Innocenti M, Baldrighi C, Delcroix L, Adani R
Careggi University Hospital - Reconstructive Microsurgery Unit, Florence, Italy.
Handchir Mikrochir Plast Chir. 2009 Dec;41(6):315-21. doi: 10.1055/s-0029-1237357. Epub 2009 Dec 18.
The quality of reconstruction of soft tissue defects in the upper extremity, resulting either from traumatic injury or tumor excision, has relevant implications both from functional and aesthetic standpoints. Various local and free flaps with more or less consistent donor-site morbidity have been described in the past. The recent introduction of the perforator-based flap concept, has led to an evolution in upper extremity reconstruction, optimizing results at the recipient site whilst minimizing damage to the donor site and, performing this in the simplest way possible. In this study between 2001 and 2008, 31 patients having post-traumatic or post-tumor excision soft tissue defects of the upper limb, were treated using local perforator flaps raised according to two different modalities: "pedicled fasciocutaneous" and "transposition fasciocutaneous/cutaneous". Complete and stable coverage of the soft tissue losses was obtained in all cases with an inconspicuous, only aesthetic, donor-site defect. Superficial or partial necrosis of the tip of the flap, due to venous congestion, was observed in 2 cases of "pedicled fasciocutaneous flap". An additional surgical procedure was required in only one of these cases. In our series all 9 patients who had a transposition flap, underwent routinely a preoperative echo color Doppler investigation to identify the main perforators. In only one case did the Doppler investigation fail to accurately locate the perforator. Local perforator flaps allow the coverage of medium size defects in the upper extremity, can be raised with a relatively simple surgical technique, have a high success rate and good aesthetic results without functional impairment. In the light of this they can be considered among the surgical choices to resurface complex soft tissue defects of the upper extremity. Preoperative identification of the perforators in case of "transposition flaps" greatly facilitates the operation. In our experience echo color Doppler investigations provided reliable results.
上肢软组织缺损无论是由创伤性损伤还是肿瘤切除引起，其重建质量从功能和美学角度都具有重要意义。过去已经描述了各种供区发病率或多或少一致的局部和游离皮瓣。基于穿支皮瓣概念的近期引入，已导致上肢重建的发展，在优化受区结果的同时，将对供区的损伤降至最低，并以尽可能简单的方式进行。在这项2001年至2008年的研究中，31例上肢创伤后或肿瘤切除后软组织缺损患者，采用根据两种不同方式掀起的局部穿支皮瓣进行治疗：“带蒂筋膜皮瓣”和“转位筋膜皮瓣/皮瓣”。所有病例均获得了软组织缺损的完全且稳定的覆盖，供区缺损不明显，仅影响美观。在2例“带蒂筋膜皮瓣”中，观察到由于静脉淤血导致皮瓣尖端浅表或部分坏死。其中仅1例需要额外的手术操作。在我们的系列中，所有9例接受转位皮瓣的患者，均常规进行术前彩色多普勒超声检查以识别主要穿支。仅1例中多普勒检查未能准确定位穿支。局部穿支皮瓣可用于覆盖上肢中等大小的缺损，可通过相对简单的手术技术掀起，成功率高，美学效果好且无功能障碍。鉴于此，它们可被视为修复上肢复杂软组织缺损的手术选择之一。对于“转位皮瓣”，术前识别穿支极大地便利了手术操作。根据我们的经验，彩色多普勒超声检查提供了可靠的结果。
