SOVREMENNAYA PEDIATRIYA.2017.7(87):90-97; doi 10.15574/SP.2017.87.90

O.A. Zhernov, Kitri Mohammed, A.O. Zhernov, S.V.Staskevich
Shupyk National Medical Academy of Postgraduate Education, Kуiv, Ukraine
Kyiv City Clinical Hospital №2, Ukraine

Introduction. Post-burn total or subtotal scar lesions of the skin in the lower limb lead to static-dynamic disorders, lympho-venous outflow disturbances, and increased pressure in the fascia-muscle sheath, the appearance of ulcers in the joints and the disorders of growth of bones and muscles in children.

The aim of the work is to improve the results of surgical treatment of children with post-burn deformities of the thigh in different areas by using extended expanded flaps on the basis of perforator vessels.

Materials and methods. The work is based on a study of 12 patients (10 females and 2 males) aged from 6 to 18 years (average age — 13.0 years). All patients underwent a reconstruction of cicatricial defects with 28 preexpanded thigh flaps were used on the basis of perforator vessels depending on the anatomical site. Flaps were formed from the tissues of the outer, inner and posterior surfaces of the thigh.

Results and discussion. The possibility of the formation of expanded joint flaps in different zones of the thigh on the basis of their own perforator vessels is shown. which made it possible to obtain a sufficient quantity of plastic material with similar tissue features to those of the defect.

Conclusions. The use of joined expanded flaps on the basis of perforator vessels in different parts of the thigh allowed to obtain good ((10(66.7%) and 8(72.7%)) and satisfactory ((5(33.3%) and 3(27.3%)) results of treatment respectively, in the nearest and distant periods.

Key words: subtotal cicatricial deformation of the thigh, perforator flaps, perforator vessels, tissue expansion.

References

1. Zhernov ОА et al. (2017, jul). Application of extended combined perforative occipito-cervical flaps post-burn contracture of the neck. Klinicheskaia khirurgiia. 4: 49-51. ISSN 2522-1396. https://hirurgiya.com.ua/index.php/journal/article/view/87

2. Zhernov OA, Zhernov AO. (UA). (2012). Pat. 73769, UA, MPK A61V 17/58, A61V 17/88. Sposib ocinky rezul`tativ operatyvnogo likuvannya rubcevyx deformacij ta kontraktur. Zayavnyk ta patentovlasnyk DU «Instytut gematologiyi ta transfuziologiyi NAMN Ukrayiny» (UA). (Ukr). N0. u201202734; zayavl. 06.03.12; opubl. 10.10.12, Byul. No.19.

3. Hsieh C-H, Yang J Ch-Sh, Chen Ch-Ch et al. (2009). Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available. Head Neck 31: 571–575. https://doi.org/10.1002/hed.20995. https://www.ncbi.nlm.nih.gov/pubmed/19132721

4. Barbour JR, Schweppe M. (2008, Jul). Lower-extremity burn reconstruction in the child. J Craniofac Surg. 19(4): 976-88. https://doi.org/10.1097/SCS.0b013e318175f35a. https://www.ncbi.nlm.nih.gov/pubmed/18650720

5. Fernandez–Riera R, Hung Sh-Yu, Wu JCh-W et al. (2017).  Free profunda femoris artery perforator flap as a first-line choice of reconstruction for partial glossectomy defect. Head Neck. 39: 737–743. https://doi.org/10.1002/hed.24675; PMid:28032690. http://onlinelibrary.wiley.com/doi/10.1002/hed.24675/full

6. Gharb BB, Salgado CJ, Moran SL et al. (2011, Feb). Free anterolateral thigh flap in pediatric patients. Ann Plast Surg. 66(2): 143-7. https://doi.org/10.1097/SAP.0b013e3181e35e38. https://www.ncbi.nlm.nih.gov/pubmed/21178758

7. Hallock GG. (2006, May). The Development of the Medial Circumflex Femoral Artery Perforator (MCFAP). Flap. Semin Plast Surg. 20(2): 121–126. https://doi.org/10.1055/s-2006-941719. https://www.researchgate.net/publication/47253085_The_Development_of_the_Medial_Circumflex_Femoral_Artery_Perforator_MCFAP_Flap

8. Hudson DA. (2004, Jan). Maximising the use of tissue expanded flaps. Br J Plast Surg. 56(8): 784-790. https://doi.org/10.1016/S0007-1226(03)00379-5. https://www.researchgate.net/publication/9011431_Maximising_the_use_of_tissue_expanded_flaps_Br_J_Plast_Surg_56_784-790

9. Kim JT, Kim WK. (2015, May). Perforator Flap versus Conventional Flap. J Korean Med Sci. 30(5): 514–522. https://doi.org/10.3346/jkms.2015.30.5.514

10. Lee MJ, Yun IS, Rah DK, Lee WJ. (2012, Jul) Lower Extremity Reconstruction Using Vastus Lateralis Myocutaneous Flap versus Anterolateral Thigh Fasciocutaneous Flap. Arch Plast Surg. 39(4): 367–375. https://doi.org/10.5999/aps.2012.39.4.367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408283/

11. Masia J, Moscatiello F, Pons G et al. (2007). Our Experience in Lower Limb Reconstruction With Perforator Flap Ann Plast Surg. 58: 507-512. doi: 10.1097/0 l.s"p.0000239841.47088.a5. http://www.clinicaplanas.com/files/0001/planas1212b127y128ytty775737219/web.system/assets/contents/cientificos/our_experince_in_lower_limb_reconstruction_with_perforator_flaps.pdf

12. Park CW, Miles BA. (2011). The expanding role of the anterolateral thigh free flap in head and neck reconstruction. Head and Neck Surgery, 19: 263–268. https://doi.org/10.1097/MOO.0b013e328347f845. https://www.ncbi.nlm.nih.gov/pubmed/21900855

13. Rifaat MA, Gawad WSA. (2005, Sep). The Use of Tensor Fascia Lata Pedicled Flap in Reconstructing Full Thickness Abdominal Wall Defects and Groin Defects Following Tumor Ablation. Journal of the Egyptian Nat. Cancer Inst. 17; 3: 139-148. http://www.nci.cu.edu.eg/Journal/Sept2005/CAN_1.pdf

14. Saint-Cyr M, Wong C, Schaverien M et al. (2009, Nov). The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 124(5): 1529-44. https://doi.org/10.1097/PRS.0b013e3181b98a6c. https://www.ncbi.nlm.nih.gov/pubmed/20009839

15. Ayad WM, Al-Shahat OA, Ehab ZE et al. (2011, Jan). The Versatility of the Medial Thigh Flap for Reconstruction of Post-Fournier’s Gangrene Complex Perineoscrotal Defects. Egypt J Plast Reconstr Surg. 35; 1: 129-132. http://www.esprs.org/Content/Journals/351_17.pdf

16. Vuksanovic-Bozaric A, Radojevic N, Muhovic DM et al. (2014). Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping. Folia Morphol. 74; 3: 389–395. http://onlinelibrary.wiley.com/doi/10.1002/hed.24675/full; https://doi.org/10.5603/FM.2015.0060; PMid:26339822

17. Wagh MS, Dixit V. (2013, May-Aug). Tissue expansion: Concepts, techniques and unfavourable results. Indian J Plast Surg. 46(2): 333–348. doi 10.4103/0970-0358.118612. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901915/; https://doi.org/10.4103/0970-0358.118612

18. Yasir M, Wani A.H, Zargar HR. (2017, Jan). Perforator Flaps for Reconstruction of Lower Limb Defects. World J Plast Surg. 6(1): 74-81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339613/; PMid:28289617 PMCid:PMC5339613