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Clinical Applications of Pedicled Perforator Flaps for Upper Limb Reconstruction
Mitsuhiro Okada, MD, PhD1; Kiyohito Takamatsu, MD, PhD2; Takuya Uemura, MD, PhD1; Mikinori Ikeda, MD1; Hideki Ueyama, MD1; Hiroaki Nakamura, MD, PhD1; (1)Osaka City University Graduate School of Medicine, (2)Osaka CIty General Hospital
Osaka City university Graduate School of Medicine, Osaka, Japan

Introduction: Pedicled perforator flaps are useful for upper limb reconstruction. Pedicled perforator flaps are available for propeller flaps based on perforator vessels and island perforator flaps with dissection of source vessels. The characteristic of pedicled perforator flaps requires no microsurgical technique and underlying muscle tissues, which can minimize the function loss of the donor sites without any restricted post-operative care. We report the results and applications of upper limb reconstruction using pedicled perforator flaps.

Methods: Pedicled perforator flaps for upper limb reconstruction were retrospectively analyzed. The location of the defects, the perforator vessels that were used, the indication of the pedicled perforator flaps, and the management of the donor sites were studied.

Results: Twenty pedicled perforator flaps were used without microsurgical technique, which demanded no restricted post-operative care. Two flaps were for cervical reconstruction, 2 flaps for shoulder and arm reconstruction, 7 flaps for forearm reconstruction, one flap for hand reconstruction, 8 flaps for finger reconstruction. Seven different vascular pedicles were utilized; the thoracoacromial artery, the thoracodorsal artery, the posterior interosseous artery, the radial artery, the ulnar artery, the dorsal metacarpal artery, and the digital artery. Eighteen flaps were harvested as propeller flaps based on perforator vessels, and 2 flaps as island perforator flaps with dissection of the source vessels. Eleven flaps were for soft tissue reconstruction, and 9 flaps for the treatment of peripheral neuropathy. In all cases, soft tissue defects and peripheral neuropathy were successfully treated. The donor sites were closed primarily in 17 flaps, and 3 flaps needed split thickness skin grafts for closer of the donor sites.

Conclusions: Pedicled perforator flaps are harvested in different 2 ways; propeller flaps based on perforator vessels, and island perforator flaps with dissection of the source vessels. These 2 types of pedicled perforator flaps can reconstruct upper limb soft tissue defects and treat peripheral neuropathy. Pedicled perforator flaps require no microsurgical technique and need no restricted post-operative care, which has the advantage for treatment of patients with significant comorbidities, compared to island flaps with underlying muscle tissues or free flaps with microsurgical anastomoses.

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