Clinical reliability of pedicled perforator flaps in the management of adult limb and trunk soft tissue sarcomas: Experience of two French expert centres
Research article published in Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2022)
Abstract
INTRODUCTION: Limb-sparing surgery combined with radiation has become the standard treatment for soft tissue sarcomas. Despite the many advantages of reconstruction procedures, such as muscle-sparing flap and local reconstruction, the use of pedicled perforator flaps remains non-consensual due to doubts about their reliability when associated with radiotherapy. This study evaluated their surgical reliability in reconstructive surgery for limb and trunk soft tissue sarcomas, in terms of healing time, wound disorders, and postoperative complications, regardless of radiation timing. PATIENTS AND METHODS: We realized a retrospective, observational, bi-center study (Cancer University Institute of Toulouse Oncopole, France and Bergonié Institute Bordeaux, France) and describes pedicled perforator flaps performed between January 2015 and January 2021. RESULTS: A total of 74 flaps were included. The median age of the population was 70-year-old. The group consisted of 68.8% (n = 51/74) propeller flaps. We found a partial necrosis rate of 28.4% (n = 21/74), scar disunion of 48.6% (n = 36/74), local infection of 10.8% (n = 8/74), and venous congestion of 13.5% (n = 10/74). Only 16.2% (n = 12/74) required secondary surgical repair to a local complication. The average length of stay was 7.3 days [1.0-25.0]. The mean operating time of our flaps was 133.4 min [38.0-280.0]. CONCLUSIONS: Pedicled perforator flaps are a surgical technique that can be used in reconstructive surgery for limb and trunk soft tissue sarcomas in adults, regardless of radiation timing. However, these flaps carry a high rate of postoperative complications so they should be reserved for expert surgeons in referral centers.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This retrospective, observational, two-center French study evaluated the surgical reliability of pedicled perforator flaps in 74 reconstructions for adult limb and trunk soft tissue sarcomas, reporting a venous congestion rate of 13.5% (n=10/74) alongside partial necrosis (28.4%), scar disunion (48.6%), and local infection (10.8%), and concluding these flaps are usable regardless of radiation timing but carry a high complication rate best handled at expert referral centers. For hirudotherapy, the relevance is indirect but concrete: venous congestion is precisely the failing-flap complication for which the medicinal leech is FDA-cleared in reconstructive microsurgery (K040187), so this study helps quantify how often that salvage scenario arises in a real flap cohort. The study did not use or assess leech therapy, and as a retrospective single-cohort series without a comparator it documents complication frequency rather than any treatment effect.
Citation
Clinical reliability of pedicled perforator flaps in the management of adult limb and trunk soft tissue sarcomas: Experience of two French expert centres.
Lafaye et al. · Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2022
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