Secondary Refinements of Free Perforator Flaps for Lower Extremity Reconstruction
Secondary Refinements of Free Perforator Flaps for Lower Extremity Reconstruction
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DOI：
10.1097/prs.0b013e3181f95b67
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发表时间：
2011-01-01
影响因子：
3.6
通讯作者：
Rodriguez, Eduardo D.
中科院分区：
文献类型：
--
作者：
Hui-Chou, Helen G.;Sulek, Jay;Rodriguez, Eduardo D.
背景：下肢重建的目标一直集中在早期伤口覆盖和功能恢复，但很少美学。游离肌瓣提供持久的覆盖;然而，它们需要皮肤移植物覆盖，并导致肌肉萎缩，限制了未来的翻修。基于穿支孔的皮瓣重建可以很容易地提升，以允许矫形和塑形手术。作者回顾了二次手术在改善穿支皮瓣修复下肢缺损后的功能和美学效果方面的作用。方法：回顾性分析了2002年至2009年在R亚当斯考利休克创伤中心治疗的70例患者，其中73例采用游离穿支皮瓣修复下肢伤口。结果：70例患者接受了穿支皮瓣重建：65例采用股前外侧皮瓣，5例采用旋髂浅动脉皮瓣。其中19例患者接受了32次重建肢体的改良手术。15例改良采用抽吸辅助脂肪切除术，21例采用复杂组织重排，包括尖锐减瘤，1例采用组织扩张器。70例患者中有27例接受了40例骨科相关的二次手术，其中游离皮瓣被抬高。骨科干预的最常见原因是胫骨骨不连需要植骨（n = 17）和骨髓炎（n = 11）。结论：保肢仍然是下肢重建的主要目标。然而，随着康复和功能恢复，外观对生活质量变得越来越重要。最初的皮瓣选择与自由穿支皮瓣，细致的嵌入，和二次完善提供了上级的功能和美学的结果。（Plast。重建127：248，2011）。
Background: The aim of lower extremity reconstruction has focused on early wound coverage and functional recovery but rarely aesthetics. Free muscle flaps provide durable coverage; however, they require skin graft coverage and result in muscle atrophy limiting future revisions. Perforator-based flap reconstructions can be easily elevated to allow for both orthopedic and contouring procedures. The authors reviewed the role of secondary procedures in achieving improved functional and aesthetic results following perforator flap reconstruction of lower extremity defects.Methods: A retrospective review identified 70 patients treated at R Adams Cowley Shock Trauma Center with 73 free perforator flaps for coverage of lower extremity wounds from 2002 to 2009.Results: Seventy patients were identified who underwent reconstruction with a perforator flap: 65 with anterolateral thigh flaps and five with superficial circumflex iliac artery flaps. Nineteen of these patients underwent 32 refinement procedures of the reconstructed limb. Fifteen refinements were performed with suction-assisted lipectomy, 21 with complex tissue rearrangement, including sharp debulking, and one with tissue expanders. Twenty-seven of the 70 patients underwent 40 orthopedic-related secondary procedures in which the free flap was elevated. The most common reasons for the orthopedic interventions were tibial nonunion requiring bone grafting (n = 17) and osteomyelitis (n = 11).Conclusions: Limb salvage remains the primary goal of lower extremity reconstruction. Following convalescence and functional recovery, however, appearance becomes increasingly important with regard to quality of life. Initial flap selection with free perforator flaps, meticulous inset, and secondary refinements provide superior functional and aesthetic outcomes. (Plast. Reconstr. Surg. 127: 248, 2011.)