Başkent Üniversitesi Makaleler
Permanent URI for this collectionhttps://hdl.handle.net/11727/13096
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Item Delayed Perforator Flaps for Reconstruction of Extensive Defects of the Posterior Trunk(Başkent Üniversitesi, 2024-03) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cagri A. UysalABSTRACT OBJECTIVES: The delay phenomenon involves neovascularization of tissue after ischemic preconditioning. When employed, the delay phenomenon promotes flap survival and increases length-to-width ratio in conventional flaps. Although well-planned perforator flaps cover defects without tension, the success rate is unpredictable in extensive defects that are closed because of the unknown vascularity of perforasomes. We aimed to increase perforator flap size by utilizing the delay phenomenon for broad defects of posterior trunks. MATERIALS AND METHODS: Between 2019 and 2020, 10 patients (6 female, 4 male) underwent posterior trunk reconstruction with delayed perforator flaps. We retrospectively analyzed etiology, defect size, flap size and type, postoperative complications, and long-term results. The etiology of defects was meningomyelocele, soft tissue sarcoma, and pressure ulcers in 3, 3, and 4 patients, respectively. Defects were covered with delayed lumbar, intercostal, and thoracodorsal perforator flaps. Flaps were planned unilateral or bilaterally. Perforators were located preoperatively with a handheld Doppler. In the first session, delaying incisions and pedicle dissection were performed. The delayed incision was primarily sutured. Perforator flaps were elevated 1 week later, and defects were closed. RESULTS: Mean defect size was 375 cm2, and mean flap size was 420 cm2 (202-625 cm2). The donor site was closed primarily for 7 patients. Two patients required split-thickness skin grafts. One patient had donor site closed with secondary healing. No flap losses among patients were shown. Hematoma was seen in 2 patients in the immediate postoperative period. After 2 weeks, seroma and donor site dehiscence were shown in 2 and 1 patient, respectively. CONCLUSIONS: The delay phenomenon can be utilized in perforator flaps as in random pattern local flaps. Perforasome areas can be extended with delayed incision. In addition, broad defects of the posterior trunk can be safely covered with delayed perforator flaps.Item The Role of Pedicled Perforator Flaps in Burn Reconstruction(Başkent Üniversitesi, 2021-03) Burak Ozkan; Cem Aydogan; Cagri A. Uysa; Abbas Albayati; Nilgun Markal Ertas; Mehmet HaberalABSTRACT OBJECTIVES: Perforator arteries raised from muscles and intermuscular septum are generally protected in burn injuries. Thus, pedicled perforator flaps are considered more reliable than conventional flaps in burn reconstruction. The role of pedicled perforator flaps changes according to injury timing. In the acute phase of injury (first 21 days), pedicled perforator flaps are used to cover exposed neurovascular and musculoskeletal systems. In the late phase of burn injuries, they are used to correct burn-related complications such as contractures and persistent defects. In this study, we present our experience with pedicled perforator flaps in both the acute and chronic phases of burn injury. MATERIALS AND METHODS: Between 2017 and 2020, our center performed 25 pedicled perforator flap procedures in 20 patients (17 men/3 women) for burn injury reconstruction. Of the 25 total pedicled perforator flaps, 4 were utilized for acute defects and 21 were performed during the late phase of injury. In the acute phase, the main indication was to cover exposed vessels. In the late phase, 16 of the 21 flaps were used to cover defects (burn scar contracture release in axilla, neck, popliteal, and antecubital region), 2 were used to cover pressure ulcers due to prolonged hospitalization, and 2 were used for persistent defects in the extremities. RESULTS: Average age of patients was 34 years (range, 28-62 years). Our success rate with pedicled perforator flaps was 88%, with 2 total losses (1 supraclavicular artery perforator flap, 1 superior epigastric artery perforator flap) and 1 partial necrosis (superior gluteal artery perforator flap) encountered in the late phase in flap with 180-degree rotation arc. CONCLUSIONS: The role of pedicled perforator flaps vary depending on the timing of burn injuries. We found that pedicled perforator flaps were a reliable reconstruction option in both acute and late phases of burn injury.