Mardini Samir, Tsai Feng-Chou, Yang Jui-yung
Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, 252 Wu Hsing Street, Taipei 110, Taiwan.
Burns. 2004 Nov;30(7):729-38. doi: 10.1016/j.burns.2004.03.009.
Extensive burn injuries and subsequent scarring result in functional and aesthetic impairments. The use of free flaps in burn reconstructions provides superior outcomes especially when other, more conservative reconstructive methods fail and curtail efforts of relentless rehabilitation. Multiple chronic scar-associated problems and extensive acute burn defects are conventionally resolved by multiple procedures. Thus, two or extensive scar regions are typically reconstructed using two free flaps (double free flaps) in two separate, procedures utilizing two independent donor sites. This leads to a protracted course of repetitive operations, hospitalizations, and rehabilitation, causing a prolonged period of discomfort and disability. The definition of double free flaps is two independent free flaps with two sets of microanastomoses. This paper illustrates, via a case-series, that double free flaps could be performed in one procedure, with both flaps harvested from either one or two donor sites. Two flaps are then utilized to resolve one large or two problem areas at the same time. Revascularization of the flaps is achieved via either a sequential-link or independent-link microanastomoses. The advantages of harvesting double free flaps from one region and using them in one stage to reconstruct one or two defect area include: (1) providing a large area of soft, pliable skin from one region for re-surfacing burn injuries or resolving scar associated problems, (2) decreasing the treatment course and potential disability, (3) decreasing donor site morbidities, (4) increasing maneuverability and conformability of the flap, and (5) affording a better functional and aesthetic outcome.
大面积烧伤及随后的瘢痕形成会导致功能和美观受损。在烧伤重建中使用游离皮瓣可带来更好的效果，尤其是当其他更保守的重建方法失败且阻碍了持续康复努力时。多个与慢性瘢痕相关的问题和大面积急性烧伤缺损通常通过多次手术解决。因此，两个或多个瘢痕区域通常在两个独立的手术中使用两个游离皮瓣（双游离皮瓣）进行重建，这两个游离皮瓣取自两个独立的供区。这会导致漫长的重复手术、住院和康复过程，造成长时间的不适和残疾。双游离皮瓣的定义是带有两组显微吻合的两个独立游离皮瓣。本文通过一个病例系列说明，双游离皮瓣可以在一次手术中完成，两个皮瓣可取自一个或两个供区。然后使用两个皮瓣同时解决一个大的或两个问题区域。皮瓣的血管重建通过序贯连接或独立连接显微吻合实现。从一个区域获取双游离皮瓣并在一个阶段用于重建一个或两个缺损区域的优点包括：（1）从一个区域提供大面积柔软、柔韧的皮肤用于覆盖烧伤创面或解决与瘢痕相关的问题；（2）缩短治疗过程和潜在的残疾时间；（3）降低供区发病率；（4）增加皮瓣的可操作性和贴合性；（5）提供更好的功能和美观效果。
