Koshima I
Department of Plastic and Reconstructive Surgery, Okayama University Medical School, Japan.
Acta Med Okayama. 2001 Dec;55(6):329-32. doi: 10.18926/AMO/31999.
Recently, combined tissues or flaps have been used for the repair of extensively massive or wide defects resulting from radical wide resection. To further advance the development of combined tissue transfers, they should be reclassified. Based on our cases with free tissue transfers, we have created a new classification of combined flaps composed of "bridge", "chimeric", "siamese", "mosaic", and "chain-circle" flaps. The bridge flap is fabricated out together of separate flaps with short vascular pedicles. These form a compound flap supplied with a solitary vascular source. The chimeric flap is compounded from multiple different flaps but consists of only a single different tissue form. Each of the flaps is usually supplied by different branches from the same source vessel. It differs from the bridge flap in that the pedicle of each flap or tissue has some length for its movement for transfer. The siamese connected flap has 2 adjacent flaps that are simultaneously elevated, and a disparate vascular pedicle for each flap must be reestablished. This connected flap has double isolated pedicles. Themosaic connected flap consists of 2 adjacent flaps that are simultaneously elevated, and the pedicle of the distal flap is anastomosed to the pedicle branch of the proximal flap in the "bridge" fashion. The vascular pedicle of the proximal flap is anastomosed to a single vascular source. The chain-circle flap has 2 or more flaps like the bridge and chimeric flaps, and the distal end of the vascular source is anastomosed to the branch of the recipient vessel. Based on results with our patients, the lateral circumflex femoral system seems to be the most suitable candidate for the axial pedicle of these combined flaps, because the system has several branches of large and small caliber, and several tissue components, such as the vascularized ilium, rectus femoris muscle, gracilis muscle, lateral femoral cutaneous nerve, and fascia lata, are located nearby.
近来，联合组织或皮瓣已被用于修复根治性广泛切除术后产生的大面积或广泛缺损。为进一步推动联合组织移植的发展，应对其进行重新分类。基于我们的游离组织移植病例，我们创建了一种联合皮瓣的新分类，包括“桥接”、“嵌合”、“连体”、“镶嵌”和“链环”皮瓣。桥接皮瓣由带有短血管蒂的独立皮瓣共同构建而成。这些形成一个由单一血管源供血的复合皮瓣。嵌合皮瓣由多个不同皮瓣复合而成，但仅由单一不同组织形式组成。每个皮瓣通常由同一源血管的不同分支供血。它与桥接皮瓣的不同之处在于，每个皮瓣或组织的蒂有一定长度以便于转移移动。连体连接皮瓣有两个相邻皮瓣同时掀起，每个皮瓣必须重新建立不同的血管蒂。这种连接皮瓣有双独立蒂。镶嵌连接皮瓣由两个相邻皮瓣同时掀起，远端皮瓣的蒂以“桥接”方式吻合至近端皮瓣的蒂分支。近端皮瓣的血管蒂吻合至单一血管源。链环皮瓣有两个或更多皮瓣，类似于桥接和嵌合皮瓣，血管源的远端吻合至受区血管的分支。根据我们患者的结果，旋股外侧系统似乎是这些联合皮瓣轴型蒂的最合适选择，因为该系统有若干大、小口径分支，并且有几个组织成分，如带血管的髂骨、股直肌、股薄肌、股外侧皮神经和阔筋膜，位于附近。
