Practical considerations for perforator flap thinning procedures revisited.
Practical considerations for perforator flap thinning procedures revisited.
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DOI：
10.5999/aps.2014.41.6.693
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发表时间：
2014-11
期刊：
影响因子：
--
通讯作者：
Rezkini P
中科院分区：
文献类型：
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作者：
Prasetyono TO;Bangun K;Buchari FB;Rezkini P
薄穿支皮瓣是修复创面的最佳方法之一。这项研究旨在重新审视和进一步检验快速发展的襟翼稀疏技术领域。我们进行了两项身体研究，以测试已知的皮瓣变薄方法，然后将这些方法应用于临床系列。在第一项研究中，5具身体通过注入彩色乳胶溶液，观察了穿支与真皮下神经丛和皮下脂肪层的解剖关系。第二项研究是在独立于第一项研究的四具身体上进行的。最后，对15例患者进行了临床系列研究。解剖10支股前外侧穿支(ALT)、7支腹壁下深动脉穿支(DIEAP)和6支胸背动脉穿支(TAP)的乳晕脂肪小叶，以彩色血管模式为导向，减少皮瓣厚度。术后ALT、DIEAP和TAP平均分别减少到32.76%±9.76%、37.01%±9.21%和35.42%±9.41%。在第二项研究中，6例ALT、6例TAP和4例MSAP皮瓣直接剥离乳晕脂肪小叶，其平均厚度分别减少53.41%±5.64%、52.30%±2.88%和47.87%±6.41%。15例患者中13例疗效满意，平均厚度减少37.91%±7.15%。这些多项研究表明，可以安全地去除深层脂肪层，以获得薄而可行的穿支皮瓣。这一证据表明，宏观襟翼减薄技术可以实现较薄的襟翼。外科医生在接受最新的超显微外科技术之前，应该考虑这项技术。
A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients. The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%. These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.