Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound

Zhao Shuming; Liu Na; Liu Xueliang; Ji Shaolin

doi:10.3760/cma.j.cn501225-20231012-00111

Volume 40 Issue 3

Mar. 2024

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(3): 281-288

Ju YK,Fang BR.Research advances on the mechanism of extracellular vesicles of adipose-derived mesenchymal stem cells in promoting wound angiogenesis[J].Chin J Burns Wounds,2023,39(1):85-90.DOI: 10.3760/cma.j.cn501225-20220322-00080.

Citation:

Zhao SM,Liu N,Liu XL,et al.Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound[J].Chin J Burns Wounds,2024,40(3):281-288.DOI: 10.3760/cma.j.cn501225-20231012-00111.

Citation:

PDF( 6950 KB)

Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound

doi: 10.3760/cma.j.cn501225-20231012-00111

1.
The Third Department of Orthopedics, Xingtai General Hospital of North China Medical and Health Group, Xingtai 054000, China
2.
Department of Medical Affairs, Xingtai General Hospital of North China Medical and Health Group, Xingtai 054000, China
3.
Department of Trauma and Hand and Foot Surgery, Shandong Provincial Third Hospital Affiliated to Shandong University, Jinan 250031, China

Funds:

The Self-funded Project of the Key Research and Development Plan of Hebei Province of China 182777243

More Information

Corresponding author: Ji Shaolin, Email: 315509203@qq.com
Received Date: 2023-10-12

Abstract

Abstract

Objective To explore the cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound. Methods This study was a retrospective historical control study. From February 2017 to October 2019, 20 patients who were admitted to the Third Department of Orthopedics of Xingtai General Hospital of North China Medical and Health Group (hereinafter referred to as our department), met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested based on the surgeon's clinical experience were selected as control group, including 16 males and 4 females, aged (37±5) years. From November 2019 to December 2022, 21 patients who were admitted to our department, met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested under the assistance of color Doppler ultrasound were selected as ultrasound-assisted group, including 15 males and 6 females, aged (38±6) years. After debridement, the area of skin and soft tissue defects of extremities ranged 5.0 cm×4.0 cm to 19.0 cm×8.0 cm, and the area of thoracodorsal artery perforator flaps ranged 6.0 cm×5.0 cm to 20.0 cm×9.0 cm. The wounds in flap donor sites were closed directly. For patients in ultrasound-assisted group, the time and cost required for color Doppler ultrasound examination were recorded, and the number, type, and location of thoracodorsal artery perforator vessels detected by preoperative color Doppler ultrasound were compared with those of intraoperative actual detection. The time required for complete flap harvest of patients in 2 groups was recorded. On postoperative day (POD) 1, 3, 5, 7, and 14, the blood perfusion of flaps in the 2 groups of patients was assessed using a flap perfusion assessment scale. On POD 14, flap survival of patients in 2 groups was observed, and the percentage of flap survival area was calculated. In postoperative 6 months, satisfaction of patients with the treatment outcome in the 2 groups was assessed using 5-grade Likert scale, and the satisfaction rate was calculated. Results For patients in ultrasound-assisted group, the time required for preoperative color Doppler ultrasound examination was (10.5±2.3) min, and the cost was 120 yuan; 21 thoracodorsal artery perforator vessels were detected and marked using preoperative color Doppler ultrasound, including 8 (38.10%) type 1 perforator vessels, 10 (47.62%) type 2 perforator vessels, and 3 (14.29%) type 3 perforator vessels; the number, type, and location of thoracodorsal artery perforator vessels detected preoperatively were consistent with those detected intraoperatively. The time required for complete flap harvest of patients in ultrasound-assisted group was (41±10) min, which was significantly shorter than (63±12) min in control group ( t=6.32, P<0.05). On POD 1, 3, 5, 7, and 14, the blood perfusion scores of flaps of patients in ultrasound-assisted group were significantly better than those in control group (with t values of 6.67, 7.48, 8.03, 8.75, and 7.99, respectively P<0.05). On POD 14, only one patient in ultrasound-assisted group had partial flap necrosis and 6 patients in control group had complete or partial necrosis of the flap; the percentage of flap survival area of patients in ultrasound-assisted group was (99±8)%, which was significantly higher than (87±8)% in control group ( t=4.57, P<0.05). In postoperative 6 months, there was no significant difference in the satisfaction rate of patients with the treatment outcome between the two groups ( P>0.05). Conclusions Preoperative color Doppler ultrasound is highly accurate in detecting the number, type, and location of perforator vessels. The cutting scheme of ultrathin thoracodorsal artery perforator flaps can be designed according to the different types of perforator vessels, with shorted flap cutting time and improved flap survival rate.
- Wounds and injuries,
- Ultrasonography, Doppler, color,
- Perforator flap,
- Ultrathin flap,
- Wound repair

FullText(HTML)

References(21)

References

[1]	王晓峰,李学渊,丁文全,等.胸背动脉穿支皮瓣的显微解剖及临床应用[J].中华显微外科杂志,2020,43(5):481-485.DOI: 10.3760/cma.j.cn441206-20200528-00244.
[2]	刘安铭,欧昌良,周鑫,等.胸背动脉穿支皮瓣在修复手背软组织缺损中的临床应用[J].中华显微外科杂志,2020,43(2):176-178.DOI: 10.3760/cma.j.cn441206-20190609-00200.
[3]	江从航,王先成,李晓芳,等.带蒂胸背动脉穿支皮瓣整复腋窝中重度瘢痕挛缩畸形的效果[J].中华烧伤杂志,2020,36(6):480-483.DOI: 10.3760/cma.j.cn501120-20190322-00133.
[4]	ChimH,Cohen-ShohetRN,ChopanM,et al.Supine harvest of vascularised scapular bone grafts-anatomical study and clinical application[J].Injury,2022,53(3):1038-1043.DOI: 10.1016/j.injury.2021.11.031.
[5]	徐宏征,张书诺,章一新,等.红外热成像技术与彩色多普勒超声在股前外侧穿支皮瓣术前穿支血管探测中的比较[J].中华显微外科杂志,2021,44(4):388-391.DOI: 10.3760/cma.j.cn441206-20210319-00084.
[6]	HortaR,MachadoP,HortaP.Reconstruction of an axillary postburn scar contracture with a previously burned thoracodorsal artery perforator flap[J].Microsurgery,2023,43(1):91-92.DOI: 10.1002/micr.30989.
[7]	NatalwalaI,LeeCYV,KayS.The posterior approach to the thoracodorsal vessels for microsurgical free tissue transfer[J].JPRAS Open,2023,37:77-81.DOI: 10.1016/j.jpra.2023.06.010.
[8]	ThomasB,FalknerF,GazyakanE,et al.The conjoined latissimus dorsi and parascapular free flap for reconstruction of extensive soft tissue defects[J].Oper Orthop Traumatol,2023,35(3/4):205-222.DOI: 10.1007/s00064-023-00806-w.
[9]	武雷,丁英状,郝敏如,等.两种下腹部组织瓣修复四肢大面积皮肤软组织缺损后患者的腹部功能与外形[J].中华烧伤与创面修复杂志,2023,39(10):959-967.DOI: 10.3760/cma.j.cn501225-20230428-00145.
[10]	SteinA,AtlanM,HervochonR,et al.Reconstruction by thoracodorsal perforator flap after petrosectomy[J].Ann Chir Plast Esthet,2021,66(1):100-105.DOI: 10.1016/j.anplas.2020.04.003.
[11]	宋达疆,李赞,章一新,等.胸背动脉前锯肌支在带蒂背阔肌肌皮瓣移植乳房再造中的补救作用[J].中华整形外科杂志,2022,38(6):612-618.DOI: 10.3760/cma.j.cn114453-20210219-00070.
[12]	董凯旋,张俊裕,罗浩天,等.CT血管成像和彩色多普勒超声在腓动脉穿支皮瓣术前穿支评估的对比研究[J].中华显微外科杂志,2023,46(1):76-81.DOI: 10.3760/cma.j.cn441206-20220711-00143.
[13]	MayerHF,Piedra BuenaI,PetersenML.The value of preoperative computed tomography angiography (CT-A) in patients undergoing delayed latissimus dorsi flap breast reconstruction after axillary lymph node dissection or irradiation and suspicion of pedicle injury[J].J Plast Reconstr Aesthet Surg,2020,73(11):2086-2102.DOI: 10.1016/j.bjps.2020.08.096.
[14]	吴双江,王雷,刘一秀,等.CT血管成像及三维重建辅助设计与彩色多普勒超声在口腔癌术后缺损股前外侧皮瓣修复重建中的应用比较[J].中华整形外科杂志,2022,38(10):1102-1110.DOI: 10.3760/cma.j.cn114453-20210428-00189.
[15]	张凯,王栋,高廷益,等.彩色多普勒超声辅助下腹部浅动脉供血皮瓣修复颌面部软组织缺损[J].中华整形外科杂志,2019,35(12):1200-1204.DOI: 10.3760/cma.j.issn.1009-4598.2019.12.007.
[16]	SahovalerA,LowH,LaxagueF,et al.Variations of the thoracodorsal axis: application for scapular tip free flap harvesting[J].Oral Maxillofac Surg,2022,26(4):619-623.DOI: 10.1007/s10006-021-01037-8.
[17]	胡瑞斌,周丹亚,王欣,等.游离胸背动脉穿支皮瓣整复面部亚单位大面积瘢痕的临床效果[J].中华烧伤杂志,2020,36(7):586-589.DOI: 10.3760/cma.j.cn501120-20190505-00223.
[18]	黄广涛,魏在荣,黄丽,等.二纵三横法在胸背动脉穿支皮瓣穿支定位及深度创面修复中的临床应用效果[J].中华烧伤与创面修复杂志,2022,38(2):165-169.DOI: 10.3760/cma.j.cn501120-20201207-00519.
[19]	计鹏,曹涛,张智,等.扩张胸背动脉穿支皮瓣游离移植整复烧伤后颈部瘢痕挛缩畸形的临床效果[J].中华烧伤与创面修复杂志,2022,38(4):328-334. DOI: 10.3760/cma.j.cn501120-20211231-00426.
[20]	HomsyC,TheunissenT,SadeghiA.The thoracodorsal artery perforator flap: a powerful tool in breast reconstruction[J].Plast Reconstr Surg,2022,150(4):755-761.DOI: 10.1097/PRS.0000000000009576.
[21]	GattoA,ParisiP,BrambillaL,et al.Thoracodorsal artery perforator flap, muscle-sparing latissimus dorsi, and descending branch latissimus dorsi: a multicenter retrospective study on early complications and meta-analysis of the literature[J].J Plast Reconstr Aesthet Surg,2022,75(11):3979-3996.DOI: 10.1016/j.bjps.2022.06.083.

Relative Articles

[1]	Cai Weixia, Zheng Zhao, Liu Jiaqi, Liu Yang, Zhang Ting, Ji Peng, Tian Chenyang. Effect of rat platelet-rich plasma gel on autologous adipose-derived mesenchymal stem cells overexpressing glia-derived neurotrophic factor[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(12): 1176-1183. doi: 10.3760/cma.j.cn501225-20240408-00126
[2]	Chen Yiqi, Zhou Yingqian, Wei Qian, Xie Xiaoye, Liu Xinzhu, Li Dawei, Shen Chuan'an. Effects of gelatin methacrylate anhydride hydrogel loaded with small extracellular vesicles derived from human umbilical cord mesenchymal stem cells in the treatment of full-thickness skin defect wounds in mice[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(4): 323-332. doi: 10.3760/cma.j.cn501225-20231218-00248
[3]	Chen Lianglong, Yu Shengxiang, Ma Jun, Gao Yanbin, Yang Lei. Research progress of biomaterials in promoting wound vascularization[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(4): 381-385. doi: 10.3760/cma.j.cn501225-20220626-00261
[4]	Cao Tao, Xiao Dan, Ji Peng, Zhang Zhi, Cai Weixia, Han Chao, Li Wen, Tao Ke. Effects of exosomes from hepatocyte growth factor-modified human adipose mesenchymal stem cells on full-thickness skin defect in diabetic mice[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(11): 1004-1013. doi: 10.3760/cma.j.cn501225-20220731-00330
[5]	Liu Wenjian, Liu Dewu. Research advances on mesenchymal stem cell-derived extracellular vesicles in promoting angiogenesis of diabetic ulcers[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(4): 393-399. doi: 10.3760/cma.j.cn501120-20201207-00520
[6]	Tang Lijun, Zhang Xiaowei, Jin Junjun, Li Xiaomei, Xu Gang. Research advances on mechanism of exosomes derived from adipose derived stem cells in the treatment of chronic wounds[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(2): 191-195. doi: 10.3760/cma.j.cn501120-20200220-00076
[7]	Cao Xiaozan, Xie Ting, Lu Shuliang. Receptor pathways of glycated basic fibroblast growth factor affecting the proliferation and vascularization of human dermal microvascular endothelial cells[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(1): 17-24. doi: 10.3760/cma.j.cn501120-20200916-00412
[8]	Yang Qinxin, Wang Dali, Xu Guangchao, Deng Chengliang, Wei Zairong. Advances in the research of effects of epithelial-mesenchymal interaction on wound healing and scar formation[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(5): 405-410. doi: 10.3760/cma.j.cn501120-20190827-00362
[9]	Shi Chenshuo, Wang Dali, Sun Jin, Yang Qinxin, Wei Zairong, Deng Chengliang, Xu Guangchao, Huang Guangtao, Xiao Shun′e. Influence of human amniotic mesenchymal stem cells on macrophage phenotypes and inflammatory factors in full-thickness skin wounds of mice[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(4): 288-296. doi: 10.3760/cma.j.cn501120-20191120-00438
[10]	Lei Xiaoxuan, Xu Pengcheng, Zhang Lei, Pang Mengru, Tian Ju, Cheng Biao. Effects of human adipose-derived mesenchymal stem cells and platelet-rich plasma on healing of wounds with full-thickness skin defects in mice[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(12): 887-894. doi: 10.3760/cma.j.issn.1009-2587.2018.12.013
[11]	Zhou Wangbiao, Li Yeyang. Advances in the research of role of integrin-linked kinase in angiogenesis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2017, 33(5): 317-320. doi: 10.3760/cma.j.issn.1009-2587.2017.05.013
[12]	Shao Huawei, Wang Xin′gang, You Chuan′gang, Han Chunmao. Advances in the research of negative-pressure wound therapy inducing the vascularization of dermal substitute[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2017, 33(8): 523-525. doi: 10.3760/cma.j.issn.1009-2587.2017.08.019
[13]	Hu Dahai, Zhang Wei. To enhance study on translation and application of mesenchymal stem cells in wound repair[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2017, 33(1): 9-11. doi: 10.3760/cma.j.issn.1009-2587.2017.01.003
[14]	Effects of rat allogeneic adipose-derived stem cells on the early neovascularization of autologous fat transplantation[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2014, 30(6): 512-517. doi: 10.3760/cma.j.issn.1009-2587.2014.06.011
[15]	Liu Lingying, Chai Jiake, Yu Yonghui, Hou Yusen. Advances in the research of the role of mesenchymai stem cell in wound healing[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2014, 30(2): 134-137. doi: 10.3760/cma.j.issn.1009-2587.2014.02.008
[16]	ZHENG Shu-juan, JIA Chi-yu. Present status of research in bone marrow-derived mesenchymai stem cells for promoting the healing of diabetic ulcer[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2012, 28(4): 291-293. doi: 10.3760/cma.j.issn.1009-2587.2012.04.019
[17]	ZHANG Xiang-rong, LIU De-wu, GUO Guang-hua, PENG Yan, ZHONG Oing-ling. Experimental study on the transfection of human vascular endothelial growth factor 165 gene into human marrow mesenchymal stem cells[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2009, 25(4): 261-264.
[18]	WANG Su-yi, HAN Chun-mao, LAI Ping-ping, CEN Hang-hui. Study on differatiation of human mesenchymal stem cells into epidermal cells[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2007, 23(1): 66-68.
[19]	HAN Bing, FU Xiao-bing, HAN Bing, LEI Yong-hong, CHEN Wei, SUN Tong-zhu. Chemotactic effects of burn rat serum on mesenchymal stem cells derived from different sources[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2007, 23(1): 25-28.
[20]	GE Kui, LU Shu-liang, QING Chun, XIE Ting, RONG Liu, NIU Yi -wen, WANG Min-jun, LIAO Zhen-jiang, SHI Ji-xiang. The influence of L-arginine on angiogenesis in burn wounds in diabetic rats[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2004, 20(4): 210-213.

Supplements(0)

Cited By

Cited by
Periodical cited type(1)
1. 董鸿斐，黄茜，王张鹏，景光旭，史明，李先慧，孙红玉. 胎盘间充质干细胞对胰腺创伤大鼠的保护作用. 解放军医学杂志. 2024(04): 439-448 .
Other cited types(1)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(3) / Tables(2)

Get Citation

PDF

XML

Article Metrics

Article views (156) PDF downloads(18)

Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound

doi: 10.3760/cma.j.cn501225-20231012-00111

Abstract

References

Relative Articles

Cited by

Periodical cited type(1)

Other cited types(1)

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound

doi: 10.3760/cma.j.cn501225-20231012-00111

Abstract

References

Relative Articles

Cited by

Periodical cited type(1)

Other cited types(1)

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Export File

Citation

Format

Content