The Experts below are selected from a list of 11754 Experts worldwide ranked by ideXlab platform
Ming-huei Cheng - One of the best experts on this subject based on the ideXlab platform.
-
Comparison of Posteromedial Thigh Profunda Artery Perforator Flap and Anterolateral Thigh Perforator Flap for Head and Neck Reconstruction.
Plastic and reconstructive surgery, 2016Co-Authors: Jung-ju Huang, Chung-kan Tsao, Mohamed Abdelrahman, Georgios Kolios, Ming-huei ChengAbstract:Background:The anterolateral thigh Perforator Flap is a common workhorse Flap for head and neck reconstruction. The authors present an alternative method using the posteromedial thigh profunda artery Perforator Flap and compare its characteristics, outcomes, donor-site morbidity, and donor-site cosm
-
Comparison of the medial sural artery Perforator Flap with the radial forearm Flap for head and neck reconstructions.
Plastic and reconstructive surgery, 2009Co-Authors: Huang-kai Kao, Fu Chan Wei, Kai-ping Chang, Ming-huei ChengAbstract:For a small to medium-sized defect in the head and neck region after cancer ablation, the free radial forearm Flap is commonly used. More recently, the free medial sural artery Perforator Flap has been used as an alternative. The authors investigated the outcome and donor-site morbidity of the free radial forearm Flap and the free medial sural artery Perforator Flap for head and neck reconstruction. Between July of 2004 and May of 2008, 47 patients (45 men and two women) underwent head and neck reconstruction, with a free radial forearm Flap used in 29 cases and a free medial sural artery Perforator Flap used in 18 cases. Patient age ranged from 30 to 70 years (mean, 50.5 years). The success rate of free radial forearm and free medial sural artery Perforator Flaps was 100.0 percent. There was no significant difference in Flap harvest time (57.5 minutes versus 60 minutes), hospital stay (24.5 days versus 19.7 days), or overall recipient-site complication rate (20.7 percent versus 11.1 percent). The free medial sural artery Perforator Flap group had a better subjective functional and cosmetic outcome in the donor site than the free radial forearm Flap group (two-sided Fisher's exact test, p = 0.0002). The medial sural artery Perforator Flap is a good alternative for head and neck reconstruction of small defects. The medial sural artery Perforator Flap is advantageous with regard to less donor-site morbidity compared with the free radial forearm Flap. The unfamiliarity of the pedicle anatomy of the medial sural artery Perforator Flap must be weighed against an easily harvested radial forearm Flap.
Edward I. Chang - One of the best experts on this subject based on the ideXlab platform.
-
prospective comparison of donor site morbidity following radial forearm and ulnar artery Perforator Flap harvest
Plastic and Reconstructive Surgery, 2020Co-Authors: Edward I. Chang, Jun LiuAbstract:Background: The forearm is a common donor site, providing thin, pliable workhorse Flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm Flap to the ulnar artery Perforator Flap. Methods: All patients undergoing forearm free Flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. Results: A total of 98 patients were enrolled (radial forearm Flap, n = 50; ulnar artery Perforator Flap, n = 48). There were three osteocutaneous radial forearm Flaps performed. The donor site was closed primarily in one radial forearm Flap patient and four ulnar artery Perforator Flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm Flap, n = 40; ulnar artery Perforator Flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm Flap, n = 5; ulnar artery Perforator Flap, n = 2); all of them healed secondarily with local wound care. There were no Flap losses in the study. Conclusions: The radial forearm and ulnar artery Perforator Flaps are equivalent in terms of success and donor-site morbidity. Selection of Flap should be based on need for pedicle length, Flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. Clinical question/level of evidence: Therapeutic, II.
-
Perforator patterns of the ulnar artery Perforator Flap.
Plastic and reconstructive surgery, 2012Co-Authors: Edward I. Chang, Jesse C. Selber, Matthew M. HanasonoAbstract:BACKGROUND: Flaps based on the ulnar artery have never gained the same popularity as the radial forearm Flap, despite several potential advantages. In this article, the authors describe a true ulnar artery Perforator Flap with Perforator mapping. METHODS: Thirty-eight consecutive patients who underwent ulnar artery Perforator Flap surgery were included in the study. The size, number, and location of Perforators were recorded intraoperatively. Preoperative and postoperative grip strength was tested and compared. RESULTS: One to three cutaneous Perforators from the ulnar artery were identified and designated as A, B, and C from distal to proximal. Perforator A was present in 79 percent of cases and located 7.3 ± 1.1 cm from the pisiform. Perforator B was present in 95 percent of cases and located 11.4 ± 1.0 cm from the pisiform. Perforator C was present in 87 percent of cases and located 15.9 ± 1.8 cm from the pisiform. All patients had at least two Perforators, and 61 percent had three Perforators. All Flaps were used for head and neck reconstruction and all were successful. Donor-site morbidity was minor. Grip testing demonstrated a transient decrease in grip strength during the postoperative period, and most recovered to the contralateral level by 3 months. CONCLUSIONS: At least two Perforators are present in the ulnar artery Perforator Flap territory. This Flap is reliable and easy to harvest and has minimal donor-site morbidity. It should be considered as an alternative to the radial forearm Flap in select patients.
Maolin Tang - One of the best experts on this subject based on the ideXlab platform.
-
New methods and technologies in the field of Perforator Flap studies
Chinese journal of plastic surgery, 2019Co-Authors: Yuanbo Liu, Mengqing Zang, Shan Zhu, Bo Chen, Tinglu Han, Maolin TangAbstract:A large number of innovative and new technologies and method in the field of Perforator Flap were proposed with the hard work of many experts and surgeons. This paper briefly reviewed the following items including the discovery of the Perforator Flap and its enlightenment to us, three-dimensional visualized anatomy, angiosome and perforasome theories, pre-operative Perforator detection techniques, techniques for evaluation of the Flap vascular perfusion, the concept of freestyle Perforator Flap, chimeric Flap, flow-through Flap technique, new designs of pedicle Perforator Flap, particularly the propeller and keystone Flaps, supramicrosurgery, superthin Flap, microdissected thin Perforator Flap, and microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. These new technologies and method have greatly improved our understanding of Flap surgery and promote the development of the reconstructive surgery. The traditional research focused on investigating the anatomic features of a single Flap and strategies for the reconstruction of different defects and organs. Nowadays, the treatment scope of reconstructive surgery is more extensive and has developed to repair various refractory wounds following trauma and oncological resection, nerve injuries, and to reconstruct defect and organ by using the vascularized composite allotransplantation. Researches on the upper limb lymphedema after breast cancer surgery have been highly valued recently. It can be expected that the direction of reconstructive surgery would be transformed from the improvement of theraputic modalities to concentrating on the treatment of diseases, and this undoubtedly conforms to the essence of medicine. The research of Perforator Flaps will be directed to more precise, minimally invasive, and individualized according to the requirements of evidence-based medicine. Key words: Perforator Flap; New technology; New method; Review; Prospect
-
Basic Perforator Flap Hemodynamic Mathematical Model.
Plastic and reconstructive surgery. Global open, 2016Co-Authors: Youlun Tao, Maolin Tang, Shimin Chang, Maochao Ding, Aiguo Wang, Yuehong Zhuang, Jin Mei, Geoffrey G. HallockAbstract:Background: A mathematical model to help explain the hemodynamic characteristics of Perforator Flaps based on blood flow resistance systems within the Flap will serve as a theoretical guide for the future study and clinical applications of these Flaps. Methods: There are 3 major blood flow resistance network systems of a Perforator Flap. These were defined as the blood flow resistance of an anastomosis between artery and artery of adjacent perforasomes, between artery and vein within a perforasome, and then between vein and vein corresponding to the outflow of that perforasome. From this, a calculation could be made of the number of such blood flow resistance network systems that must be crossed for all perforasomes within a Perforator Flap to predict whether that arrangement would be viable. Results: The summation of blood flow resistance networks from each perforasome in a given Perforator Flap could predict which portions would likely survive. This mathematical model shows how this is directly dependent on the location of the vascular pedicle to the Flap and whether supercharging or superdrainage maneuvers have been added. These configurations will give an estimate of the hemodynamic characteristics for the given Flap design. Conclusions: This basic mathematical model can (1) conveniently determine the degree of difficulty for each perforasome within a Perforator Flap to survive; (2) semiquantitatively allow the calculation of basic hemodynamic parameters; and (3) allow the assessment of the pros and cons expected for each pattern of perforasomes encountered clinically based on predictable hemodynamic observations.
-
reconstruction of distal limb defects with the free medial sural artery Perforator Flap
Plastic and Reconstructive Surgery, 2013Co-Authors: Xin Wang, Wei-wen Zhang, Jin Mei, Jiadong Pan, Hong Chen, Maolin TangAbstract:BACKGROUND The medial sural artery Perforator Flap is a reliable cutaneous Flap that can be used for soft-tissue reconstruction in the extremities. The purposes of this article are to fully document the vascular basis of the medial sural artery Flap and to report its use in reconstruction of distal extremities. METHODS Ten fresh cadavers were injected with a standardized injection of lead oxide for three-dimensional visualization reconstruction using a spiral computed tomography scanner and specialized software (Materialise Interactive Medical Image Control System). The origin, course, and distribution of the medial sural artery Perforator in the posterior leg region were observed. Between April of 2007 and December of 2010, the authors used the free medial sural artery Perforator Flap for distal limb reconstruction in 34 clinical cases. Flaps size varied from 5.5 × 4.5 cm to 14 × 9 cm. RESULTS The average diameter of medial sural artery Perforators was 0.9 ± 0.2 mm, with each Perforator supplying an average territory of 55 ± 20 cm. Extensive anastomoses were found between the medial sural artery Perforators and multiple adjacent source arteries. Twenty-nine Flaps (85.3 percent) fully survived and five (14.7 percent) underwent partial necrosis. Follow-up observations were conducted for 6 to 21 months, and the cosmetic results were satisfactory and without apparent bulkiness. CONCLUSIONS The free medial sural artery Perforator Flap transfer is appropriate for extremity defect reconstruction. The donor site not only supplies a thin skin Flap but also provides the option to harvest a cross-boundary Perforator Flaps that could be useful for repairing widespread traumatic soft-tissue defects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
-
the anatomical basis of the deep circumflex iliac artery Perforator Flap with iliac crest
Plastic and Reconstructive Surgery, 2007Co-Authors: Leonard Bergeron, Maolin Tang, Steven F. MorrisAbstract:Background: Perforator Flaps are increasingly used because of advantages including reduced Flap bulk, less donor-site morbidity, and more donor-site options. The deep circumflex iliac artery (DCIA) osteomusculocutaneous Flap with iliac crest has been one of the most useful Flaps used for mandibular reconstruction. However, its use has been limited by its bulkiness and added donor-site morbidity because of the inclusion of an “obligatory muscle cuff” of abdominal muscle. Early results at designing a DCIA Perforator Flap to circumvent this problem have been varied. Details regarding the location, number, and reliability of DCIA musculocutaneous Perforators have been conflicting. The purpose of this study was to comprehensively document the anatomical basis of the DCIA Perforator Flap. Methods: Six fresh bodies underwent whole-body lead oxide injection (n = 12 specimens). Landmarks were identified with radiopaque markers. Dissection, angiography, and photography were used to document the precise course of individual Perforators in the flank region. Angiograms were assembled with Adobe Photoshop and analyzed with Scion Image Beta. Results: An average of 1.6 DCIA Perforators with a diameter of 0.7 mm was present in 92 percent of specimens. Perforators were located 5 to 11 cm posterior to the anterior superior iliac spine, 1 to 35 mm superior to the iliac crest, with a Perforator zone of 31 cm2. The DCIA perfused the medial aspect of the iliac crest. Conclusions: This article establishes the anatomical basis of the DCIA Perforator Flap with iliac crest. This Perforator Flap, along with a split iliac crest, will likely diminish donor-site morbidity and facilitate oromandibular reconstruction.
Jian Lin - One of the best experts on this subject based on the ideXlab platform.
-
Superior and Inferior Gluteal Artery Perforator Flap
Atlas of Perforator Flap and Wound Healing, 2018Co-Authors: He-ping Zheng, Jian LinAbstract:The superior and inferior gluteal artery Perforator Flap was developed from gluteus maximus myocutaneous Flap. The superior gluteal artery Perforator Flap supplied by superior gluteal artery was first reported to repair sacral bedsore by Koshima in 1993. It was then applied in reconstruction of breast by Allen, and also used for repair of spinal meningocele and bedsore wound in pedicled form. The inferior gluteal artery Perforator Flap supplied by inferior gluteal artery was first reported to repair sciatic wound by Xiancheng Wang.
-
Internal Mammary Artery Perforator Flap
Atlas of Perforator Flap and Wound Healing, 2018Co-Authors: He-ping Zheng, Jian LinAbstract:The internal mammary artery Perforator Flap was first reported by Yu in 2006 for coverage of defects left by tracheostomy or defects by other causes in the anterior aspect of the neck. This Perforator Flap, an islanded one supplied by a single Perforator given off from the internal thoracic artery, enjoys a greater arc of rotation. As a modification of the thoracic triangular Flap, this Perforator Flap has overcome such drawbacks of the thoracic triangular Flap as having a broad base, and limited rotational radium.
-
Deep Circumflex Iliac Artery Perforator Flap
Atlas of Perforator Flap and Wound Healing, 2018Co-Authors: He-ping Zheng, Jian LinAbstract:Ever since the successful transplantation of the deep circumflex iliac artery Flap associated with the iliac bone Flap which was reported by Taylor (Taylor and Watson 1978; Taylor et al. 1979a, b) in 1979, the iliac chimeric Flap has been widely used in clinic work and has become a good method to restore bone and soft-tissue defects. However, the traditional iliac bone Flap was hard to separate bone from skin and the axial line of the Flap should be kept the same with the iliac which made it inconvenient to use. In 2007, the deep circumflex iliac artery chimeric Perforator Flap was claimed by Kang (2007) which made up the disadvantage and therefore turned out a satisfied clinical application.
-
Lateral Crural Perforator Flap
Atlas of Perforator Flap and Wound Healing, 2018Co-Authors: He-ping Zheng, Jian LinAbstract:The peroneal artery Perforator Flap was developed from the lateral crural Flap which could be designed as the proximal-middle peroneal artery Perforator Flap and the distal peroneal artery Perforator Flap. The former was suitable for coverage of a local crural wound and it might also be transferred as a free Flap to restore medium or small skin defects on the foot or hand. While the latter was suitable for restoration of skin and soft-tissue defects on the lower leg, around the ankle joint or on the dorsum of the foot, and it might also be transferred as a free Flap to restore small defects on the limbs. The distal peroneal artery Perforator Flap classified into three types: the superior (anterior) lateral malleolus Perforator Flap, the posterior superior lateral malleolus Perforator Flap and the posterior lateral malleolus Perforator Flap.
-
Concept of Perforator Flap
Atlas of Perforator Flap and Wound Healing, 2018Co-Authors: He-ping Zheng, Jian LinAbstract:The concept of Perforator Flap was first put forward in the late 1980s. It is an axial pattern Flap of skin and subcutaneous tissue with small-diameter skin Perforator vessel (Perforator artery and Perforator vein) as the pedicles (Fig. 2.1a). Perforator Flap is a development in microsurgery and has advantages as flexible design, small wounds at donor site, convenient transfer and good appearance of recipient site etc. At the beginning, Perforator Flap developed slowly and failed to attract much attention. Then two milestone meetings in Ghent, Belgium (2001) and Yinchuan, China (2005) promoted the research and development of Perforator Flap. A large number of basic researches and clinical application of Perforator Flap were reported since. Series of symposia and forums focused as well as collections and works published on Perforator Flap have laid an important theoretical basis for the development of Perforator Flap and raised a great enthusiasm in its research. With the increase of new donor sites and wide clinical application, dispute over the concept and nomenclature of Perforator Flap emerged. At the third Summit of Chinese Microsurgical Perforator Flap held in Ningbo in September 2013, following a principle of “seeking consensus on major issues while reserving dissensus on minor issues”, some domestic experts in Flap surgery made profound discussions about current concept of Perforator Flap in China and reached a consensus on issues as whether to carry deep fascia and superior source artery.
Jun Liu - One of the best experts on this subject based on the ideXlab platform.
-
prospective comparison of donor site morbidity following radial forearm and ulnar artery Perforator Flap harvest
Plastic and Reconstructive Surgery, 2020Co-Authors: Edward I. Chang, Jun LiuAbstract:Background: The forearm is a common donor site, providing thin, pliable workhorse Flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm Flap to the ulnar artery Perforator Flap. Methods: All patients undergoing forearm free Flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. Results: A total of 98 patients were enrolled (radial forearm Flap, n = 50; ulnar artery Perforator Flap, n = 48). There were three osteocutaneous radial forearm Flaps performed. The donor site was closed primarily in one radial forearm Flap patient and four ulnar artery Perforator Flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm Flap, n = 40; ulnar artery Perforator Flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm Flap, n = 5; ulnar artery Perforator Flap, n = 2); all of them healed secondarily with local wound care. There were no Flap losses in the study. Conclusions: The radial forearm and ulnar artery Perforator Flaps are equivalent in terms of success and donor-site morbidity. Selection of Flap should be based on need for pedicle length, Flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. Clinical question/level of evidence: Therapeutic, II.
-
Simultaneous tracheal and esophageal reconstruction for thyroid cancer involving trachea and esophagus using a free bipaddled posterior tibial artery Perforator Flap
Head & neck, 2019Co-Authors: Jun Liu, Jianjun Ren, Ji Wang, Di Deng, Haiyang Wang, Fei ChenAbstract:BACKGROUND Simultaneous tracheal and esophageal reconstruction after tumor resection is a great challenge. Here we present an innovative operative technique to simultaneously reconstruct tracheal and esophageal defects, in which a free posterior tibial artery Perforator Flap was made into a free bipaddled Flap to cover both tracheal and esophageal defects. METHODS A free bipaddled posterior tibial artery Perforator Flap was utilized to conduct simultaneous tracheal and esophageal reconstruction for a 72-year-old female patient with papillary thyroid carcinoma and massive trachea and esophagus invasion, who underwent radical resection. RESULTS Satisfactory breathing and swallowing functions were gained independent of nasal feeding and tracheotomy. Voice was still hoarse due to tumor invasion of left recurrent laryngeal nerve. During a period of 2-year follow-up, no sign of tumor recurrence was observed. CONCLUSION A free bipaddled posterior tibial artery Perforator Flap could be a decent choice for simultaneous reconstruction of large tracheal and esophageal defects.
