Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbili...Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper limbs.Methods:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated.Their injuries included damage to the fingers,dorsal skin of the hands,wrist,or forearm.Their tendons or bones were exposed after debridement.In some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects.Results:All flaps survived and healed well.After a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional review.Conclusions:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.展开更多
Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-select...Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m<sup>2</sup>. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.展开更多
Background:It is challenging to repair wide or irregular defects with traditional skin flaps,and anterolateral thigh(ALT)lobulated perforator flaps are an ideal choice for such defects.However,there are many variation...Background:It is challenging to repair wide or irregular defects with traditional skin flaps,and anterolateral thigh(ALT)lobulated perforator flaps are an ideal choice for such defects.However,there are many variations in perforators,so good preoperative planning is very important.This study attempted to explore the feasibility and clinical effect of digital technology in the use of ALT lobulated perforator flaps for repairing complex soft tissue defects in limbs.Methods:Computed tomography angiography(CTA)was performed on 28 patients with complex soft tissue defects of the limbs,and the CTA data were imported into Mimics 20.0 software in DICOM format.According to the perforation condition of the lateral circumflex femoral artery and the size of the limb defect,one thigh that had two or more perforators from the same source vessel was selected for 3D reconstruction of the ALT lobulated perforator flap model.Mimics 20.0 software was used to visualize the vascular anatomy,virtual design and harvest of the flap before surgery.The intraoperative design and excision of the ALT lobulated perforator flap were guided by the preoperative digital design,and the actual anatomical observations and measurements were recorded.Results:Digital reconstruction was successfully performed in all patients before surgery;this reconstruction dynamically displayed the anatomical structure of the flap vasculature and accurately guided the design and harvest of the flap during surgery.The parameters of the harvested flaps were consistent with the preoperative parameters.Postoperative complications occurred in 7 patients,but all flaps survived uneventfully.All of the donor sites were closed directly.All patients were followed up for 13-27 months(mean,19.75 months).The color and texture of each flap were satisfactory and each donor site exhibited a linear scar.Conclusions:Digital technology can effectively and precisely assist in the design and harvest of ALT lobulated perforator flaps,provide an effective approach for individualized evaluation and flap design and reduce the risk and difficulty of surgery.展开更多
Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperati...Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperative preparation,especially concerning computed tomography(CT) and magnetic resonance imaging of the donor site.The objective of this study was to aid the surgical approach to the LAP flap in female patients by precisely determining the characteristics of the lumbar perforators.Methods: We retrospectively reviewed the computed tomographic angiography images of 20 patients who underwent evaluation of the perforator positions from the four lumbar arteries.Four characteristics were studied:length,diameter,path of the lumbar pedicle,and thickness of the tissues available for transfer.Results: We analyzed 20 CT images,identifying 149 perforating vessels of the lumbar artery.The most suitable perforator for flap harvesting was the L4 perforator,which exhibited a larger diameter,a greater number of perforasomes,and a higher percentage of the cutaneous-septal tract.Conclusion: The LAP flap is a viable option for breast reconstruction and as a free flap in women.The L4 perforator artery is the most suitable for harvesting,owing to its superior perfusion capacity,diameter,and course;however,an interposition graft may be required to lengthen the vascular pedicle.展开更多
Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside a...Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside assessments of aesthetic symmetry,functional restoration,complication rates,and long-term stability of the reconstruction.This study aimed to assess the mobility of the reconstructed breast following various breast reconstruction techniques,specifically by comparing deep inferior epigastric perforator(DIEP) flaps and pedicled transverse rectus abdominis musculocutaneous(TRAM) flaps.We conducted a longitudinal case study to investigate the changes in breast movement resulting from different surgical interventions.The comparison showed that DIEP flap reconstruction was more likely to achieve superior breast mobility outcomes than TRAM flap reconstruction.For a better breast aesthetic outcome,it is fundamental to improve the awareness of the dynamic evaluation of the reconstructed breast at the surgical strategy level.展开更多
Lower extremity reconstruction is challenging for a variety of reasons.New techniques for soft tissue coverage continue to evolve.While free flaps are always an option,free flaps require significant microsurgical expe...Lower extremity reconstruction is challenging for a variety of reasons.New techniques for soft tissue coverage continue to evolve.While free flaps are always an option,free flaps require significant microsurgical expertise,a proficient staff,advanced equipment,and a patient with a somewhat healthy baseline.However,as microsurgery has evolved,so has the identification of new anatomy and new techniques-namely,perforator based pedicled flaps.These flaps have expanded options for lower extremity reconstruction,and continue to advance the field of microsurgery.The purpose of this article is to review the evolution of perforator based pedicled flaps in the lower extremity,review the anatomy,and offer examples of design and indications.展开更多
BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-...BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.展开更多
Background:Owing to its unique characteristics,the lateral circumflex femoral artery perforator(LCFAP)flap is often preferred for repairing head wounds with exposed skulls.However,given the vascular distribution in th...Background:Owing to its unique characteristics,the lateral circumflex femoral artery perforator(LCFAP)flap is often preferred for repairing head wounds with exposed skulls.However,given the vascular distribution in the head,particularly the veins,can lead to postoperative complications such as venous congestion of the flap.The rates of vascular exploration and necrosis in these flaps are significantly higher than in other body regions.Therefore,it is crucial to identify a safe and effective method for venous anastomosis of free flaps in the head region.Methods:This retrospective case series study included 10 patients with large head soft tissue defects treated at the Burn and Plastic Surgery Department of the Affiliated Hospital of Zunyi Medical University from January 2020 to December 2022.The head defects were reconstructed using LCFAP flaps,with flap veins anastomosed to the external jugular vein in the neck,either directly or via a bridging technique.Results:Among the 10 adult patients with massive head wound defects,7(70%)were men.The patients’mean age was 53.0 years(48–59 years).The wound defects were caused by trauma in 6(60%)patients and by tumors in 4(40%)patients.Postoperatively,no significant complications occurred,and all LCFAP flap survived without necrosis.Conclusion:The descending branch of the LCFAP flap effectively repairs massive head wound defects.The venous anastomosis method for this flap is associated with a low incidence of venous complications and a high patency rate,making it a clinically valuable reference.展开更多
AIM: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine ...AIM: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine patient and flap related outcomes in advanced lower extremity disease. Methods: The authors conducted a retrospective review of fasciocutaneous free flaps of variable thickness for lower extremity salvage. Osteomyelitis and non-osteomyelitis patients were compared according to our primary outcome measures: functional ambulation, bone healing and complications to flap and patient. Subgroups with critical limb ischemia, Charcot collapse and diabetic foot were analyzed separately. Results: Fifty-nine patients underwent free flap reconstruction: osteomyelitis (n = 20, 34%), Charcot collapse (n = 22, 37%), and/or critical limb ischemia (n = 12, 20%). All patients underwent anterolateral thigh flaps tailored for defect-specific thicknesses: 17 superthin, 25 suprafascial, 17 subfascial. There were no significant differences between groups in terms of partial and complete flap loss (P = 1.000 and P = 0.108). Ninety-one percent of patients were ambulatory at follow up. Eighty-tive percent of individuals with osteomyelitis cleared their infection demonstrating radiographic bone healing. Two patients developed recalcitrant deep space infections ultimately requiring amputation. Subgroup analysis did not show any differences in flap related complications within the diabetic Charcot population. In multivariate regression, preoperative revascularization was independently associated with failure of limb salvage. ;Conclusion: Primarily thinned perforator flaps performed well in the setting of lower extremity limb salvage, critical limbischemia, osteomyelitis, and the Charcot foot - expanding their role in the armamentarium for lower extremity care.展开更多
Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 200...Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle展开更多
BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical di...BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free ant...BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.展开更多
Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reco...Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.展开更多
Facial defect coverage is a common subject in the field of reconstructive surgery.There are many methods for facial defect reconstruction,and reconstructive surgeons should choose the most appropriate method on a case...Facial defect coverage is a common subject in the field of reconstructive surgery.There are many methods for facial defect reconstruction,and reconstructive surgeons should choose the most appropriate method on a case-by-case basis to achieve both functional and aesthetic improvement.Among various options for facial reconstruction,the local flap technique is considered the best reconstructive modality to provide good tissue matches of color and texture,which is consistent with the ideal goal of reconstruction(replacement of like-with-like).Keystone design perforator island flap(KDPIF),devised by Behan in 2003,has been applied to various fields of reconstructive surgery in the past decade due to its design simplicity,robust vascular supply,and reproducibility.Several studies have reported KDPIF reconstruction of facial defects,such as large parotid defects,small-to-moderate nasal defects,and eyelid defects.However,KDPIF has been used relatively less in facial defects than in other body regions,such as the trunk and extremities.The purpose of this review is to provide an organized overview of facial KDPIF reconstruction including the classification of KDPIF,modifications,physiology,mechanism of flap movement,consideration of facial relaxed skin tension lines and aesthetics,surgical techniques,clinical applications,and precautions for successful execution of KDPIF reconstruction.展开更多
Nasal defects can be reconstructed with a nasolabial perforator flap,resulting in good aesthetic outcomes based on the facial subunit principle,owing to the combined advantages of the traditional nasolabial flap and t...Nasal defects can be reconstructed with a nasolabial perforator flap,resulting in good aesthetic outcomes based on the facial subunit principle,owing to the combined advantages of the traditional nasolabial flap and the perforator flap.However,the localization of perforators makes the clinical application of a nasolabial perforator flap difficult.This review aims to provide a comprehensive summary of the nasolabial perforator flap from anatomical,methodological,and clinical application aspects,intending to provide plastic surgeons with a reference on conducting nasal reconstruction with a nasolabial perforator flap.展开更多
<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span...<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:Verdana;"> Pilonidal disease is a chronic inflammatory disease of the sacrococcygeal region that mainly affects young people. Its incidence is 26 cases per 100,000 persons. Although many techniques have been described, there is no consensus on the treatment of pilonidal sinus disease (PSD). </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Materials</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">and</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">This study included 30 patients with PSD who were treated between May 2014 and September 2017. All cases underwent excision and flap reconstruction. The operative time, postoperative complications, the length of hospital stay, painless sitting and walking time, patient satisfaction and recurrence were evaluated prospectively. </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">The results of this prospective, randomized and comparative study are based on experience of a single surgical centre. All patients were followed up 18 months after discharge from the hospital. There is a difference in surgery durations (minutes) between the two groups (33.86 ± 2.89 min. in “keystone” flap vs. 41.26 ± 4.19 in the “rhombic” flap group) (p = 0.001). There were no significant differences in the length of hospital stay, painless sitting and walking time or patient satisfaction. The total complication rate was 66.6% after rhomboid flap compared with 6.6% after keystone flap. There was no flap necrosis. </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:Verdana;"> Both of these methods have shown to be successful in treatment of PSD. The KPIF is associated with the advantages of very simple design, abundant blood supply from the perforator vessels and lower rate of complication.</span>展开更多
Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in s...Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.展开更多
Free flap autologous breast reconstruction is becoming more and more common for post-mastectomy reconstruction.Abdominally-based tissue flaps are the first choice for many reconstructive breast microsurgeons,but not a...Free flap autologous breast reconstruction is becoming more and more common for post-mastectomy reconstruction.Abdominally-based tissue flaps are the first choice for many reconstructive breast microsurgeons,but not all patients are candidates,whether due to their leaner habitus or a history of prior abdominal surgery.The gluteal donor site in many patients can provide adequate soft tissue for autologous breast reconstruction,even in lean patients,with a scar that remains well-hidden.This review presents an overview of the superior gluteal artery perforator(SGAP)flap as an invaluable tool for autologous breast reconstruction.展开更多
Despite its technical complexity,the lumbar artery perforator(LAP)flap remains a valuable asset in the realm of autologous breast reconstruction,providing an option for patients who may not be suitable candidates for ...Despite its technical complexity,the lumbar artery perforator(LAP)flap remains a valuable asset in the realm of autologous breast reconstruction,providing an option for patients who may not be suitable candidates for abdominal flaps.The LAP flap offers dimensions and volume suitable for recreating a natural breast shape,including a sloping upper pole and optimal projection in the lower third.Harvesting LAP flaps can also lead to simultaneous improvement in body contour by lifting the buttocks and narrowing the waist,following the principles of aesthetic body lift procedures.展开更多
The gold standard for post-mastectomy autologous breast reconstruction is abdominally based free flaps.For patients with contraindications to abdominal free flap reconstruction,utilization of other donor sites should ...The gold standard for post-mastectomy autologous breast reconstruction is abdominally based free flaps.For patients with contraindications to abdominal free flap reconstruction,utilization of other donor sites should be considered.The profunda artery perforator flap has become a popular option for autologous reconstruction as it offers many advantages,including a long pedicle,muscle preservation,and easy soft tissue contouring.This review will provide an extensive outline of the history,anatomy,clinical indications,surgical techniques,and outcomes of the profunda artery perforator flap.It will also discuss appropriate preoperative imaging(CTA,MRA)and present a case of a patient who received a profunda artery perforator flap at our institution.展开更多
文摘Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper limbs.Methods:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated.Their injuries included damage to the fingers,dorsal skin of the hands,wrist,or forearm.Their tendons or bones were exposed after debridement.In some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects.Results:All flaps survived and healed well.After a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional review.Conclusions:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.
文摘Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m<sup>2</sup>. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.
文摘Background:It is challenging to repair wide or irregular defects with traditional skin flaps,and anterolateral thigh(ALT)lobulated perforator flaps are an ideal choice for such defects.However,there are many variations in perforators,so good preoperative planning is very important.This study attempted to explore the feasibility and clinical effect of digital technology in the use of ALT lobulated perforator flaps for repairing complex soft tissue defects in limbs.Methods:Computed tomography angiography(CTA)was performed on 28 patients with complex soft tissue defects of the limbs,and the CTA data were imported into Mimics 20.0 software in DICOM format.According to the perforation condition of the lateral circumflex femoral artery and the size of the limb defect,one thigh that had two or more perforators from the same source vessel was selected for 3D reconstruction of the ALT lobulated perforator flap model.Mimics 20.0 software was used to visualize the vascular anatomy,virtual design and harvest of the flap before surgery.The intraoperative design and excision of the ALT lobulated perforator flap were guided by the preoperative digital design,and the actual anatomical observations and measurements were recorded.Results:Digital reconstruction was successfully performed in all patients before surgery;this reconstruction dynamically displayed the anatomical structure of the flap vasculature and accurately guided the design and harvest of the flap during surgery.The parameters of the harvested flaps were consistent with the preoperative parameters.Postoperative complications occurred in 7 patients,but all flaps survived uneventfully.All of the donor sites were closed directly.All patients were followed up for 13-27 months(mean,19.75 months).The color and texture of each flap were satisfactory and each donor site exhibited a linear scar.Conclusions:Digital technology can effectively and precisely assist in the design and harvest of ALT lobulated perforator flaps,provide an effective approach for individualized evaluation and flap design and reduce the risk and difficulty of surgery.
文摘Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperative preparation,especially concerning computed tomography(CT) and magnetic resonance imaging of the donor site.The objective of this study was to aid the surgical approach to the LAP flap in female patients by precisely determining the characteristics of the lumbar perforators.Methods: We retrospectively reviewed the computed tomographic angiography images of 20 patients who underwent evaluation of the perforator positions from the four lumbar arteries.Four characteristics were studied:length,diameter,path of the lumbar pedicle,and thickness of the tissues available for transfer.Results: We analyzed 20 CT images,identifying 149 perforating vessels of the lumbar artery.The most suitable perforator for flap harvesting was the L4 perforator,which exhibited a larger diameter,a greater number of perforasomes,and a higher percentage of the cutaneous-septal tract.Conclusion: The LAP flap is a viable option for breast reconstruction and as a free flap in women.The L4 perforator artery is the most suitable for harvesting,owing to its superior perfusion capacity,diameter,and course;however,an interposition graft may be required to lengthen the vascular pedicle.
文摘Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside assessments of aesthetic symmetry,functional restoration,complication rates,and long-term stability of the reconstruction.This study aimed to assess the mobility of the reconstructed breast following various breast reconstruction techniques,specifically by comparing deep inferior epigastric perforator(DIEP) flaps and pedicled transverse rectus abdominis musculocutaneous(TRAM) flaps.We conducted a longitudinal case study to investigate the changes in breast movement resulting from different surgical interventions.The comparison showed that DIEP flap reconstruction was more likely to achieve superior breast mobility outcomes than TRAM flap reconstruction.For a better breast aesthetic outcome,it is fundamental to improve the awareness of the dynamic evaluation of the reconstructed breast at the surgical strategy level.
文摘Lower extremity reconstruction is challenging for a variety of reasons.New techniques for soft tissue coverage continue to evolve.While free flaps are always an option,free flaps require significant microsurgical expertise,a proficient staff,advanced equipment,and a patient with a somewhat healthy baseline.However,as microsurgery has evolved,so has the identification of new anatomy and new techniques-namely,perforator based pedicled flaps.These flaps have expanded options for lower extremity reconstruction,and continue to advance the field of microsurgery.The purpose of this article is to review the evolution of perforator based pedicled flaps in the lower extremity,review the anatomy,and offer examples of design and indications.
基金Supported by The Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT),No.RS-2023-00220408.
文摘BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.
基金supported by the National Natural Science Foundation of China(grant no.82260392).
文摘Background:Owing to its unique characteristics,the lateral circumflex femoral artery perforator(LCFAP)flap is often preferred for repairing head wounds with exposed skulls.However,given the vascular distribution in the head,particularly the veins,can lead to postoperative complications such as venous congestion of the flap.The rates of vascular exploration and necrosis in these flaps are significantly higher than in other body regions.Therefore,it is crucial to identify a safe and effective method for venous anastomosis of free flaps in the head region.Methods:This retrospective case series study included 10 patients with large head soft tissue defects treated at the Burn and Plastic Surgery Department of the Affiliated Hospital of Zunyi Medical University from January 2020 to December 2022.The head defects were reconstructed using LCFAP flaps,with flap veins anastomosed to the external jugular vein in the neck,either directly or via a bridging technique.Results:Among the 10 adult patients with massive head wound defects,7(70%)were men.The patients’mean age was 53.0 years(48–59 years).The wound defects were caused by trauma in 6(60%)patients and by tumors in 4(40%)patients.Postoperatively,no significant complications occurred,and all LCFAP flap survived without necrosis.Conclusion:The descending branch of the LCFAP flap effectively repairs massive head wound defects.The venous anastomosis method for this flap is associated with a low incidence of venous complications and a high patency rate,making it a clinically valuable reference.
文摘AIM: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine patient and flap related outcomes in advanced lower extremity disease. Methods: The authors conducted a retrospective review of fasciocutaneous free flaps of variable thickness for lower extremity salvage. Osteomyelitis and non-osteomyelitis patients were compared according to our primary outcome measures: functional ambulation, bone healing and complications to flap and patient. Subgroups with critical limb ischemia, Charcot collapse and diabetic foot were analyzed separately. Results: Fifty-nine patients underwent free flap reconstruction: osteomyelitis (n = 20, 34%), Charcot collapse (n = 22, 37%), and/or critical limb ischemia (n = 12, 20%). All patients underwent anterolateral thigh flaps tailored for defect-specific thicknesses: 17 superthin, 25 suprafascial, 17 subfascial. There were no significant differences between groups in terms of partial and complete flap loss (P = 1.000 and P = 0.108). Ninety-one percent of patients were ambulatory at follow up. Eighty-tive percent of individuals with osteomyelitis cleared their infection demonstrating radiographic bone healing. Two patients developed recalcitrant deep space infections ultimately requiring amputation. Subgroup analysis did not show any differences in flap related complications within the diabetic Charcot population. In multivariate regression, preoperative revascularization was independently associated with failure of limb salvage. ;Conclusion: Primarily thinned perforator flaps performed well in the setting of lower extremity limb salvage, critical limbischemia, osteomyelitis, and the Charcot foot - expanding their role in the armamentarium for lower extremity care.
文摘Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle
基金Supported by Research fund of Dankook University in 2023,No.R202300627.
文摘BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.
文摘BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
文摘Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.
文摘Facial defect coverage is a common subject in the field of reconstructive surgery.There are many methods for facial defect reconstruction,and reconstructive surgeons should choose the most appropriate method on a case-by-case basis to achieve both functional and aesthetic improvement.Among various options for facial reconstruction,the local flap technique is considered the best reconstructive modality to provide good tissue matches of color and texture,which is consistent with the ideal goal of reconstruction(replacement of like-with-like).Keystone design perforator island flap(KDPIF),devised by Behan in 2003,has been applied to various fields of reconstructive surgery in the past decade due to its design simplicity,robust vascular supply,and reproducibility.Several studies have reported KDPIF reconstruction of facial defects,such as large parotid defects,small-to-moderate nasal defects,and eyelid defects.However,KDPIF has been used relatively less in facial defects than in other body regions,such as the trunk and extremities.The purpose of this review is to provide an organized overview of facial KDPIF reconstruction including the classification of KDPIF,modifications,physiology,mechanism of flap movement,consideration of facial relaxed skin tension lines and aesthetics,surgical techniques,clinical applications,and precautions for successful execution of KDPIF reconstruction.
基金supported by the Key Clinical Projects of Peking University Third Hospital (grant no. BYSYFY2021005)
文摘Nasal defects can be reconstructed with a nasolabial perforator flap,resulting in good aesthetic outcomes based on the facial subunit principle,owing to the combined advantages of the traditional nasolabial flap and the perforator flap.However,the localization of perforators makes the clinical application of a nasolabial perforator flap difficult.This review aims to provide a comprehensive summary of the nasolabial perforator flap from anatomical,methodological,and clinical application aspects,intending to provide plastic surgeons with a reference on conducting nasal reconstruction with a nasolabial perforator flap.
文摘<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:Verdana;"> Pilonidal disease is a chronic inflammatory disease of the sacrococcygeal region that mainly affects young people. Its incidence is 26 cases per 100,000 persons. Although many techniques have been described, there is no consensus on the treatment of pilonidal sinus disease (PSD). </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Materials</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">and</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">This study included 30 patients with PSD who were treated between May 2014 and September 2017. All cases underwent excision and flap reconstruction. The operative time, postoperative complications, the length of hospital stay, painless sitting and walking time, patient satisfaction and recurrence were evaluated prospectively. </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">The results of this prospective, randomized and comparative study are based on experience of a single surgical centre. All patients were followed up 18 months after discharge from the hospital. There is a difference in surgery durations (minutes) between the two groups (33.86 ± 2.89 min. in “keystone” flap vs. 41.26 ± 4.19 in the “rhombic” flap group) (p = 0.001). There were no significant differences in the length of hospital stay, painless sitting and walking time or patient satisfaction. The total complication rate was 66.6% after rhomboid flap compared with 6.6% after keystone flap. There was no flap necrosis. </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:Verdana;"> Both of these methods have shown to be successful in treatment of PSD. The KPIF is associated with the advantages of very simple design, abundant blood supply from the perforator vessels and lower rate of complication.</span>
文摘Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.
文摘Free flap autologous breast reconstruction is becoming more and more common for post-mastectomy reconstruction.Abdominally-based tissue flaps are the first choice for many reconstructive breast microsurgeons,but not all patients are candidates,whether due to their leaner habitus or a history of prior abdominal surgery.The gluteal donor site in many patients can provide adequate soft tissue for autologous breast reconstruction,even in lean patients,with a scar that remains well-hidden.This review presents an overview of the superior gluteal artery perforator(SGAP)flap as an invaluable tool for autologous breast reconstruction.
文摘Despite its technical complexity,the lumbar artery perforator(LAP)flap remains a valuable asset in the realm of autologous breast reconstruction,providing an option for patients who may not be suitable candidates for abdominal flaps.The LAP flap offers dimensions and volume suitable for recreating a natural breast shape,including a sloping upper pole and optimal projection in the lower third.Harvesting LAP flaps can also lead to simultaneous improvement in body contour by lifting the buttocks and narrowing the waist,following the principles of aesthetic body lift procedures.
基金supported in part by the Cancer Center Support Grant P30 CA008748,which supports the research infrastructure at Memorial Sloan Kettering Cancer Center.
文摘The gold standard for post-mastectomy autologous breast reconstruction is abdominally based free flaps.For patients with contraindications to abdominal free flap reconstruction,utilization of other donor sites should be considered.The profunda artery perforator flap has become a popular option for autologous reconstruction as it offers many advantages,including a long pedicle,muscle preservation,and easy soft tissue contouring.This review will provide an extensive outline of the history,anatomy,clinical indications,surgical techniques,and outcomes of the profunda artery perforator flap.It will also discuss appropriate preoperative imaging(CTA,MRA)and present a case of a patient who received a profunda artery perforator flap at our institution.
