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Volume 40 Issue 7
Jul.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(7): 643-649
Cheng L,Liu XQ,Du WL,et al.Clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis[J].Chin J Burns Wounds,2024,40(7):643-649.DOI: 10.3760/cma.j.cn501225-20231120-00198.
Citation: Cheng L,Liu XQ,Du WL,et al.Clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis[J].Chin J Burns Wounds,2024,40(7):643-649.DOI: 10.3760/cma.j.cn501225-20231120-00198.
shu

Clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis

doi: 10.3760/cma.j.cn501225-20231120-00198
  • 1.

    Department of Burns, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China

  • 2.

    Department of Burns and Plastics, Yantai Yeda Hospital, Yantai 265500, China

Funds:

Talent Cultivation Plan of Notable Emerging Talent in Beijing Jishuitan Hospital XKXX2022003

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    Abstract
  •   Objective  To explore the clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis.  Methods  This study was a retrospective observational study. From January 2018 to December 2022, 20 patients with wounds with bone or internal fixation exposure and wounds with osteomyelitis who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, including 19 males and 1 female, aged from 21 to 73 years. Among the 21 wounds, there were 5 wounds with bone exposure, 12 wounds with osteomyelitis, and 4 wounds with internal fixation exposure. After the debridement in the first stage, the wound area was 6 cm×3 cm to 22 cm×10 cm. Then vacuum sealing drainage was carried out for 5 to 7 days. In the second stage, the wounds were covered with pedicled chimeric medial sural artery perforator flap, pedicled chimeric posterior tibialis artery perforator flap, free chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery, free chimeric medial sural artery perforator flap or free chimeric deep circumflex iliac artery perforator flap with incision area of 7 cm×5 cm to 25 cm×12 cm. The chimeric muscle flap was used to fill and cover irregular deep cavities. The wounds in the flap donor sites were sutured directly or repaired with medium-thickness skin grafts from the thigh. The survival of flap and the healing of wound in flap donor site were observed after operation. The recurrence of infection was followed up.  Results  Among the 18 free chimeric perforator flaps, 16 flaps survived successfully; one flap experienced a venous crisis on the day of surgery and survived completely after emergency exploration and re-anastomosis; another one flap had partial distal necrosis, which healed after dressing changes. All the wounds in the flap donor sites healed evenly. All 3 pedicled chimeric perforator flaps survived; one of them developed sub-flap infection but healed after debridement and bone cement placement. The wound in the donor site of 1 flap developed incision dehiscence, which healed successfully after redebridement and suturing. The donor site wounds of the rest 2 flaps healed well. During 3 to 12 months of follow-up, the patients with wounds with bone or internal fixation exposure showed no signs of abnormal exudation or infection, and no infection recurrence was observed in patients with wounds with osteomyelitis.  Conclusions  The application of chimeric perforator flaps is effective in covering wounds, filling dead spaces, and controlling infection in wounds with bone or internal fixation exposure and wounds with osteomyelitis. Moreover, this method minimizes the damage to the donor site.

     

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    • References(35)
  • [1]
    杜伟力,沈余明,胡骁骅,等.下肢关节部位外伤行骨科内固定手术后切口感染创面临床治疗方法探讨[J].中华烧伤杂志,2021,37(3):216-224.DOI: 10.3760/cma.j.cn501120-20201108-00463.
    [2]
    LewDP,WaldvogelFA.Osteomyelitis[J].Lancet,2004,364(9431):369-379.DOI: 10.1016/S0140-6736(04)16727-5.
    [3]
    张春,刘亦杨,郭峭峰,等.显微外科技术与慢性骨髓炎的一期手术治疗——理念与临床应用[J].中华显微外科杂志,2022,45(1):14-20.DOI: 10.3760/cma.j.cn441206-20211215-00296.
    [4]
    LaughlinRT,SinhaA,CalhounJH,et al.Osteomyelitis[J].Curr Opin Rheumatol,1994,6(4):401-407.DOI: 10.1097/00002281-199407000-00009.
    [5]
    BuonoP, CastusP, Dubois-FerrièreV, et al. Muscular versus non-muscular free flaps for soft tissue coverage of chronic tibial osteomyelitis[J]. World J Plast Surg,2018,7(3):294-300. DOI: 10.29252/wjps.7.3.294.
    [6]
    RaoN,ZiranBH,LipskyBA.Treating osteomyelitis: antibiotics and surgery[J].Plast Reconstr Surg,2011,127Suppl 1:177S-187S.DOI: 10.1097/PRS.0b013e3182001f0f.
    [7]
    DymH, ZeidanJ. Microbiology of acute and chronic osteomyelitis and antibiotic treatment[J]. Dent Clin North Am,2017,61(2): 271-282. DOI: 10.1016/j.cden.2016.12.001.
    [8]
    汤玉泉,唐举玉,吴攀峰,等.旋股外侧动脉降支嵌合穿支皮瓣游离移植治疗胫骨创伤后骨髓炎[J].中国现代医学杂志,2017,27(8):76-79.DOI: 10.3969/j.issn.1005-8982.2017.08.016.
    [9]
    化昊天,王新卫,张磊,等.慢性骨髓炎的诊疗研究进展[J].中国骨与关节杂志,2022,11(2):132-136.DOI: 10.3969/j.issn.2095-252X.2022.02.011.
    [10]
    ChangN,MathesSJ.Comparison of the effect of bacterial inoculation in musculocutaneous and random-pattern flaps[J].Plast Reconstr Surg,1982,70(1):1-10.DOI: 10.1097/00006534-198207000-00001.
    [11]
    CalderónWL,LenizP.Comparison of the vascularity of fasciocutaneous tissue and muscle for coverage of open tibial fractures[J].Plast Reconstr Surg,2010,125(5):1582.DOI: 10.1097/PRS.0b013e3181d62cbf.
    [12]
    SalgadoCJ,MardiniS,JamaliAA,et al.Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects[J].Plast Reconstr Surg,2006,118(6):1401-1411.DOI: 10.1097/01.prs.0000239579.37760.92.
    [13]
    GlassGE,ChanJK,FreidinA,et al.TNF-alpha promotes fracture repair by augmenting the recruitment and differentiation of muscle-derived stromal cells[J].Proc Natl Acad Sci U S A,2011,108(4):1585-1590.DOI: 10.1073/pnas.1018501108.
    [14]
    ChanJK, HarryL, WilliamsG, et al. Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps[J]. Plast Reconstr Surg,2012,130(2): 284e-295e. DOI: 10.1097/PRS.0b013e3182589e63.
    [15]
    LüthjeFL,JensenLK,JensenHE,et al.The inflammatory response to bone infection - a review based on animal models and human patients[J].APMIS,2020,128(4):275-286.DOI: 10.1111/apm.13027.
    [16]
    CalderonW,ChangN,MathesSJ.Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps[J].Plast Reconstr Surg,1986,77(5):785-794.DOI: 10.1097/00006534-198605000-00016.
    [17]
    ZhaoXZ, ShenYM. Island perforator muscle flaps for chronic osteomyelitis of the lower extremities: a retrospective analysis of 21 consecutive cases[J]. Plast Reconstr Surg,2022,150(3):677-687. DOI: 10.1097/PRS.0000000000009472.
    [18]
    VareyAHR, KhanU.Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps[J].Plast Reconstr Surg,2013,131(3):448e.DOI: 10.1097/PRS.0b013e31827c723b.
    [19]
    TachiM, ToriyabeS, ImaiY, et al. Versatility of chimeric flap based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap in reconstructing lower-extremity bone defects due to osteomyelitis[J]. J Reconstr Microsurg,2010,26(6):417-424.DOI: 10.1055/s-0030-1251560.
    [20]
    MatsumotoT,TsumuraT,KishimotoK,et al.Sequential chimeric free deep circumflex iliac artery bone flap and superficial circumflex iliac artery perforator flap from the same site for one-stage reconstructions of severe hand injury: a report of two cases[J].JPRAS Open,2020,26:49-53.DOI: 10.1016/j.jpra.2020.09.005.
    [21]
    YamamotoT,YamamotoN.A triple-component deep inferior epigastric artery perforator chimeric free flap for three-dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis[J].Microsurgery,2021,41(4):370-375.DOI: 10.1002/micr.30698.
    [22]
    HallockGG.In an era of perforator flaps, are muscle flaps passé?[J].Plast Reconstr Surg,2009,123(4):1357-1363.DOI: 10.1097/PRS.0b013e3181a0a111.
    [23]
    KoshimaI. Combined tissue transfer for extensive lower limb complex defects: flow-through flaps, chimera, and "Orochi" flaps[J]. J Reconstr Microsurg,2021, 37(1): 17-21. DOI: 10.1055/s-0040-1715814.
    [24]
    韦卫甲,蔡明,廖海浪.游离修薄股前外侧血流桥接穿支皮瓣修复四肢GustiloⅢC型损伤34例[J].安徽医药,2020,24(6):1206-1208,封3.DOI: 10.3969/j.issn.1009-6469.2020.06.037.
    [25]
    LiRG, ZengCJ, YuanS, et al. Reconstruction of large area of deep wound in the foot and ankle with chimeric anterolateral thigh perforator flap[J]. Orthop Surg,2021,13(5): 1609-1617. DOI: 10.1111/os.13046.
    [26]
    ChaiyasateK, GuptaR, JohnJ, et al. Utilization of a chimeric medial femoral condyle free flap for mandibular osteoradionecrosis[J]. Plast Reconstr Surg Glob Open,2022,10(8): e4489. DOI: 10.1097/GOX.0000000000004489.
    [27]
    SmithRK,WykesJ,MartinDT,et al.Perforator variability in the anterolateral thigh free flap: a systematic review[J].Surg Radiol Anat,2017,39(7):779-789.DOI: 10.1007/s00276-016-1802-y.
    [28]
    GravvanisA,TsoutsosD,KarakitsosD,et al.Blood perfusion of the free anterolateral thigh perforator flap: its beneficial effect in the reconstruction of infected wounds in the lower extremity[J].World J Surg,2007,31(1):11-18.DOI: 10.1007/s00268-006-0298-8.
    [29]
    QingLM, WuPF, LiangJY, et al. Use of flow-through anterolateral thigh perforator flaps in reconstruction of complex extremity defects[J]. J Reconstr Microsurg,2015,31(8): 571-578. DOI: 10.1055/s-0035-1555138.
    [30]
    FranchiA,HäfeliM,ScaglioniMF,et al.The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand[J].Microsurgery,2019,39(5):416-422.DOI: 10.1002/micr.30434.
    [31]
    DusseldorpJR,PhamQJ,NgoQ,et al.Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns[J].J Plast Reconstr Aesthet Surg,2014,67(9):1267-1275.DOI: 10.1016/j.bjps.2014.05.016.
    [32]
    ParkG,KimH.Treatment of chronic osteomyelitis using the medial sural perforator flap[J].J Plast Reconstr Aesthet Surg,2010,63(1):153-159.DOI: 10.1016/j.bjps.2008.07.018.
    [33]
    XieXT,ChaiYM.Medial sural artery perforator flap[J].Ann Plast Surg,2012,68(1):105-110.DOI: 10.1097/SAP.0b013e31821190e6.
    [34]
    HallockGG. The medial sural artery perforator flap: a historical trek from ignominious to "workhorse"[J]. Arch Plast Surg,2022,49(2): 240-252. DOI: 10.1055/s-0042-1744425.
    [35]
    DaarDA, AbdouSA, CohenJM, et al. Is the medial sural artery perforator flap a new workhorse flap? A systematic review and meta-analysis[J]. Plast Reconstr Surg,2019,143(2): 393e-403e. DOI: 10.1097/PRS.0000000000005204.
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