Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Yaojun , REN Zhongliang , XUE Jiajie , GUO Lei , GAO Dengwen , HAO Qingye , GAO Fucheng , YANG Jie

Department of Burn & Plastic and Hand & Foot Surgery, the Second Hospital of Yulin City, Yulin Shaanxi, 719000, P.R.China;

Corresponding author：

WANG Yaojun, Email: doctwyj@163.com

Keywords：

Latissimus dorsi myocutaneous flap; posterior intercostal artery perforator flap; relaying flap; soft tissue defect; donor site

DOI：

10.7507/1002-1892.201803046

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ObjectiveTo investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer.MethodsBetween January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly.ResultsAll the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites.ConclusionThe latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.

Citation： WANG Yaojun, REN Zhongliang, XUE Jiajie, GUO Lei, GAO Dengwen, HAO Qingye, GAO Fucheng, YANG Jie. Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1187-1191. doi: 10.7507/1002-1892.201803046 Copy

1.	曹东升, 盛辉, 汪春兰, 等. 应用带少许肌袖的背阔肌肌皮瓣修复下肢软组织缺损. 中国修复重建外科杂志, 2007, 21(11): 1206-1208.
2.	唐举玉, 李康华, 刘俊, 等. 背阔肌皮瓣游离移植修复下肢巨大软组织缺损. 中国修复重建外科杂志, 2006, 20(11): 1087-1089.
3.	Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
4.	刘志远, 唐修俊, 王达利, 等. 背阔肌 Kiss 皮瓣修复上臂复合组织缺损及功能重建. 中国修复重建外科杂志, 2017, 31(9): 1106-1110.
5.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
6.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7.	唐举玉, 卿黎明, 梁捷予, 等. 改良背阔肌皮瓣移植修复下肢巨大面积皮肤软组织缺损. 中华显微外科杂志, 2013, 36(3): 211-214.
8.	俞芳, 唐举玉, 汪华侨, 等. 中国穿支皮瓣应用进入新时代—— 第七届中国穿支皮瓣高峰论坛”在长沙召开. 中华显微外科杂志, 2017, 40(6): 后插 5-后插 7.
9.	唐举玉, 汪华侨, Hallock GG, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
10.	常树森, 何春念, 金文虎, 等. 股前外侧皮瓣的供区并发症. 中华显微外科杂志, 2018, 41(1): 101-104.
11.	中华医学会显微外科学分会. MBCMA 股前外侧皮瓣临床实践指南 (2016 征求意见稿). 中华显微外科杂志, 2016, 39(4): 313-317.
12.	Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
13.	吕春柳, 李赞, 周晓, 等. 带蒂背阔肌 Kiss 皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.
14.	金文虎, 魏在荣, 邓呈亮, 等. 游离旋股外侧动脉降支穿支组织瓣的临床应用及对供区影响观察. 中国修复重建外科杂志, 2015, 29(10): 1284-1287.
15.	滕云升, 梁高峰, 文波, 等. 股前穿支接力皮瓣修复游离股前外侧皮瓣供区创面. 中华显微外科杂志, 2017, 40(2): 126-129.
16.	宋达疆, 李赞, 周晓, 等. 股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用. 中国修复重建外科杂志, 2017, 31(1): 52-56.
17.	周晓, 芮永军, 薛明宇, 等. 以旋髂深动脉肌皮穿支为蒂的 V-Y 接力皮瓣修复腹部供区创面的临床应用. 中华显微外科杂志, 2015, 38(5): 421-424.
18.	周晓, 薛明宇, 许亚军, 等. 以指动脉皮穿支蒂接力皮瓣修复指端皮肤软组织缺损. 中华整形外科杂志, 2015, 31(6): 422-425.
19.	Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
20.	Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg, 1978, 61(5): 653-665.

1. 曹东升, 盛辉, 汪春兰, 等. 应用带少许肌袖的背阔肌肌皮瓣修复下肢软组织缺损. 中国修复重建外科杂志, 2007, 21(11): 1206-1208.
2. 唐举玉, 李康华, 刘俊, 等. 背阔肌皮瓣游离移植修复下肢巨大软组织缺损. 中国修复重建外科杂志, 2006, 20(11): 1087-1089.
3. Branford OA, Kelemen N, Hartmann CE, et al. Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques. Plast Reconstr Surg, 2013, 132(4): 737-748.
4. 刘志远, 唐修俊, 王达利, 等. 背阔肌 Kiss 皮瓣修复上臂复合组织缺损及功能重建. 中国修复重建外科杂志, 2017, 31(9): 1106-1110.
5. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
6. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
7. 唐举玉, 卿黎明, 梁捷予, 等. 改良背阔肌皮瓣移植修复下肢巨大面积皮肤软组织缺损. 中华显微外科杂志, 2013, 36(3): 211-214.
8. 俞芳, 唐举玉, 汪华侨, 等. 中国穿支皮瓣应用进入新时代—— 第七届中国穿支皮瓣高峰论坛”在长沙召开. 中华显微外科杂志, 2017, 40(6): 后插 5-后插 7.
9. 唐举玉, 汪华侨, Hallock GG, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
10. 常树森, 何春念, 金文虎, 等. 股前外侧皮瓣的供区并发症. 中华显微外科杂志, 2018, 41(1): 101-104.
11. 中华医学会显微外科学分会. MBCMA 股前外侧皮瓣临床实践指南 (2016 征求意见稿). 中华显微外科杂志, 2016, 39(4): 313-317.
12. Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
13. 吕春柳, 李赞, 周晓, 等. 带蒂背阔肌 Kiss 皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.
14. 金文虎, 魏在荣, 邓呈亮, 等. 游离旋股外侧动脉降支穿支组织瓣的临床应用及对供区影响观察. 中国修复重建外科杂志, 2015, 29(10): 1284-1287.
15. 滕云升, 梁高峰, 文波, 等. 股前穿支接力皮瓣修复游离股前外侧皮瓣供区创面. 中华显微外科杂志, 2017, 40(2): 126-129.
16. 宋达疆, 李赞, 周晓, 等. 股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用. 中国修复重建外科杂志, 2017, 31(1): 52-56.
17. 周晓, 芮永军, 薛明宇, 等. 以旋髂深动脉肌皮穿支为蒂的 V-Y 接力皮瓣修复腹部供区创面的临床应用. 中华显微外科杂志, 2015, 38(5): 421-424.
18. 周晓, 薛明宇, 许亚军, 等. 以指动脉皮穿支蒂接力皮瓣修复指端皮肤软组织缺损. 中华整形外科杂志, 2015, 31(6): 422-425.
19. Schwabegger AH, Harpf C, Rainer C, et al. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg, 2003, 111(4): 1407-1411.
20. Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg, 1978, 61(5): 653-665.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer

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