Bravo Francisco G, Schwarze Hardy P
Doce de Octubre University Hospital, Madrid, Spain.
J Plast Reconstr Aesthet Surg. 2009 May;62(5):602-8; discussion 609. doi: 10.1016/j.bjps.2008.11.086. Epub 2009 Jan 31.
Defect reconstruction according to the free-style concept applied to perforator flaps allows flap harvesting in any anatomical region where an audible Doppler signal of a perforator is detected. We report the results of a study in which local perforator flaps were selected for reconstruction in different anatomical areas and were harvested using the free-style concept.
During a 2-year period, defect coverage was carried out in 21 patients (n=21) in the following anatomical areas: cervical (n=3), sternal/parasternal (n=4), axillary (n=2), tibial (n=5), trochanteric (n=2) and sacral/gluteal (n=5). The mean age of patients (15 male and six female) was 57.8 years. Flap selection was based solely on preoperative Doppler mapping in areas adjacent to soft-tissue defects. The mean follow-up period was 1 year.
All flaps survived, demonstrating postoperatively acceptable aesthetic results with good patient satisfaction. The donor sites were closed primarily in 17 patients; four patients required skin grafting. Two patients required surgical revision due to flap-margin dehiscence. There was no loss of function at donor sites. Increased flap mobility could be achieved through extended perforator dissection. One perforator-based flaps offered the widest arc of rotation serving as propeller flaps. If more than one perforator vessel was preserved, flap mobility was limited, but still allowed sufficient flap movement either as a rotation or advancement flap or as a combination of both. A classification is proposed according to the number of perforator vessels preserved and to the type of flap movement.
The concept of free-style local perforator flaps represents a safe, versatile and reliable surgical procedure. It not only offers a greater freedom in flap selection but also provides good aesthetic results. The classification proposed might aid in the decision-making process involved in order to achieve adequate results with this procedure.
根据应用于穿支皮瓣的自由式概念进行缺损修复，可在检测到穿支可闻多普勒信号的任何解剖区域切取皮瓣。我们报告一项研究结果，该研究中选择局部穿支皮瓣用于不同解剖区域的修复，并采用自由式概念进行切取。
在2年期间，对21例患者（n = 21）的以下解剖区域进行了缺损覆盖：颈部（n = 3）、胸骨/胸骨旁（n = 4）、腋窝（n = 2）、胫骨（n = 5）、转子（n = 2）和骶骨/臀部（n = 5）。患者平均年龄为57.8岁（男性15例，女性6例）。皮瓣选择仅基于软组织缺损相邻区域的术前多普勒定位。平均随访期为1年。
所有皮瓣均存活，术后美学效果可接受，患者满意度高。17例患者的供区直接缝合；4例患者需要植皮。2例患者因皮瓣边缘裂开需要手术修复。供区无功能丧失。通过延长穿支解剖可增加皮瓣活动度。一个基于穿支的皮瓣作为推进皮瓣可提供最宽的旋转弧。如果保留多个穿支血管，皮瓣活动度受限，但仍可作为旋转皮瓣或推进皮瓣或两者结合进行足够的皮瓣移动。根据保留的穿支血管数量和皮瓣移动类型提出了一种分类方法。
自由式局部穿支皮瓣概念是一种安全、通用且可靠的手术方法。它不仅在皮瓣选择上提供了更大的自由度，而且美学效果良好。提出的分类方法可能有助于该手术获得满意效果的决策过程。
