Pub Perforatorflap
Pub Perforatorflap
Pub Perforatorflap
net/publication/359327004
Islanded Pedicled Perforator Flaps for Various Soft Tissue Defects: Our
Experience in a Tertiary Hospital
CITATIONS READS
0 8
1 author:
Mainak Mallik
All India Institute of Medical Sciences Kalyani
21 PUBLICATIONS 3 CITATIONS
SEE PROFILE
All content following this page was uploaded by Mainak Mallik on 18 March 2022.
Abstract: Introduction: Soft tissue defects requiring flap coverage are resurfaced by peninsular flaps, musculocutaneous flaps or
distant free flaps. Islanding flaps in a single stage avoids unaesthetic standing cutaneous deformity and bulges of local peninsular flaps
and reduces the prolonged duration of hospital stay over certain staged procedures like cross-leg flaps. Aims and objectives: This
prospective interventional study over one year aimed at executing islanded, pedicled perforator flaps and to assess the operative time for
reconstruction, the complications and the post-operative hospital stay. Methodology: Patients were selected based on the defects to be
reconstructed, the pre operative work up and anesthesia check up were done, they were admitted and operated. Planning in reverse was
done in every case, the source vessels and the perforators were identified and marked with hand held Doppler pre-operatively, the
primary defect defined after excision and the flaps were harvested based on the perforator, inset given and donor sites managed. Post-
operatively the flaps were monitored clinically, the complications and issues addressed, dressings changed on frequent intervals and
results interpreted. After discharge, they were followed up at regular intervals. Results: Out of 35 patients, in 15 patients, the flaps were
harvested on perforators as propeller flaps. In 20 patients we dissected up to and included the source vessel of the perforators to gain
additional length. The mean operative time for reconstruction was 105 minutes. Among the overall complications of 14%, minor
complications of wound dehiscence and widened scar in 3% of the cases. The post-operative hospital stay ranged from 3 to 14 days with
a mean of 4.75 days. Conclusion: Islanded perforator flaps can be executed rapidly increasing the daily number of reconstructions in a
high volume centre with reduced hospital stay, less donor site morbidities and more aesthetically pleasing results.
4. Results region, the shoulder, the abdomen, the groin, the upper and
the lower limbs.
With the propeller flaps, we covered defects over the back,
shoulder, the upper and the lower limbs. With source vessel Overall, the etiology of the defects were post-traumatic,
perforator flaps, we covered defects in the head and neck malignancy, post burn contracture release, post-infective non
Case 1:
Figure 4: A. The flap planned over a Peroneal perforator marked with a hand-held Doppler. B. Anterior exploring incision
placed and subfacial dissection done to trace the perforator. C. At least 3 cm length of perforator dissected out and flap
islanded. D. Flap rotated into the defect. E. Donor site skin grafted. F. Follow-up after 3 months.
Figure 5: A. Axillary hidradenitis. B. Thoracodorsal artery perforator marked C. Perforator dissected out D. Flap inset into
the defect and the donor site closed primarily. E, F. Flap and the donor site after 3 months.
Case 3:
Figure 6: A. Post-burn contracture of the elbow. B. Propeller flap elevated over proximal radial artery perforator. C. Close-up
of the perforator. D. Flap rotated into the defect. E. Donor site skin grafted. F. Flap and donor site on follow-up after 2 weeks.
CASE 4:
Figure 7: A. Ectopia vesicae defect on lower abdomen. B. Flap planned over Dopplered Anterolateral thigh perforator. C.
Intramuscular dissection of the perforator through vastus lataralis. D. Perforator dissected proximally to include the source
vessel i.e. Lateral circumflex femoral artery. E. Flap inset into defect and donor site closed primarily F. Flap after 3 months
of follow-up.
CASE 5:
Figure 8: A. Verrucous carcinoma oral mucosa. B. Submental artery perforator flap planned over a Dopplered perforator. C.
Flap islanded on the source vessel. D. Donor site closed primarily. E. Flap after inset. F. Flap on follow-up visit after 10 days