Effect of perforator flap with preserved Choke vessel area in repairing the defect induced by tumor removal

Abstract

Objective To explore the clinical significance of protection " Choke vessel area" in the application of perforator flap to repair large defect of trunk after tumor resection. Methods A total of 62 patients (38 males and 24 females, aged from 19 to 79 years) from the Department of Plastic Surgery, Second Affiliated Hospital of Suzhou University underwent reconstructive surgery for large area defects of the trunk from March 2012 to January 2016. The perforator flap was designed according to the perforator location detected by Doppler before surgery. The flaps were harvested on the pedicle of perforators and dissected on the deep layer of deep fascia (including part of the myolemma). The areas of flap ranged from 5.0 cm × 10.0 cm to 19.0 cm × 22.0 cm. The donor site was sutured directly or local flap was transferred to repair. Results Flaps survived well in 59 of the 62 cases. The tip of flap was necrotic and healed after dressing change in 1 diabetic patient. The distal part of flap was necrotic on cuticular layer and healed after dressing change in another patient with scrotal defect. One patient had flap necrosis 10 days after operation and was repaired twice. The results were satisfied after following-up from 3 months to 2 years for 17 cases and from 6 months to 2 years for 25 cases. Fibrosarcoma protuberant and squamous cell carcinoma recurred in 1 case each, but the function and appearance were satisfactory after primary repair. Conclusions The procedure of preserving Choke vessel area can improve the blood supply of perforator flap and obtain larger survival area and survival quality. It is worthy of clinical application. Key words: Neoplasms; Defects; Body surface area; Free-style perforate flap; Choke vessel; Survival quality