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An anatomical study of the lymph-collecting vessels of the medial thigh and clinical applications of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative indocyanine green (ICG) lymphography.
- Source :
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Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2020 Sep; Vol. 73 (9), pp. 1768-1774. Date of Electronic Publication: 2020 May 19. - Publication Year :
- 2020
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Abstract
- Background and Objectives: The profunda femoris artery perforator (PAP) flap is gaining popularity in microsurgical reconstruction. The complications that can occur after the PAP flap harvest include donor-site lymphedema, seroma, or cellulitis. The aim of this study was to evaluate and establish a safer technique for the elevation of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative ICG lymphography. In this article, we also evaluate the anatomical relationship between the PAP flap and lymph-collecting vessels.<br />Methods: From July of 2018 to January of 2019, 24 patients with soft tissue defects after tumor resection underwent reconstruction using PAP flaps. The lymph-collecting vessels at the medial thigh area were identified using pre- and intraoperative ICG lymphography. A PAP flap was elevated taking care not to damage lymph-collecting vessels. After flap elevation, the anatomical correlation between lymph-collecting vessels and the anterior edge of the gracilis muscle was measured. The postoperative complications were assessed.<br />Results: PAP flaps survived completely in all cases. In all cases, using intraoperative ICG lymphography, surgeons confirmed that the lymph-collecting vessels in the medial thigh region were left intact. There were no donor site complications such as lymphedema, lymphorrhea, or cellulitis.<br />Conclusion: The elevation technique of an LpPAP flap is effective in reducing the risk of damage to lymph-collecting vessels, and thus reducing chances of postoperative lymphorrhea or iatrogenic lower limb lymphedema.<br /> (Copyright © 2020. Published by Elsevier Ltd.)
Details
- Language :
- English
- ISSN :
- 1878-0539
- Volume :
- 73
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of plastic, reconstructive & aesthetic surgery : JPRAS
- Publication Type :
- Academic Journal
- Accession number :
- 32475738
- Full Text :
- https://doi.org/10.1016/j.bjps.2020.03.023