[Clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors].

Objective: To investigate the clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh. Methods: This study was a retrospective case series study. From June 2016 to June 2023, 12 patients (8 males and 4 females, aged 58 to 76 years) with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burn Plastic Surgery and Wound Healing of the 988th Hospital of the Joint Logistics Support Force of PLA. In all patients, the depth of tumor invasion extended close to the major vessels and/or nerves. Radical extended resection of the tumors was performed, resulting in postoperative soft tissue defects ranging from 16 cm×13 cm to 37 cm×17 cm in size. A pedicled double-perforator flap of the inferior epigastric artery based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm×14 cm to 38 cm×18 cm. The flaps were transferred to the recipient site wound through a subcutaneous tunnel and sutured in place. Primary closure of the donor site wound was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first approximated with sutures to reduce its size, then covered with negative-pressure sealing drainage dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and wound healing of donor and recipient sites. Operative duration and length of hospital stay of patients were recorded. During follow-up after surgery, tumor recurrence, flap contour, and donor site scar were observed, and whether abdominal wall function was affected by the scar was assessed. Results: All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Wounds in both donor and recipient sites healed successfully. Operative duration of patients ranged from 2.0 to 3.0 hours, and length of hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years after surgery, no local tumor recurrence was observed. Some flaps appeared slightly bulky, but their elasticity and texture showed no significant differences compared with the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function. Conclusions: For soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh, the pedicled double-perforator flap of the inferior epigastric artery is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on aesthetics and function of the donor site.