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Volume 41 Issue 12
Dec.  2025
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2025  >  41(12): 1192-1200
Zhong S,Liu LF,Wang YP,et al.Clinical efficacy of free lower abdominal conjoined perforator flap transplantation in repairing the extensive soft tissue defects in extremities[J].Chin J Burns Wounds,2025,41(12):1192-1200.DOI: 10.3760/cma.j.cn501225-20250127-00043.
Citation: Zhong S,Liu LF,Wang YP,et al.Clinical efficacy of free lower abdominal conjoined perforator flap transplantation in repairing the extensive soft tissue defects in extremities[J].Chin J Burns Wounds,2025,41(12):1192-1200.DOI: 10.3760/cma.j.cn501225-20250127-00043.
shu

Clinical efficacy of free lower abdominal conjoined perforator flap transplantation in repairing the extensive soft tissue defects in extremities

doi: 10.3760/cma.j.cn501225-20250127-00043
  • 1.

    Department of HandFoot and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China

  • 2.

    Department of Hand and Foot Surgery and Repair and Reconstruction of the Ward, Shandong Public Health Clinical Center, Jinan 250100, China

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    Abstract
  •   Objective  To investigate the clinical efficacy of free lower abdominal conjoined perforator flap transplantation in repairing the extensive soft tissue defects in extremities.  Methods  This study was a retrospective observational study. From May 2021 to March 2024, 9 patients with extensive soft tissue defects in extremities meeting the inclusion criteria were admitted to two hospitals, including 6 cases in Shandong Provincial Hospital Affiliated to Shandong First Medical University and 3 cases in Shandong Public Health Clinical Center. There were 6 male patients and 3 female patients, aged 34 to 66 years. After the wound infection was controlled, the areas of soft tissue defects in the upper extremities ranged from 30 cm×10 cm to 45 cm×18 cm, and those in the lower extremities ranged from 32 cm×12 cm to 40 cm×9 cm. The wounds in 8 patients were repaired with lower abdominal conjoined perforator flaps. In one patient with an excessively large wound area, the wound was repaired using a lower abdominal conjoined perforator flap combined with a full-thickness skin graft prepared from avulsed skin. The flap harvest areas were 30 cm×10 cm to 45 cm×13 cm for repairing the wounds in the upper extremities, and those were 32 cm×12 cm to 40 cm×9 cm for repairing the wounds in the lower extremities. Most wounds in the abdominal donor sites could be directly sutured in stage Ⅰ. If there was high local tension, the wounds were repaired by transplanting the "dog-ear" soft tissue or replanting the avulsed skin, or temporarily covered with negative pressure materials and closed in stage Ⅱ after tension relief. The carried blood vessels of the flaps and anastomosis methods of the blood vessels were recorded. Postoperatively, the flap survival (including the occurrence of vascular crisis) and the wound healing in the donor sites were observed. During follow-up, the appearance, texture, and sensory recovery of the flaps, as well as the occurrence of scars and complications in the donor sites were observed. At the last follow-up, the 5-grade Likert scale was used to investigate the satisfaction of patients with the treatment effects in the recipient and donor sites.  Results  The flaps carried bilateral superficial branch of the superficial circumflex iliac artery (SCIA-SB) and superficial inferior epigastric artery (SIEA) in 4 patients, the flaps carried unilateral SCIA-SB and bilateral SIEA in two patients, and the flaps carried bilateral SCIA-SB and unilateral SIEA in three patients. In one patient, there was a vascular defect of approximately 3 cm in length at the planned anastomosis site, an ipsilateral dorsal pedal vein was used for bridging anastomosis; the blood vessels in the donor and recipient sites were directly anastomosed in the remaining patients. Postoperatively, the flaps survived smoothly, without vascular crisis. Postoperatively, the wounds in the donor sites healed well in 7 patients; the wound in the donor site of one patient had high tension after surgery but healed after stage Ⅱ skin grafting; one patient had abdominal suture dehiscence after surgery and healed after dressing changes. Except for one patient who was lost to follow-up, the remaining 8 patients were followed up for 12 to 24 months. The flaps had a soft texture without swelling or ulceration, and protective sensation was recovered in all patients. Only mild scars remained in the abdominal donor site, without complications such as abdominal hernia. At the last follow-up, the satisfaction scores of patients with the treatment effects in the recipient and donor sites were 4-5 (with the mean score of 4.6) and 4-5 (with the mean score of 4.2), respectively.  Conclusions  The lower abdominal conjoined perforator flaps can be used to repair extensive soft tissue defects in extremities. The postoperative appearance and function of the recipient sites are good; most wounds in the donor sites can be sutured directly, and only mild scars are left after wound healing, which has little impact on the appearance and function of the donor sites; patients are satisfied with the treatment effect of the donor and recipient sites.

     

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