Chimeric perforator flap with muscle flap for repairing refractory wounds with deep dead space

Objective To investigate the clinical effect of using chimeric perforator flap with muscle flap in repairing deep dead space of refractory wound. Methods From February 2015 to February 2019, 22 cases of refractory wounds with deep dead space were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of the PLA, including 17 males and 5 females, aged from 17 to 72 years old, with an average age of 36.4 years old. 6 cases were located in the plantar, 6 in the calf and ankle joints, 5 in the perineum, 2 in the elbow, 2 in the back and 1 in the orbit. Defect area ranged from 5 cm×4 cm to 16 cm×11 cm. Dead space ranged from 3 cm×2 cm to 10 cm×4 cm. 14 cases were repaired with free transplantation of anterolateral femoral chimeric perforator flap, 5 cases with anterolateral femoral chimeric perforator flap, 1 case with peroneal artery chimeric perforator flap, 1 case with superficial peroneal artery chimeric perforator flap, and 1 case with posterior tibial artery chimeric perforator flap. Results In the 22 cases of this group, the flap area ranged from 6 cm×5 cm to 17 cm×12 cm, and the muscle flap area ranged from 3 cm×2 cm to 10 cm×4 cm. One case of refractory wound repaired by superficial peroneal artery perforator chimeric flap was poorly healed in the margin of the flap, which was healed by skin grafting in the second stage after dressing change. One case of refractory wound repaired by anterolateral femoral chimeric perforator flap presented subcutaneous sinus after surgery. The wound was healed after dressing change and debridement. All the other 20 cases survived well. The patients were followed up for 3-18 months, and the appearance and function of the wound were recovered satisfactorily. Conclusions In the chimeric perforator flap with muscle flap, the muscle flap filled up the dead space and the flap covered the wound on body surface at the same time, which is one of the good methods to repair the refractory wound with deep dead space. Key words: Perforator flap; Surgical flaps; Reconstructive surgical procedures; Wound healing