Kim J T, Koo B S, Kim S K
Department of Plastic and Reconstructive Surgery, School of Medicine, Dong-A University, Busan, Korea.
Plast Reconstr Surg. 2001 Feb;107(2):374-82. doi: 10.1097/00006534-200102000-00012.
The authors present their experience with "thin" latissimus dorsi perforator-based free flaps for resurfacing defects. Perforator-based free flaps have been used for various kinds of reconstruction by presenting important donor structures. The thin latissimus dorsi perforatorbased free flap included only the skin and superficial adipose layer to reduce its bulkiness by dissection through the superficial fascial plane. This flap was used in 12 clinical cases, without flap necrosis or other serious postoperative complications. All of the patients were examined by preoperative power Doppler ultrasound in the spectral Doppler mode to search for the most reliable perforator. This noninvasive ultrasound technique determines the exact location and course of and ensures the reliable flow of the perforators; therefore, it greatly assists microsurgeons in saving operation time and in selecting the most suitable design for perforator flap reconstruction. We used perforators that were identified several centimeters from the lateral border of the latissimus dorsi muscle. The thin flap dimensions could be safely designed for flaps measuring up to 20 cm in length and 8 cm in width for primary closure of the donor site. Generally, a long pedicle is not required for resurfacing reconstructions, where small recipient arteries in the bed are acceptable for anastomosis with pedicles. However, pedicle dissection to the proximal vessels through the latissimus dorsi muscle was required when it was necessary to match the recipient vein for anastomosis. The authors conclude that this thin latissimus dorsi perforator-based free flap has great potential for resurfacing because of its constant thickness, easy elevation with the help of power Doppler ultrasound information, and proper flap size for moderate defects caused by scar contracture release, superficial tumor ablation, and so on.
作者介绍了他们使用基于背阔肌穿支的“薄”游离皮瓣修复缺损的经验。基于穿支的游离皮瓣通过保留重要的供区结构已被用于各种重建手术。基于背阔肌穿支的薄游离皮瓣仅包含皮肤和浅脂肪层，通过在浅筋膜平面进行解剖来减少其厚度。该皮瓣应用于12例临床病例，未出现皮瓣坏死或其他严重的术后并发症。所有患者术前均采用频谱多普勒模式的功率多普勒超声检查，以寻找最可靠的穿支。这种无创超声技术可确定穿支的确切位置和走行，并确保穿支的可靠血流；因此，它极大地帮助显微外科医生节省手术时间，并为穿支皮瓣重建选择最合适的设计。我们使用的穿支位于距背阔肌外侧缘几厘米处。薄皮瓣尺寸可安全设计，长度可达20 cm，宽度可达8 cm，以便一期关闭供区。一般来说，修复重建手术不需要长蒂，创面内较小的受区动脉可与蒂部吻合。然而，当需要匹配受区静脉进行吻合时，需要通过背阔肌向近端血管进行蒂部解剖。作者得出结论，这种基于背阔肌穿支的薄游离皮瓣因其厚度恒定、借助功率多普勒超声信息易于掀起以及对于瘢痕挛缩松解术、浅表肿瘤切除等所致中度缺损而言皮瓣大小合适，在修复方面具有巨大潜力。
