Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps
Background:. Free flaps have evolved from musculocutaneous flaps to perforator-based cutaneous flaps. The subdermal plexus is now thought to play a significant role in skin paddle perfusion. We propose a new concept, the “intradermal plexus,” allowing survival of dermis flaps, according to our study...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2019-11-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002411 |
| _version_ | 1818292422246924288 |
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| author | Hidehiko Yoshimatsu, MD Akitatsu Hayashi, MD Takumi Yamamoto, MD Giuseppe Visconti, MD Ryo Karakawa, MD Yuma Fuse, MD Takuya Iida, MD |
| author_facet | Hidehiko Yoshimatsu, MD Akitatsu Hayashi, MD Takumi Yamamoto, MD Giuseppe Visconti, MD Ryo Karakawa, MD Yuma Fuse, MD Takuya Iida, MD |
| author_sort | Hidehiko Yoshimatsu, MD |
| collection | DOAJ |
| description | Background:. Free flaps have evolved from musculocutaneous flaps to perforator-based cutaneous flaps. The subdermal plexus is now thought to play a significant role in skin paddle perfusion. We propose a new concept, the “intradermal plexus,” allowing survival of dermis flaps, according to our study.
Methods:. A dermis flap was used in 6 cases to reconstruct small defects. The superficial branch of the superficial circumflex iliac artery was traced distally using an ultrasound device with a 70-MHz linear array transducer until the artery’s branch entered the dermis. The location of the dermis entry site was marked and the vessels running inside the dermis were observed and video-recorded. A flap was elevated above the superficial fascia, and the adipose tissue was removed using scissors after confirmation of the vessels’ dermis entry point.
Results:. The use of 70-MHz ultrasonography permitted observation in all patients of small arteries entering the dermis layer. The artery was observed to give off branches after entering the dermis, in effect constituting an “intradermal plexus.” Small veins entering the dermis were similarly visualized using 70 MHz ultrasonography. All flaps survived completely.
Conclusions:. Small arteries and veins entering and running inside the dermis were visualized for the first time with 70 MHz real-time ultrasonography. Knowledge of the existence of this “intradermal plexus” made it possible to discard nearly all subdermal adipose tissue quickly and safely, without resorting to the elaborate measures described in previous reports. |
| first_indexed | 2024-12-13T02:59:42Z |
| format | Article |
| id | doaj.art-c023904b07504dd9b87453165d1c0a65 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-13T02:59:42Z |
| publishDate | 2019-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-c023904b07504dd9b87453165d1c0a652022-12-22T00:01:52ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742019-11-01711e241110.1097/GOX.0000000000002411201911000-00031Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator FlapsHidehiko Yoshimatsu, MD0Akitatsu Hayashi, MD1Takumi Yamamoto, MD2Giuseppe Visconti, MD3Ryo Karakawa, MD4Yuma Fuse, MD5Takuya Iida, MD6From the *Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan†Department of Breast Center, Kameda Medical Center, Chiba, Japan‡Center Hospital of National Center for Global Health and Medicine, Plastic and Reconstructive Surgery, Tokyo, Japan§Department of Plastic and Reconstructive Surgery, Università Cattolica del “Sacro Cuore,” University Hospital “A. Gemelli,” Rome, ItalyFrom the *Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan‡Center Hospital of National Center for Global Health and Medicine, Plastic and Reconstructive Surgery, Tokyo, Japan¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.Background:. Free flaps have evolved from musculocutaneous flaps to perforator-based cutaneous flaps. The subdermal plexus is now thought to play a significant role in skin paddle perfusion. We propose a new concept, the “intradermal plexus,” allowing survival of dermis flaps, according to our study. Methods:. A dermis flap was used in 6 cases to reconstruct small defects. The superficial branch of the superficial circumflex iliac artery was traced distally using an ultrasound device with a 70-MHz linear array transducer until the artery’s branch entered the dermis. The location of the dermis entry site was marked and the vessels running inside the dermis were observed and video-recorded. A flap was elevated above the superficial fascia, and the adipose tissue was removed using scissors after confirmation of the vessels’ dermis entry point. Results:. The use of 70-MHz ultrasonography permitted observation in all patients of small arteries entering the dermis layer. The artery was observed to give off branches after entering the dermis, in effect constituting an “intradermal plexus.” Small veins entering the dermis were similarly visualized using 70 MHz ultrasonography. All flaps survived completely. Conclusions:. Small arteries and veins entering and running inside the dermis were visualized for the first time with 70 MHz real-time ultrasonography. Knowledge of the existence of this “intradermal plexus” made it possible to discard nearly all subdermal adipose tissue quickly and safely, without resorting to the elaborate measures described in previous reports.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002411 |
| spellingShingle | Hidehiko Yoshimatsu, MD Akitatsu Hayashi, MD Takumi Yamamoto, MD Giuseppe Visconti, MD Ryo Karakawa, MD Yuma Fuse, MD Takuya Iida, MD Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps Plastic and Reconstructive Surgery, Global Open |
| title | Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps |
| title_full | Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps |
| title_fullStr | Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps |
| title_full_unstemmed | Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps |
| title_short | Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps |
| title_sort | visualization of the intradermal plexus using ultrasonography in the dermis flap a step beyond perforator flaps |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002411 |
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