Hamdi Moustapha, Van Landuyt Koenraad, Hijjawi John B, Roche Nathalie, Blondeel Phillip, Monstrey Stan
Gent, Belgium From the Plastic Surgery Department, Gent University Hospital.
Plast Reconstr Surg. 2008 May;121(5):1632-1641. doi: 10.1097/PRS.0b013e31816c3bfa.
The thoracodorsal artery perforator flap is considered a technically difficult flap because of significant anatomical variations in perforator location. The authors' strategy to facilitate the harvest of these flaps includes careful preoperative mapping of perforators and a standardized planning and harvesting technique. The authors evaluated 99 pedicled thoracodorsal artery perforator flaps, with an emphasis on preoperative planning, surgical technique, and analysis of complications.
Between May of 2000 and October of 2006, 99 patients underwent pedicled thoracodorsal artery perforator flaps in the authors' department. Their charts and postoperative results were reviewed retrospectively.
A thoracodorsal artery perforator flap was harvested in 90 cases. The perforators were unsuitable in the other 10 flaps; therefore, a muscle-sparing technique was used (type I or type II). Unidirectional Doppler imaging was used exclusively in 92 percent of cases to map the perforator preoperatively. The average flap size was 20 x 8 cm. Average operative time for flap harvest was 80 minutes. Perforators were located at 8 to 13 cm from the axillary crease (average, 10.8 cm). Major flap necrosis occurred in one case (1 percent). Limited partial or palpable fat necrosis occurred in three cases (3 percent). Seroma formation was not encountered in any of the thoracodorsal artery perforator flaps or muscle-sparing thoracodorsal artery perforator type I flaps.
Careful preoperative perforator mapping and a standardized approach to flap planning and harvest can significantly reduce the difficulty of executing pedicled thoracodorsal artery perforator flaps.
由于穿支位置存在显著的解剖变异，胸背动脉穿支皮瓣被认为是一种技术难度较大的皮瓣。作者促进这些皮瓣切取的策略包括术前仔细标记穿支以及采用标准化的规划和切取技术。作者评估了99例带蒂胸背动脉穿支皮瓣，重点关注术前规划、手术技术及并发症分析。
2000年5月至2006年10月期间，作者所在科室有99例患者接受了带蒂胸背动脉穿支皮瓣手术。对他们的病历和术后结果进行了回顾性分析。
90例成功切取了胸背动脉穿支皮瓣。另外10例皮瓣的穿支不合适，因此采用了保留肌肉技术（I型或II型）。92%的病例仅使用单向多普勒成像在术前标记穿支。皮瓣平均大小为20×8cm。皮瓣切取的平均手术时间为80分钟。穿支位于距腋窝皱襞8至13cm处（平均10.8cm）。1例（1%）发生了严重皮瓣坏死。3例（3%）出现了局限性部分或可触及的脂肪坏死。在任何胸背动脉穿支皮瓣或保留肌肉的I型胸背动脉穿支皮瓣中均未出现血清肿形成。
术前仔细标记穿支以及采用标准化的皮瓣规划和切取方法可显著降低实施带蒂胸背动脉穿支皮瓣的难度。
