Clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors

Zhou Shuping; Zhang Dong; Wei Haili; Li Shimin; Chen Junjie; Li Sen; Shi Pancheng; Xing Xinfeng; Chang Chaonan; Shi Yingguang; Zheng Liwu; Wang Huanpeng; Gai Yuning

doi:10.3760/cma.j.cn501225-20250227-00096

Volume 42 Issue 7

Jul. 2026

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2026 > 42(7): 641-648

Zhou SP,Zhang D,Wei HL,et al.Clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors[J].Chin J Burns Wounds,2026,42(7):641-648.DOI: 10.3760/cma.j.cn501225-20250227-00096.

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Clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors

doi: 10.3760/cma.j.cn501225-20250227-00096

Department of Burn Plastic Surgery and Wound Healing, the 988th Hospital of the Joint Logistics Support Force of PLA, Zhengzhou 450007, China

Funds:

Medical Science and Technology Research and Development Plan Project of Henan Province of China LHGJ20240983

Optional Research Projects in Key Disciplines of the 988th Hospital of the Joint Logistics Support Force of PLA YNZX2025010

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Corresponding author: Li Shimin, Email: zsplovezyy@163.com
Received Date: 2025-02-27

Abstract

Abstract

Objective To investigate the clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh. Methods This study was a retrospective case series study. From June 2016 to June 2023, 12 patients (8 males and 4 females, aged 58 to 76 years) with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burn Plastic Surgery and Wound Healing of the 988^th Hospital of the Joint Logistics Support Force of PLA. In all patients, the depth of tumor invasion extended close to the major vessels and/or nerves. Radical extended resection of the tumors was performed, resulting in postoperative soft tissue defects ranging from 16 cm×13 cm to 37 cm×17 cm in size. A pedicled double-perforator flap of the inferior epigastric artery based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm×14 cm to 38 cm×18 cm. The flaps were transferred to the recipient site wound through a subcutaneous tunnel and sutured in place. Primary closure of the donor site wound was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first approximated with sutures to reduce its size, then covered with negative-pressure sealing drainage dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and wound healing of donor and recipient sites. Operative duration and length of hospital stay of patients were recorded. During follow-up after surgery, tumor recurrence, flap contour, and donor site scar were observed, and whether abdominal wall function was affected by the scar was assessed. Results All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Wounds in both donor and recipient sites healed successfully. Operative duration of patients ranged from 2.0 to 3.0 hours, and length of hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years after surgery, no local tumor recurrence was observed. Some flaps appeared slightly bulky, but their elasticity and texture showed no significant differences compared with the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function. Conclusions For soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh, the pedicled double-perforator flap of the inferior epigastric artery is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on aesthetics and function of the donor site.
- Perforator flap,
- Microsurgery,
- Skin neoplasms,
- Malignant complex wounds,
- Wound repair

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References(45)

References

[1]	RatushnyV, GoberMD, HickR, et al. From keratinocyte to cancer: the pathogenesis and modeling of cutaneous squamous cell carcinoma[J]. J Clin Invest, 2012,122(2):464-472. DOI: 10.1172/JCI57415.
[2]	HarwoodCA, ProbyCM, InmanGJ, et al. The promise of genomics and the development of targeted therapies for cutaneous squamous cell carcinoma[J]. Acta Derm Venereol, 2016, 96(1):3-16. DOI: 10.2340/00015555-2181.
[3]	郑大伟, 黎章灿, 裴广楠, 等. 显微修薄的股前外侧皮瓣在肢体肿瘤整形外科治疗中的应用[J].中华整形外科杂志,2024,40(6):626-633. DOI: 10.3760/cma.j.cn114453-20231222-00271.
[4]	TamaşC, PintilieCT, AtănăsoaeIV, et al. Surgical reconstruction of post-tumoral facial defects[J]. Rom J Morphol Embryol, 2018,59(1):285-291.
[5]	周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性[J].中国肿瘤,2001,10(12):694-695. DOI: 10.3969/j.issn.1004-0242.2001.12.009.
[6]	王宝云,肖向阳,郑德义,等.游离穿支皮瓣对前臂和手部电击伤创面的美学修复[J]. 中华整形外科杂志,2019,35(10):1004-1007. DOI: 10.3760/cma.j.issn.1009-4598.2019.10.011.
[7]	中华医学会皮肤性病学分会皮肤肿瘤研究中心, 中国医师协会皮肤科医师分会皮肤肿瘤学组. 皮肤鳞状细胞癌诊疗专家共识(2021)[J].中华皮肤科杂志,2021,54(8):653-664. DOI: 10.35541/cjd.20201140.
[8]	中华医学会皮肤性病学分会皮肤肿瘤研究中心, 中国医师协会皮肤科医师分会皮肤肿瘤学组. 皮肤基底细胞癌诊疗专家共识(2021)[J].中华皮肤科杂志,2021,54(9):757-764. DOI: 10.35541/cjd.20201139.
[9]	王臻, 王佳玉, 徐海荣, 等. 肢体软组织肉瘤临床诊疗专家共识的解读[J].临床肿瘤学杂志,2014,19(7):637-648.
[10]	茅剑强, 陈晓雯, 钱坚革. 局部旋转皮瓣和前臂皮瓣修复颌面部肿瘤术后皮肤缺损的临床效果分析[J].浙江创伤外科,2017,22(5):936-938. DOI: 10.3969/j.issn.1009-7147.2017.05.055.
[11]	夏成德, 雷豆豆. 癌性复杂创面的临床诊断与治疗策略[J].中华烧伤与创面修复杂志,2025,41(5):426-431. DOI: 10.3760/cma.j.cn501225-20250406-00166.
[12]	StratigosA, GarbeC, LebbeC, et al. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline[J]. Eur J Cancer, 2015,51(14):1989-2007. DOI: 10.1016/j.ejca.2015.06.110.
[13]	曹彤瑜, 杜伟力, 于东宁, 等. 大血管部位严重放射性溃疡的治疗策略[J].中华烧伤与创面修复杂志,2025,41(5):432-439. DOI: 10.3760/cma.j.cn501225-20240521-00191.
[14]	储国平, 蒋朝龙, 宣天梵, 等. 股动脉假性动脉瘤合并感染创面的处理策略[J].中华烧伤与创面修复杂志,2023,39(7):641-647. DOI: 10.3760/cma.j.cn501225-20221122-00501.
[15]	栾夏刚, 张伟, 张卫东, 等. 颈项部复杂创面的修复策略与临床效果[J].中华烧伤与创面修复杂志,2025,41(5):454-462. DOI: 10.3760/cma.j.cn501225-20241201-00471.
[16]	KimJM, KimSA, KwonHJ, et al. Reconstruction of radiation-induced ulcers with free flaps using the perforating vessel as a recipient vessel[J]. Microsurgery, 2019,39(7):613-620.DOI: 10.1002/micr.30504.
[17]	韩飞, 张万福, 佟琳, 等. 阔筋膜-股前外侧皮瓣复合移植修复颌面部根治性肿瘤切除术后复杂缺损的临床效果[J].中华烧伤与创面修复杂志,2025,41(5):440-446. DOI: 10.3760/cma.j.cn501225-20240801-00290.
[18]	杨力, 庞远翔, 薛君荣, 等. 基于显微外科技术的穿支皮瓣修复体表恶性肿瘤切除后继发创面[J].中华整形外科杂志,2021,37(8):856-862. DOI: 10.3760/cma.j.cn114453-20210303-00097.
[19]	孙向东, 李成志, 悟拉木·艾力, 等. 股前外侧穿支皮瓣移植修复头面颈部皮肤恶性肿瘤根治性切除后创面的临床效果[J].中华烧伤与创面修复杂志,2025,41(1):28-35. DOI: 10.3760/cma.j.cn501225-20240920-00341.
[20]	DaiZ, MaihemutiM, SunY, et al. Resection and reconstruction of huge tumors in the chest wall[J]. J Cardiothorac Surg, 2022, 17(1):116. DOI: 10.1186/s13019-022-01877-9.
[21]	柳若冰, 郑德义, 王宝云, 等. 股前外侧或股前内侧穿支皮瓣修复皮肤鳞状细胞癌切除后皮肤软组织缺损的临床效果[J].中华烧伤与创面修复杂志,2024,40(6):564-571. DOI: 10.3760/cma.j.cn501225-20231114-00193.
[22]	朱珊, 刘元波, 于胜吉, 等. 穿支螺旋桨皮瓣在四肢软组织恶性肿瘤切除后创面修复中的临床应用[J].中国修复重建外科杂志,2016,30(1):82-86. DOI: 10.7507/1002-1892.20160017.
[23]	王扬剑, 华祖广, 魏鹏, 等. 自由式穿支蒂螺旋桨皮瓣修复大腿皮肤软组织恶性肿瘤扩大切除后创面[J].中国修复重建外科杂志,2021,35(9):1177-1181. DOI: 10.7507/1002-1892.202104052.
[24]	HongJP, KwonJG, SuhHP, et al. The evolution of perforator flaps and the future of microsurgery[J].JPRAS Open,2025,47:33-42. DOI: 10.1016/j.jpra.2025.09.016.
[25]	HsiehHH, ShiehSJ. Reconstruction with flow-through chimeric anterolateral thigh flap combining vascularized fibular bone graft for extensive composite tissue defect of the forearm: a case report[J]. Ann Plast Surg, 2024, 92(1S Suppl 1):S65-S69.DOI: 10.1097/SAP.0000000000003758.
[26]	唐举玉. 特殊形式穿支皮瓣的临床应用教程[J].中华显微外科杂志,2013,36(2):201-205. DOI: 10.3760/cma.j.issn.1001-2036.2013.02.038.
[27]	唐举玉, 章伟文, 张世民, 等. 中国特殊形式穿支皮瓣的名词术语与定义专家共识[J].中华显微外科杂志,2013,36(2):113-114. DOI: 10.3760/cma.j.issn.1001-2036.2013.02.005.
[28]	中国抗癌协会皮肤肿瘤专业委员会. 皮肤恶性肿瘤组织缺损修复重建策略专家共识(2020)[J].中国肿瘤外科杂志,2020,12(2):93-99. DOI: 10.3969/j.issn.1674-4136.2020.02.001.
[29]	刘婷, 徐立斌. 皮肤鳞状细胞癌的诊疗现状及展望[J].中国医师进修杂志,2022,45(4):293-297. DOI: 10.3760/cma.j.cn115455-20211009-01200.
[30]	BoydJB, TaylorGI, CorlettR. The vascular territories of the superior epigastric and the deep inferior epigastric systems[J]. Plast Reconstr Surg, 1984,73(1):1-16. DOI: 10.1097/00006534-198401000-00001.
[31]	范启申, 王世明, 张尔坤, 等. 胸脐皮瓣的解剖研究与临床应用[J].中华显微外科杂志,1987,10(3):129-131. DOI: 10.3760/cma.j.issn.1001-2036.1987.03.101.
[32]	郑浩, 刘勇, 王丽丽, 等. 胸脐皮瓣联合腹部随意皮瓣修复儿童小腿大面积软组织缺损[J].中华显微外科杂志,2022,45(5):528-533. DOI: 10.3760/cma.j.cn441206-20220403-00066.
[33]	谢庆平, 穆籣, 刘元波, 等. 腹壁下动脉穿支皮瓣专家共识[J].中华显微外科杂志,2020,43(5):417-423. DOI: 10.3760/cma.j.cn441206-20200826-00331.
[34]	巨积辉, 李雷, 徐磊, 等. 双血供来源的超长胸脐联体穿支皮瓣修复前臂大面积皮肤缺损[J].中华显微外科杂志,2018,41(2):137-141. DOI: 10.3760/cma.j.issn.1001-2036.2018.02.009.
[35]	谢欣彤, 林栋材, 谢丽, 等. 双血管蒂腹壁下动脉穿支皮瓣在即刻乳房重建中的应用[J].中国现代手术学杂志,2023,27(5):356-360. DOI: 10.16260/j.cnki.1009-2188.2023.05.002.
[36]	李罡, 张志, 李叶扬, 等. 颈横动脉颈段皮支皮瓣修复颈部放射性溃疡的临床效果[J].中华烧伤杂志,2021,37(12):1116-1121. DOI: 10.3760/cma.j.cn501120-20200807-00371.
[37]	杜伟力, 沈余明, 程琳, 等. 乳腺癌根治术后胸部放射性溃疡的修复策略及其临床效果[J].中华烧伤与创面修复杂志,2024,40(6):521-528. DOI: 10.3760/cma.j.cn501225-20240315-00099.
[38]	YuD,ZhangS,MoW,et al.Transplantation of the stromal vascular fraction (SVF) mitigates severe radiation-induced skin injury[J].Radiat Res,2021,196(3):250-260.DOI: 10.1667/RADE-20-00156.1.
[39]	杨飞,谢卫国,张伟,等.放射性溃疡严重程度分型及临床治疗分析[J].组织工程与重建外科杂志,2022,18(1):62-66.DOI: 10.3969/j.issn.1673-0364.2022.01.015.
[40]	欧昌良, 罗旭超, 周鑫, 等. 游离腹壁下动脉穿支皮瓣联合旋髂浅动脉髂骨瓣修复足部复合组织缺损[J].中华显微外科杂志,2023,46(2):193-196. DOI: 10.3760/cma.j.cn441206-20220924-00201.
[41]	张月恒, 宋坤修, 刘小智, 等. 改良穿支体区CTA三维重建在股前外侧穿支皮瓣及腹壁下动脉穿支皮瓣中的应用[J].中华显微外科杂志,2022,45(5):521-527. DOI: 10.3760/cma.j.cn441206-20220319-00056.
[42]	于龙华,陈佳佳,高宅崧,等.CTA三维重建指导四肢软组织大面积缺损的游离皮瓣穿支定位及设计[J].实用医学杂志,2026,42(9):1662-1669.DOI: 10.3969/j.issn.1006-5725.2026.09.023.
[43]	YuL,JiangY,ZhangJ,et al.Three dimensional-CTA versus Doppler ultrasound for anterolateral thigh flap reconstruction in limb defects: a retrospective study[J].Plast Reconstr Surg Glob Open,2025,13(11):e7308.DOI: 10.1097/GOX.0000000000007308.
[44]	周树萍, 李士民, 石英光, 等. 并联组合血流桥接穿支皮瓣治疗伴血运障碍肢体环形热压伤的临床效果[J].中华烧伤与创面修复杂志,2024,40(7):665-672. DOI: 10.3760/cma.j.cn501225-20231201-00222.
[45]	宋达疆,李赞,章一新.带蒂腹直肌皮瓣联合游离腹壁下动脉穿支皮瓣移植重建胸壁巨大缺损的手术策略[J].组织工程与重建外科,2022,18(5):386-391.DOI: 10.3969/j.issn.1673-0364.2022.05.003.