Ozkan Ozlenen, Ozkan Omer
Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey.
J Plast Reconstr Aesthet Surg. 2009 Sep;62(9):1202-4. doi: 10.1016/j.bjps.2007.12.091. Epub 2008 Jul 2.
We describe a simple and reliable technique for tunneling of the vascular pedicle of the free flap with a long pedicle, that may otherwise cause twisting and/or kinking of the pedicle. There are two modifications of the technique. In the cross-groin anastomosis modification, using a haemostat in a blunt manner, a suprapubic subcutaneous tunnel is created between two groin regions. The vascular pedicle of the flap is pulled and passed through this tunnel to the contralateral region. While the anastomoses are done on one site, the flap is inserted to the contralateral groin. In the second modification ('groin anastomosis-cross dorsum flap insert procedure'), the flap is transferred to the dorsum of the rat at approximately the same level of the groin. Using a haemostat, a large subcutaneous tunnel safe enough for the pedicle is created between the groin region and the rat dorsum lateral to the hip region. The anastomoses are done in the groin region, and the flap is inserted on the dorsum. This technique was used in 16 animals, with a free cutaneous maximus muscle musculocutaneous flap transfer based on the axillary vessels being done in eight animals; and a posterior thigh perforator-based flap based on the popliteal vascular pedicle in the remaining eight. Both groups had a pedicle length of approximately 4 cm, with a 100% survival rate. In conclusion, the technique is simple, reliable, and can be easily carried out without necessitating special procedures. It provides a straight course for the vascular pedicle with tension-free anastomosis by appropraitely adjusting the distance of the vascular anastomosis and flap insertion site.
我们描述了一种简单可靠的技术，用于游离皮瓣长蒂血管蒂的隧道化，否则可能导致血管蒂扭转和/或扭结。该技术有两种改进方法。在交叉腹股沟吻合改良法中，用止血钳钝性操作，在两个腹股沟区域之间创建一个耻骨上皮下隧道。将皮瓣的血管蒂牵拉并穿过该隧道至对侧区域。在一个部位进行吻合时，将皮瓣插入对侧腹股沟。在第二种改良法（“腹股沟吻合-交叉背部皮瓣插入法”）中，将皮瓣转移至大鼠背部大致与腹股沟同一水平处。用止血钳在腹股沟区域与大鼠背部髋部外侧之间创建一个对血管蒂足够安全的大皮下隧道。在腹股沟区域进行吻合，然后将皮瓣插入背部。该技术应用于16只动物，其中8只动物进行了基于腋血管的游离股薄肌肌皮瓣转移；其余8只进行了基于腘血管蒂的大腿后穿支皮瓣转移。两组血管蒂长度均约为4 cm，成活率均为100%。总之，该技术简单、可靠，无需特殊操作即可轻松实施。通过适当调整血管吻合和皮瓣插入部位的距离，可为血管蒂提供一条无张力吻合的直线路径。
