Seoul, Korea; and Groningen, The Netherlands From the Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, and the Department of Plastic and Reconstructive Surgery, University Medical Center Groningen.
Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e408-e418. doi: 10.1097/PRS.0b013e3181bf844b.
Initial temporary vascular insufficiency of the perforator flap is confused with real flap ischemia or congestion during the initial period of reconstruction. Latissimus dorsi and thoracodorsal perforator flaps are no exception. Since a reliable perforator is not always consistent in its location or diameter, and recipient vessels may not always be healthy, the vascular pedicle is frequently spastic or the flap is readily congested. Risk factors were reviewed and several preparations were necessary.
In a preliminary study, 73 patients undergoing reconstruction with a latissimus dorsi or thoracodorsal perforator flap were retrospectively reviewed. Temporary flap congestion was observed in 10 patients (13.7 percent), and six risk factors were identified. To alleviate flap congestion, four supplementary measures were prepared for patients with risk factors: T-anastomosis for the flow dispersion, inclusion of an additional vein, inclusion of a supercharged perforator, and a muscle-sparing technique.
Flap congestion was observed in two of 32 patients (6.3 percent); there was no marginal necrosis. T-anastomosis was the most commonly prepared measure. An additional draining vein or a supercharged perforator was frequently used in large, thin, or relatively long flaps, and a muscle-sparing technique was used for flaps based on a less reliable perforator.
Perforator selection and careful dissection of the pedicle are required for successful reconstruction in latissimus dorsi or thoracodorsal perforator flaps. A perforator pedicle is more sensitive than a conventional flap, and flap congestion is a concern in patients with risk factors, even though most cases are relieved in time. To prevent congestion, the appropriate flap design with preparation of supplementary measures is recommended for better results when the flap is elevated.
穿支皮瓣在重建初期会出现暂时的血管供血不足，这种情况容易与皮瓣真正缺血或淤血相混淆。背阔肌和胸背穿支皮瓣也不例外。由于可靠的穿支在位置或直径上并不总是一致的，而且受区血管也并不总是健康的，所以血管蒂可能经常痉挛，或者皮瓣容易淤血。需要对危险因素进行评估，并做一些必要的准备。
在一项初步研究中，回顾性分析了 73 例行背阔肌或胸背穿支皮瓣修复的患者。10 例（13.7%）患者出现了暂时性皮瓣淤血，确定了 6 个危险因素。为了缓解皮瓣淤血，对有危险因素的患者准备了 4 项补充措施：T 型吻合以分散血流，包含额外的静脉，包含超量穿支，以及保留肌肉技术。
32 例患者中有 2 例（6.3%）出现皮瓣淤血；无边缘坏死。T 型吻合是最常用的准备措施。在较大、较薄或相对较长的皮瓣中，通常会使用额外的引流静脉或超量穿支，对于基于不太可靠穿支的皮瓣，会使用保留肌肉技术。
背阔肌或胸背穿支皮瓣成功重建需要选择合适的穿支，并仔细解剖蒂部。穿支蒂比传统皮瓣更敏感，有危险因素的患者皮瓣淤血是一个关注点，尽管大多数病例都能及时缓解。为了防止淤血，建议在皮瓣抬高时，根据皮瓣设计选择合适的补充措施，以获得更好的效果。
