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Practical considerations for perforator flap thinning procedures revisited.

Prasetyono TO, Bangun K, Buchari FB, Rezkini P - Arch Plast Surg (2014)

Bottom Line: In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found.In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%.These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.

ABSTRACT

Background: A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques.

Methods: We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients.

Results: The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%.

Conclusions: These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.

No MeSH data available.


Related in: MedlinePlus

The form of the fat lobulesThe lamellar (L) in the deep layer and areolar (A) in the superficial layer.
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Figure 2: The form of the fat lobulesThe lamellar (L) in the deep layer and areolar (A) in the superficial layer.

Mentions: To confirm the first cadaveric study, the second cadaveric study was performed in February 2007 in a forensic laboratory using four fresh cadavers with the same inclusion criteria as the first study. ALT, TAP, and the medial sural artery perforator (MSAP) flaps were elevated on both sides. Flap thickness was measured, and the morphology of the fat lobules was observed. Then, the thinning procedure was performed using scissors, but without the aid of a microscope. The procedure was carefully performed to preserve the superficial fat layer (areolar form) and excise the deeper fat layer (lamellar form), which was approximately 2-5 mm from the skin surface. Fig. 2 shows the different forms of the fat lobules. Additional effort was made to preserve the perforator vessels and subdermal plexus.


Practical considerations for perforator flap thinning procedures revisited.

Prasetyono TO, Bangun K, Buchari FB, Rezkini P - Arch Plast Surg (2014)

The form of the fat lobulesThe lamellar (L) in the deep layer and areolar (A) in the superficial layer.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228212&req=5

Figure 2: The form of the fat lobulesThe lamellar (L) in the deep layer and areolar (A) in the superficial layer.
Mentions: To confirm the first cadaveric study, the second cadaveric study was performed in February 2007 in a forensic laboratory using four fresh cadavers with the same inclusion criteria as the first study. ALT, TAP, and the medial sural artery perforator (MSAP) flaps were elevated on both sides. Flap thickness was measured, and the morphology of the fat lobules was observed. Then, the thinning procedure was performed using scissors, but without the aid of a microscope. The procedure was carefully performed to preserve the superficial fat layer (areolar form) and excise the deeper fat layer (lamellar form), which was approximately 2-5 mm from the skin surface. Fig. 2 shows the different forms of the fat lobules. Additional effort was made to preserve the perforator vessels and subdermal plexus.

Bottom Line: In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found.In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%.These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.

ABSTRACT

Background: A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques.

Methods: We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients.

Results: The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%.

Conclusions: These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.

No MeSH data available.


Related in: MedlinePlus