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(3): 319-322.
11. Thomas BP, Geddes CR, Tang M, et al. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg, 2005, 116(3): 818-822.
12. 李涛, 陈振兵, 翁雨雄, 等. T形血管吻合的游离胸背动脉穿支皮瓣的临床应用. 中华手外科杂志, 2015, 31(1): 56-60.
13. Shaw RJ, Ho MW, Brown JS. Thoracodorsal artery perforator-scapular flap in oromandibular reconstruction with associated large facial skin defects. Br J Oral Maxillofac Surg, 2015, 53(6): 569-571.
14. 孙涛, 王晓峰, 周坚龙, 等. 胸背动脉穿支皮瓣修复手部皮肤软组织缺损35例. 中华显微外科杂志, 2016, 39(3): 221-224.
15. 庄加川, 张振伟, 李敏姣, 等. 胸背动脉穿支皮瓣修复手部皮肤缺损的临床应用. 中华手外科杂志, 2018, 34(3): 161-163.
16. 庞梦茹, 肖海涛, 王怀胜, 等. 应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析. 中国修复重建外科杂志, 2016, 30(3): 382-384.
17. 姚志浩, 黄馗, 罗世洪, 等. CT 血管造影辅助设计股前外侧(肌)皮瓣修复口腔颌面部软组织缺损. 中国修复重建外科杂志, 2017, 31(6): 702-708.
18. Tashiro K, Yamashita S, Araki J, et al. Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators. J Plast Reconstr Aesthet Surg, 2016, 69(3): 346-350.
19. Schwabegger AH, Harpf C, Rainer C. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of thoracodorsal artery perforator flap in repair of serious scar contracture of opisthenar

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