Application of deep inferior epigastric perforator flap for repair of extreme defects around knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Xin ¹ , TANG Lin ¹ , LIU Anming ¹ , CHEN Xiaojun ¹ , WANG Shaoliang ² ,  ZOU Yonggen ¹

1. Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;
2. Department of Plastic and Cosmetic Surgery, the Second Affiliated Hospital of Army Military Medical University, Chongqing, 400037, P. R. China;

Corresponding author：

ZOU Yonggen, Email: Yonggenzou1975@163.com

Keywords：

Deep inferior epigastric perforator flap; knee; soft tissue defect; repair and reconstruction

DOI：

10.7507/1002-1892.202203046

Video：

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Objective To investigate the effectiveness of the deep inferior epigastric perforator (DIEP) flap for extreme defects around the knee. Methods Between June 2017 and December 2018, 15 patients with the extreme defects around the knee were admitted. There were 9 males and 6 females with a median age of 36 years (range, 23-51 years). The etiology was the traffic accident in 7 cases, tumor in 5 cases, and burn in 3 cases. The injured location was left knee in 8 cases and right knee in 7 cases. The size of soft tissue defects ranged from 15 cm×10 cm to 30 cm×20 cm, and all defects complicated with exposure of blood vessels, nerves, tendons, and other tissues. Transverse DIEP flaps with 1-2 vascular pedicles were prepared according to the size of the defect, including 6 cases of single-pedicle flaps and 9 cases of double-pedicle conjoined flaps. According to the depth of the defect, 10 cases of skin flaps were thinned under microscope. The size of the DIEP flaps ranged from 16 cm×10 cm to 32 cm×20 cm; the average thickness was 1.5 cm (range, 0.8-1.8 cm); the average pedicle length was 7.5 cm (range, 5.0-9.0 cm). The donor site was directly sutured. Results One single-pedicle flap developed distal necrosis after operation, and healed after skin grafting; the other skin flaps survived, and the wounds at the donor and recipient sites healed by first intention. All patients were followed up 16-28 months (mean, 24 months). The shape and texture of the flap were satisfactory, and there was no abnormal hair growth or obvious pigmentation. There was only linear scar at the donor site and no complication such as abdominal hernia. The appearance and function of the knee were satisfactory. No recurred tumor was observed, and the scar contracture was released. At last follow-up, 13 cases were excellent and 2 cases were good, according to the Knee Society Score (KSS) criteria. Conclusion The DIEP flap is an ideal alternative for repairing the extreme defects around knee, with a concealed donor site, easy dissection, flexible design, as well as less complication.

Citation： ZHOU Xin, TANG Lin, LIU Anming, CHEN Xiaojun, WANG Shaoliang, ZOU Yonggen. Application of deep inferior epigastric perforator flap for repair of extreme defects around knee. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 840-844. doi: 10.7507/1002-1892.202203046 Copy

1.	Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg, 2008, 121(5): 1642-1649.
2.	Ravindra BR, Ramkumar S, Venkatramani H. Soft tissue coverage for defects around the knee joint. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India, 2019, 52(1): 125-133.
3.	Li Z, Li P, Tan Q. Reconstruction of soft tissue defects around the knee with pedicled perforator flaps. Ann Plast Surg, 2018, 81(4): 462-467.
4.	Chen CY, Hsieh CH, Kuo YR, et al. An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee. Plast Reconstr Surg, 2007, 120(2): 470-473.
5.	Hierner R, Reynders-Frederix P, Bellemans J, et al. Free myocutaneous latissimus dorsi flap transfer in total knee arthroplasty. J Plast Reconstr Aesthet Surg, 2009, 62(12): 1692-1700.
6.	Wong CH, Goh T, Tan BK, et al. The anterolateral thigh perforator flap for reconstruction of knee defects. Ann Plast Surg, 2013, 70(3): 337-342.
7.	Yamamoto T, Yamamoto N. A triple-component deep inferior epigastric artery perforator chimeric free flap for three-dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis. Microsurgery, 2021, 41(4): 370-375.
8.	Pachón Suárez JE, Sadigh PL, Shih HS, et al. Achieving direct closure of the anterolateral thigh flap donor site—an algorithmic approach. Plast Reconstr Surg Glob Open, 2014, 2(10): e232. doi: 10.1097/GOX.0000000000000205.
9.	Fang T, Zhang EW, Lineaweaver WC, et al. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg, 2013, 71(4): 429-433.
10.	谢庆平, 穆籣, 刘元波, 等. 腹壁下动脉穿支皮瓣专家共识. 中华显微外科杂志, 2013, 71(4): 429-433.Fang T, Zhang EW, Lineaweaver WC, et al. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg, 2013, 71(4): 429-433.
11.	Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
12.	Satake T, Muto M, Kou S, et al. Contralateral unaffected breast augmentation using zone Ⅳ as a SIEA flap during unilateral DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2019, 72(9): 1537-1547.
13.	Yoshimatsu H, Yamamoto T, Hayashi A, et al. Use of a 72-cm-long extended bilateral deep inferior epigastric artery perforator free flap for reconstruction of a lower leg with no suitable recipient vessel around the injury zone: A case report. Microsurgery, 2018, 38(1): 89-93.
14.	Beugels J, Vasile JV, Tuinder SMH, et al. The stacked hemiabdominal extended perforator flap for autologous breast reconstruction. Plast Reconstr Surg, 2018, 142(6): 1424-1434.
15.	Wisecarver IR, Mundinger GS, Tarakji MS, et al. Microsurgical engineering: Bilateral deep inferior epigastric artery perforator flap with flow-through intraflap anastomosis. Plast Reconstr Surg Glob Open, 2018, 6(1): e1554. doi: 10.1097/GOX.0000000000001554.
16.	Rozen WM, Chubb D, Whitaker IS, et al. The importance of the superficial venous anatomy of the abdominal wall in planning a superficial inferior epigastric artery (SIEA) flap: case report and clinical study. Microsurgery, 2011, 31(6): 454-457.
17.	Taylor GI, Corlett RJ, Boyd JB. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg, 1984, 37(3): 330-350.
18.	Rozen WM, Murray AC, Ashton MW, et al. The cutaneous course of deep inferior epigastric perforators: implications for flap thinning. J Plast Reconstr Aesthet Surg, 2009, 62(8): 986-990.
19.	Yu J, Luo Z, Wu P, et al. Novel design of the chimeric deep inferior epigastric artery perforator flap that provides for three-dimensional reconstruction of composite tissue defects of the heel in children. Orthop Surg, 2021, 13(1): 216-224.
20.	王蕾, 宋爱莉, 宋达疆, 等. 游离带感觉神经腹壁下动脉穿支皮瓣在乳房再造中的应用. 中华解剖与临床杂志, 2021, 26(3): 320-325.
21.	Scaglioni MF, Meroni M, Fritsche E. Application of the “Open-Y” technique in recipient perforator vessels: A comparison study between “Open-Y” and conventional end-to-end anastomosis in terms of postoperative complications. Microsurgery, 2021, 41(6): 527-532.
22.	Satake T, Sugawara J, Yasumura K, et al. “Mini-Flow-Through” deep inferior epigastric perforator flap for breast reconstruction with preservation of both internal mammary and deep inferior epigastric vessels. Arch Plast Surg, 2015, 42(6): 783-787.

1. Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg, 2008, 121(5): 1642-1649.
2. Ravindra BR, Ramkumar S, Venkatramani H. Soft tissue coverage for defects around the knee joint. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India, 2019, 52(1): 125-133.
3. Li Z, Li P, Tan Q. Reconstruction of soft tissue defects around the knee with pedicled perforator flaps. Ann Plast Surg, 2018, 81(4): 462-467.
4. Chen CY, Hsieh CH, Kuo YR, et al. An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee. Plast Reconstr Surg, 2007, 120(2): 470-473.
5. Hierner R, Reynders-Frederix P, Bellemans J, et al. Free myocutaneous latissimus dorsi flap transfer in total knee arthroplasty. J Plast Reconstr Aesthet Surg, 2009, 62(12): 1692-1700.
6. Wong CH, Goh T, Tan BK, et al. The anterolateral thigh perforator flap for reconstruction of knee defects. Ann Plast Surg, 2013, 70(3): 337-342.
7. Yamamoto T, Yamamoto N. A triple-component deep inferior epigastric artery perforator chimeric free flap for three-dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis. Microsurgery, 2021, 41(4): 370-375.
8. Pachón Suárez JE, Sadigh PL, Shih HS, et al. Achieving direct closure of the anterolateral thigh flap donor site—an algorithmic approach. Plast Reconstr Surg Glob Open, 2014, 2(10): e232. doi: 10.1097/GOX.0000000000000205.
9. Fang T, Zhang EW, Lineaweaver WC, et al. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg, 2013, 71(4): 429-433.
10. 谢庆平, 穆籣, 刘元波, 等. 腹壁下动脉穿支皮瓣专家共识. 中华显微外科杂志, 2013, 71(4): 429-433.Fang T, Zhang EW, Lineaweaver WC, et al. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg, 2013, 71(4): 429-433.
11. Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
12. Satake T, Muto M, Kou S, et al. Contralateral unaffected breast augmentation using zone Ⅳ as a SIEA flap during unilateral DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2019, 72(9): 1537-1547.
13. Yoshimatsu H, Yamamoto T, Hayashi A, et al. Use of a 72-cm-long extended bilateral deep inferior epigastric artery perforator free flap for reconstruction of a lower leg with no suitable recipient vessel around the injury zone: A case report. Microsurgery, 2018, 38(1): 89-93.
14. Beugels J, Vasile JV, Tuinder SMH, et al. The stacked hemiabdominal extended perforator flap for autologous breast reconstruction. Plast Reconstr Surg, 2018, 142(6): 1424-1434.
15. Wisecarver IR, Mundinger GS, Tarakji MS, et al. Microsurgical engineering: Bilateral deep inferior epigastric artery perforator flap with flow-through intraflap anastomosis. Plast Reconstr Surg Glob Open, 2018, 6(1): e1554. doi: 10.1097/GOX.0000000000001554.
16. Rozen WM, Chubb D, Whitaker IS, et al. The importance of the superficial venous anatomy of the abdominal wall in planning a superficial inferior epigastric artery (SIEA) flap: case report and clinical study. Microsurgery, 2011, 31(6): 454-457.
17. Taylor GI, Corlett RJ, Boyd JB. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg, 1984, 37(3): 330-350.
18. Rozen WM, Murray AC, Ashton MW, et al. The cutaneous course of deep inferior epigastric perforators: implications for flap thinning. J Plast Reconstr Aesthet Surg, 2009, 62(8): 986-990.
19. Yu J, Luo Z, Wu P, et al. Novel design of the chimeric deep inferior epigastric artery perforator flap that provides for three-dimensional reconstruction of composite tissue defects of the heel in children. Orthop Surg, 2021, 13(1): 216-224.
20. 王蕾, 宋爱莉, 宋达疆, 等. 游离带感觉神经腹壁下动脉穿支皮瓣在乳房再造中的应用. 中华解剖与临床杂志, 2021, 26(3): 320-325.
21. Scaglioni MF, Meroni M, Fritsche E. Application of the “Open-Y” technique in recipient perforator vessels: A comparison study between “Open-Y” and conventional end-to-end anastomosis in terms of postoperative complications. Microsurgery, 2021, 41(6): 527-532.
22. Satake T, Sugawara J, Yasumura K, et al. “Mini-Flow-Through” deep inferior epigastric perforator flap for breast reconstruction with preservation of both internal mammary and deep inferior epigastric vessels. Arch Plast Surg, 2015, 42(6): 783-787.

Chinese Journal of Reparative and Reconstructive Surgery

Application of deep inferior epigastric perforator flap for repair of extreme defects around knee

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