Park S, Han S H, Lee T J
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Plast Reconstr Surg. 1999 Jun;103(7):1937-48. doi: 10.1097/00006534-199906000-00019.
The proper selection of a recipient vessel is essential for the success of free tissue transfer, especially when the transfer is to the lower extremity. However, a general agreement on which vessel to use has not been reached yet. Conflicting data have been reported on the survival and outcome of the transferred flaps, depending on the vessel used or the location of anastomosis. The aim of this study was to identify the patterns and problems in the selection of recipient vessels for free tissue transfer to the lower extremity and to establish a general guideline for proper selection. From September of 1990 to December of 1997, 50 consecutive, microvascular, free tissue transfers were performed on the lower extremity. The causes requiring soft-tissue coverage included trauma (25), unstable scar (11), chronic osteomyelitis (7), and tumors (7). The mean follow-up period was 22.4 months (range, 2 to 41 months). In 25 cases, the posterior tibial vessel was used as the recipient vessel. The microvascular anastomosis was done proximal to the zone of injury in 45 cases. The two most important factors in the selection of a recipient vessel are the site of injury and the vascular status of the lower extremity. Less important factors include the flap to be used, method, and site of microvascular anastomosis. All the currently feasible options for recipient vessels are included, and the opinions of other surgeons are reviewed. A general guideline is established, and an algorithm for the proper selection of a recipient vessel is proposed. This algorithm is a fast and convenient guide for evaluating the wound and planning the free flap to the lower extremity.
对于游离组织移植的成功而言，合适的受区血管选择至关重要，尤其是当移植部位为下肢时。然而，关于使用何种血管尚未达成普遍共识。根据所使用的血管或吻合部位的不同，已报道了关于移植皮瓣存活及转归的相互矛盾的数据。本研究的目的是确定下肢游离组织移植受区血管选择的模式及问题，并建立合适选择的通用指南。1990年9月至1997年12月，对下肢连续进行了50例微血管游离组织移植。需要软组织覆盖的原因包括创伤（25例）、不稳定瘢痕（11例）、慢性骨髓炎（7例）和肿瘤（7例）。平均随访期为22.4个月（范围2至41个月）。25例中，使用胫后血管作为受区血管。45例微血管吻合在损伤区域近端进行。选择受区血管时两个最重要的因素是损伤部位和下肢的血管状况。不太重要的因素包括所使用的皮瓣、方法及微血管吻合部位。纳入了目前所有可行的受区血管选择方案，并回顾了其他外科医生的观点。建立了通用指南，并提出了合适选择受区血管的算法。该算法是评估伤口及规划下肢游离皮瓣的快速便捷指南。
