ObjectiveTo generalize the application and prospect of computed tomographic angiography (CTA) in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction.MethodsThe related literature using CTA for DIEP flap reconstruction of breast in recent years was reviewed and analyzed.ResultsPreoperative CTA can accurately assess the vascular anatomy of the chest and abdomen wall, precisely locating the perforator in the abdominal donor site, and identifying the dominant perforator; guide the selection of intercostal space to explore internal mammary artery and internal mammary artery perforator in the chest recipient vessels. It can also reconstruct the volume of the abdominal flap with reference to the size of the contralateral breast and pre-shape the abdominal flap, which are crucial to formulate the surgical plan and improve the reliability of flap.ConclusionPreoperative CTA has enormous application potential and prospects in locating donor area perforator, in selecting recipient vessels, and in evaluating breast volume for autologous breast reconstruction with DIEP flap.
ObjectiveTo investigate the clinical value of pedicled latissimus dorsi Kiss flap in repairing chest wall large skin defect after tumor operation. MethodsA retrospective analysis was made on the clinical data from 15 cases of chest wall tumors treated between December 2010 and December 2015. There were 2 males and 13 females with an average age of 51.8 years (range, 43-60 years); there were 11 cases of locally advanced breast cancer, 3 cases of fibrosarcoma in chest wall, and 1 case of chest wall radiation ulcer with a median disease duration of 24.1 months (range, 6 months to 8 years). The area of skin defects was 17 cm×12 cm to 20 cm×18 cm after primary tumor resection; the pedicled latissimus dorsi Kiss flap was designed to repair wounds. The flap was a two-lobed flap at a certain angle on the surface of latissimus dorsi based on the thoracodorsal artery, with a size of 17 cm×6 cm to 20 cm×9 cm for each lobe. The donor site was sutured directly. ResultsFourteen flaps survived with primary healing of wound; delayed healing was observed in 1 flap because of distal necrosis; and healing by first intention was obtained at the donor sites. The follow-up time was from 6 months to 3 years (mean, 21.6 months). The flap had good appearance with no bloated pedicle. The shoulder joint activities were normal. No local recurrence occurred, but distant metastasis in 2 cases. No obvious scar was found at donor sites. ConclusionThe application of pedicled latissimus dorsi Kiss flap to repair chest wall skin defects after tumor resection has important clinical value, because of the advatages of simple operation, minor donor site damage and rapid postoperative recovery, especially for late stage cancer patients.
ObjectiveTo explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection.MethodsBetween September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly.ResultsAll wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites.ConclusionPedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.
Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
ObjectiveTo explore the effectiveness of pedicled thoracoacromial artery perforator (TAAP) flap for pharyngocutaneous fistula repair after total laryngectomy and radiotherapy. MethodsBetween February 2012 and January 2015, TAAP flap was used to repair pharyngocutaneous fistula after total laryngectomy and radiotherapy in 8 patients. The eight patients were male, aged from 46 to 72 years (mean, 51.8 years). The disease duration was 8-62 months (mean, 27.5 months). Fistula size ranged from 4.0 cm×2.5 cm to 6.0 cm×4.0 cm and the skin defect size ranged from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. The flap size ranged from 7.0 cm×4.0 cm×0.3 cm to 9.5 cm×6.0 cm×0.5 cm. The length of pedicle was (8.3±0.5)mm. The distance from pivot point of flap to central point of recipient site was (94.5±1.9) mm. ResultsAll 8 flaps survived and all incisions healed smoothly. The hospitalization time was 7-14 days (mean, 9.6 days). The barium meal examination showed no fistula or stenosis. The patients were followed up 8-42 months (mean, 28.5 months). During follow-up, the neck appearance was good, and no fistulas or stenosis occurred. Only linear scars were observed at the donor sites, pectoralis major muscle function was normal in all patients. ConclusionPharyngocutaneous fistula should be repaired as early as possible after total laryngectomy. TAAP flap is suitable for the reconstruction of pharyngocutaneous fistula after total laryngectomy.
Objective To investigate the clinical application of relaying anteromedial thigh (AMT) perforator flap in resurfacing of the donor defect after anterolateral thigh (ALT) flap transfer. Methods Between February 2012 and December 2015, 23 cases of oral carcinoma underwent radical resection; after resection of lesions, the tongue or mouth floor defects were reconstructed by ALT perforator flaps, and the donor sites were repaired with relaying AMT perforator flap at the same stage. There were 21 males and 2 females,with a mean age of 52.6 years (range, 29-74 years). Sixteen patients had tongue squamous cell carcinoma and 7 patients had buccal cancer. According to TNM tumor stage, 3 cases were classified as T4N0M0, 5 cases as T4N1M0, 7 cases as T3N1M0, 5 cases as T3N2M0, and 3 cases as T3N0M0. The disease duration ranged from 6 to 18 months (mean, 8.8 months). Results The AMT perforators existed consistently in all patients. All flaps survived, and primary healing of wounds was obtained at recipient sites and donor sites. No vascular crisis, wound dehiscence, or obvious swelling occurred. All patients were followed up 6-20 months (mean, 9.4 months). There was only linear scar at the donor sites, and the function of thighs was normal. The color and contour of the flaps were satisfactory. Conclusion The relaying AMT perforator flap is an ideal choice to reconstruct the donor site of ALT flap.
Objective To investigate the clinical outcome of free thoracoacromial artery perforator (TAAP) flap in the reconstruction of tongue and mouth floor defects after radical resection of tongue carcinoma. Methods Between May 2010 and February 2015, 11 cases of tongue carcinoma underwent radical resection and reconstruction of tongue and mouth floor defects with free TAAP flaps. The locations of tongue carcinoma were the lingual margin in 7 cases, the ventral tongue in 2 cases, and the mouth floor in 2 cases. According to Union for International Cancer Control (UICC) TNM stage, 3 cases were classified as T4N0M0, 3 cases as T4NlM0, 2 cases as T3N1M0, 2 cases as T3N2M0, and 1 case as T3N0M0. The disease duration ranged from 3 to 28 months, 10.6 months on average. The tumor size ranged from 6.0 cm×3 cm to 10 cm×5 cm. The TAAP flap ranged from 7.0 cm×4.0 cm to 11.0 cm×5.5 cm in size, and 0.6-1.2 cm (0.8 cm on average) in thickness, with a pedicle length of 6.8-9.9 cm (7.2 cm on average). Results All 11 flaps survived, the donor site was closed directly and healed primarily in all cases. The patients were followed up 12-24 months (17.2 months on average). The reconstructed tongue had satisfactory appearance and good functions of swallowing and language. No local recurrence was observed during follow-up. Only linear scar was left at the donor site, and the function of pectoralis major muscle was normal. Conclusion The TAAP flap is an ideal choice in the reconstruction of tongue defect after resection of tongue carcinoma, which has good texture, appearance, and function results.
ObjectiveTo investigate the effect of indocyanine green (ICG)-based fluorescent angiography in autologous tissue breast reconstruction.MethodsBetween June 2016 and June 2017, 14 female patients were treated with the autologous tissue breast reconstruction. The age ranged from 27 to 64 years with the median age of 46.5 years. There were 11 patients of one-stage reconstruction, including 9 with invasive ductal carcinoma of breast, 1 with recurrence tumor on chest wall, and 1 with angiosatcoma in the breast. The disease duration ranged from 9 days to 48 months (mean, 6.8 months). There were 3 patients of second-stage breast reconstruction, who underwent mastectomy 3-4 years ago. During operation, the first ICG-based fluorescent angiography was done before cutting off the flap pedicle. According to the results, 13 patients were adjusted the strategy of operation or cut part of flap, only 1 patient kept the original design. Then, the infusion of flaps were confirmed by the second ICG-based fluorescent angiography after transplanted to the recipient site. The area of flap ranged from 24 cm×11 cm to 36 cm×15 cm. All incisions of recipient site were closed by primary suture.ResultsThe fat liquefaction of incision occurred in 1 patient with type 2 diabetes, and the incision healed after debridement operation. The other flaps survived with no flap perfusion related complication. Both donor sites and recipient sites healed by first intention. All patients were followed up 1-14 months (mean, 4 months) with satisfied result of reconstruction. There was no tumor recurrence.ConclusionICG-based fluorescent angiography can reveal the perfusion of the flap in operation instantly and accurately. It should be very helpful to adjusting the strategy in reconstructive operation, especially in the large tissue demanded kinds such as breast reconstruction.