Oki Kotoho, Murakami Masahiro, Tanuma Kumiko, Ogawa Rei, Ozawa Hitoshi, Hyakusoku Hiko
Tokyo, Japan From the Department of Plastic, Reconstructive and Aesthetic Surgery and the Department of Anatomy and Neurobiology, Nippon Medical School.
Plast Reconstr Surg. 2009 Jun;123(6):1789-1800. doi: 10.1097/PRS.0b013e3181a65ac3.
The authors have used pectoral intercostal perforator flaps to reconstruct burned or injured hands by staged transfer. This flap is designed with a narrow skin pedicle that includes intercostal perforators from the fifth to eighth intercostal spaces, with a wide flap area that lies on the upper abdomen. The distal area is thinned down to the subdermal vascular network level; thus, such flaps are called "superthin flaps" or subdermal vascular network flaps. In this article, the authors discuss the arterial networks associated with this flap and present clinical cases.
The authors performed an anatomical study using 13 cadavers to obtain angiograms and dissect the anterior chest and abdominal region. Clinically, the authors retrospectively analyzed 21 cases over 13 years.
Anatomically, the anterior intercostal regions could be divided into three segments with regard to vascular supply to the skin and subcutaneous layer. In particular, in the fifth to eighth intercostal spaces, perforators communicated with one another to form a "latticework" pattern. In addition, the vascular territories participating in the pectoral intercostal perforator flap, that is, the intercostal perforators, the superior epigastric artery system, and the deep inferior epigastric artery system, linked with each other through choke vessels. In the authors' clinical cases, functional and aesthetic results were satisfactory.
The pectoral intercostal perforator flap was supported by the arterial networks among perforators in the intercostal spaces and in the upper abdomen. This flap is one useful method for reconstruction of the hand region, providing good quality in terms of thinness and texture.
作者采用胸肋间穿支皮瓣通过分期转移来重建烧伤或受伤的手部。该皮瓣设计有一个狭窄的皮肤蒂，包含来自第五至第八肋间间隙的肋间穿支，皮瓣面积较大，位于上腹部。远端区域减薄至皮下血管网层面；因此，此类皮瓣被称为“超薄皮瓣”或皮下血管网皮瓣。在本文中，作者讨论了与该皮瓣相关的动脉网络并展示了临床病例。
作者使用13具尸体进行解剖学研究以获取血管造影图像并解剖前胸和腹部区域。临床上，作者回顾性分析了13年间的21例病例。
在解剖学上，就皮肤和皮下层的血供而言，肋间前区可分为三个节段。特别是在第五至第八肋间间隙，穿支相互连通形成“网格状”模式。此外，参与胸肋间穿支皮瓣的血管区域，即肋间穿支、腹壁上动脉系统和腹壁下动脉系统，通过吻合血管相互连接。在作者的临床病例中，功能和美学效果均令人满意。
胸肋间穿支皮瓣得到肋间间隙和上腹部穿支之间动脉网络的支持。该皮瓣是手部区域重建的一种有用方法，在薄度和质地方面具有良好质量。
