Complications of free flap donor sites

A variety of free tissue transfers are available for microsurgical reconstruction. To date little attention has been placed on the donor site, both from the potential for acute complications as well as long-term morbidity. In this review the various types of tissue transfers in different anatomical locations have been assessed for potential problems at the donor site. An assessment system is proposed to better evaluate this problem as well as to allow comparison of the different donor sites. © 1995 Wiley-Liss, Inc.     

Complications of radial forearm flap donor sites

The complications of radial forearm flap donor sites in 15 patients from two centres have been reviewed. The complications included skin graft failure, swelling of the hand, stiffness of joints, reduced strength and sensation, cold-induced symptoms and fractures of the radius. Methods to reduce the incidence of such complications are discussed.     

The sensory potential of free flap donor sites

Microneurovascular techniques make transfer of innervated soft tissue a reality. The present study investigated the sensory potential of four such donor sites: volar wrist, dorsal hand, dorsal foot, and great toe. Normal moving and static two-point discrimination values for these areas are reported. A sensory reeducation protocol demonstrated that even these normal values may be improved with training. This suggests that the full potential of transferred innervated soft tissue may best be achieved by incorporating sensory reeducation routinely in the postoperative rehabilitation program.     

静脉皮瓣供区预扩张的实验研究

目的研究皮肤软组织扩张术对静脉皮瓣成活的影响,探讨静脉皮瓣经预扩张后皮瓣成活安全性的变化。方法以新西兰成年兔为实验对象,进行自身双耳对照。采用激光多普勒微循环成像、酶组织化学染色+计算机图像分析、组织形态计量学测量以及皮瓣成活面积的测量等方法,观测预扩张静脉皮瓣的微循环变化及皮瓣的成活情况。结果静脉皮瓣经预扩张后,皮瓣的微血管管径由扩张前的(7.2±0.7)μm增至扩张后的(15.6±1.9)μm,微血管密度由(0.010 8±0.000 2)μm2/μm2增至(0.052 5±0.002 1)μm2/μm2(P<0.01),成活率由(21.89±1.12)%增至(85.10±2.32)%(P<0.001)。结论静脉皮瓣经预扩张后,皮瓣的微血管密度、管径均有明显增加,皮瓣的成活率显著提高。     

静脉皮瓣供区预扩张的实验研究

目的研究皮肤软组织扩张术对静脉皮瓣成活的影响,探讨静脉皮瓣经预扩张后皮瓣成活安全性的变化.方法以新西兰成年兔为实验对象,进行自身双耳对照.采用激光多普勒微循环成像、酶组织化学染色+计算机图像分析、组织形态计量学测量以及皮瓣成活面积的测量等方法,观测预扩张静脉皮瓣的微循环变化及皮瓣的成活情况.结果静脉皮瓣经预扩张后,皮瓣的微血管管径由扩张前的(7.2±0.7) μm增至扩张后的(15.6±1.9) μm,微血管密度由(0.010 8±0.000 2) μm2/μm2增至(0.052 5±0.002 1) μm2/μm2(P＜0.01),成活率由(21.89±1.12)%增至(85.10±2.32)%(P＜0.001).结论静脉皮瓣经预扩张后,皮瓣的微血管密度、管径均有明显增加,皮瓣的成活率显著提高.     

Mesh assisted direct closure of bilateral TRAM flap donor sites.

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a popular choice for patients requesting breast reconstruction. Criticism of all techniques that harvest the rectus abdominis muscle centre on abdominal wall weakness.[Dulin WA, Avila RA, Verheyden CN, Grossman L. Evaluation of abdominal wall strength after TRAM flap surgery. Plast Reconstr Surg 2004; 113: 1662-1665] Primary fascial closure of the donor site has been shown to reduce abdominal wall weakness and the subsequent risk of hernia and bulge. [Mizgala CL, Hartrampf CR Jr, Bennett GK. Abdominal function after pedicled TRAM flap surgery. Clin Plast Surg 1994; 21: 255-272]2 Primary fascial closure of all uni-lateral and most bilateral muscle preserving TRAM flap donor sites is possible. In a series of 23 bilateral TRAM flaps, excessive abdominal tension prevented direct fascial closure of the donor site in seven. Using a technique that includes muscle preservation, muscle relaxation and mesh assistance; tensionfree, direct fascial closure was achieved in all. The mesh buttress supports the rectus sheath during closure and provides long term shape and stability.     

皮肤伸展术在皮瓣供区关闭中的应用

目的　探讨皮肤伸展术在皮瓣供区关闭中的应用 ,为关闭皮瓣供区提供一种新方法。方法　回顾总结 2 4例应用皮肤伸展术关闭皮瓣供区的病例。患者年龄为 3～ 48岁 ,游离皮瓣供区 2 1例 ,轴型皮瓣供区 3例 ,皮瓣宽度为 8～ 16cm。结果　全部病例的供区通过牵张后直接关闭缝合 ,随访结果显示无显著瘢痕增生和增宽。结论　皮肤伸展术操作简单 ,效果良好 ,是快速关闭比较宽的皮瓣供区的一种行之有效的方法     

皮肤伸展术在皮瓣供区关闭中的应用

目的探讨皮肤伸展术在皮瓣供区关闭中的应用,为关闭皮瓣供区提供一种新方法.方法回顾总结24例应用皮肤伸展术关闭皮瓣供区的病例.患者年龄为3～48岁,游离皮瓣供区21例,轴型皮瓣供区3例,皮瓣宽度为8～16cm.结果全部病例的供区通过牵张后直接关闭缝合,随访结果显示无显著瘢痕增生和增宽.结论皮肤伸展术操作简单,效果良好,是快速关闭比较宽的皮瓣供区的一种行之有效的方法.     

Vaginal reconstruction with an upper abdominal island flap]

This paper presents a method for vaginal reconstruction. On the basis of anatomic studies, we designed an island flap obtained from the upper abdomen, with the blood supply from the deep inferior epigastric artery. At the time of operation, this flap was transferred under the symphysis pubis to the artificial space created between the urinary bladder and rectum. The operation was done on 7 patients and complete survival of the flap was seen in 6 cases. The failure was due to a twist of the flap vessel pedicle. The patients were followed up for 6 months to 2 years, and it was found that the vaginal wall was not only pliable but elastic, and the married patients enjoyed a satisfactory sexual life.     

Evaluation of donor site morbidity after radial flap harvesting]

Donor sites of 58 radial forearm flaps in 56 patients were analysed and evaluated on the basis of documentation and follow-up examination. In 2 patients 2 radial flaps were harvested. There were 25 females and 31 males aged 9-85 (mean age: 35 years). 35 free flaps (31 on to feet, 2 on to tibial stumps and 2 on to contralateral forearm) and 4 pedicled flaps (on to the head) were transferred to distal body regions. Two of them included a part of the vascularized radius. The same upper extremity was covered with 19 pedicled radial forearm flaps (13 with retrograde blood flow). Six of them were osteo-fascio-cutaneous flaps. After harvesting 52 flaps (in 50 patients), the donor sites were covered with full or split thickness skin grafts. In 5 cases the donor sites were sutured, and in one case local V-Y plasty was used. In 11 cases the following complications were observed at the donor sites: delayed healing of the wound for more than 6 weeks in 4 cases;--chronic vascular insufficiency in 1 case;--dysesthesias on the dorsal part of the hand in 3 cases;--periodical pain and oedema of the hand in 2 cases;--unacceptable hypertrophic scar in 1 case. No acute ischemia of the hand, no fracture of the radial bone, and no neuroma of the sensory branch of the radial nerve were observed at the donor site.     

改良封闭负压引流技术在腹部皮瓣供瓣区的临床应用

目的：探讨改良封闭负压引流（vaccLlm sealing drainage,VSD）技术在腹部皮瓣供瓣区应用的临床效果。方法：选择2010年2月-2012年1月期间行腹部皮瓣修复手或上肢创面的患者14例,创面大小为15cm×10cm-9cm×5cm。创面清创后行腹部随意皮瓣转移,皮瓣长宽比例在2：1以内,面积15cm×12cm-9cm×7cm。供瓣区及皮瓣蒂部裸露区应用医用海绵覆盖,医用半透性粘贴薄膜封闭整个术区。连接负压吸引装置,腹带固定患肢。术后第2天,在医用海绵的远端,刺入静脉输液针,每天500ml生理盐水持续进行灌洗。皮瓣移植14-18天后行皮瓣断蒂术,术后10-12天切口拆线。结果：所有病例皮瓣全部成活,切口甲级愈合13例,乙级愈合1例。9例患者供瓣区通过局部皮瓣转移后,直接缝合,未予植皮。4例患者行局部部分拉拢缝合,缩小创面后,移植皮片覆盖。植皮面积8cm×5cm-5cm×3cm。无VSD装置更换病例。3例患者术后3天出现负压引流区轻度疼痛。其余患者无不适反应。所有病例静脉输液针穿刺孔未发生可见漏气现象,未影响负压引流的正常进行。结论：改良VSD技术延长了VSD装置的使用时间,明显减少了VSD的并发症;改良VSD技术减少了腹部供瓣区的植皮率,降低了术区感染率,简化了腹部皮瓣手术过程。     

Functional evaluation of anterolateral thigh flap donor sites: isokinetic torque comparisons for knee function

Background: The anterolateral thigh flap is thought to have minor donor site morbidity, but muscle dissection is unavoidable when skin perforator vessels run through the vastus lateralis muscle. The purpose of this study was to investigate the functional problems associated with the anterolateral thigh flap donor site. Method: We evaluated 12 patients who underwent free anterolateral thigh flap transfer between March 2003 and November 2005. A questionnaire and dynamic functional evaluation of the knee joint using the Biodex System were performed preoperatively and 6 months postoperatively. Results: No patients reported any disturbance in their daily life. No significant differences were found between donor and normal thighs on isokinetic power tests of the quadriceps muscle. Conclusion: The function of the donor site after harvesting the anterolateral thigh flap was maintained. Damage to or functional disturbance of the donor site is minimal even if muscle is injured when harvesting the flap. © 2008 Wiley‐Liss, Inc. Microsurgery, 2008.     

Tendon graft donor sites

Each of 480 extremities from 120 cadavers was dissected. Particular attention was given to potential donors for tendon grafts. Both the palmaris longus and the extensor digiti minimi had an average length of 16 cm and an average width of 3 mm. The extensor indicis tendon averaged 13 cm in length and 3 mm in width. The plantaris and second toe extensors averaged 35 cm in length and 2 to 2.5 mm in width. None of these measurements correlated well with age, sex, or hand or foot size. There was, however, a high correlation between right- and left-side measurements in each specimen, in spite of some degree of anatomic variation for all the tendons studied. The palmaris longus was missing in 25% of the upper extremities, and the plantaris in 19% of the lower extremities dissected.     

A pedicled anterolateral thigh flap for abdominal reconstruction after previous degloving injury of the donor site: Revascularisation of the donor site

A pedicled anterolateral thigh flap was used to reconstruct an abdominal defect after traumatic degloving of the entire skin of the right upper leg two-and-a-half years earlier. There are few reports about revascularisation of skin flaps after previous interruption of the blood supply. As far as I know this is the first report of a revascularised (anterolateral thigh) perforator flap.