Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2011 Nov;64(11):1483-9. doi: 10.1016/j.bjps.2011.06.019. Epub 2011 Jul 20.
Perforator flap surgery enables surgeons to tailor flaps to individual requirements with reduced donor-site morbidity. The technique allows better aesthetic results to be achieved in various fields of microsurgical reconstruction, but reports on aesthetic resurfacing and contour restoration of extremity deformities are sparse. The authors present their experience of elective reconstructions of established deformities in the extremities for aesthetic purposes using free perforator flaps. Aesthetic results were evaluated using a questionnaire and by photographic grading. From March 2006 to June 2010, 15 free flaps were transferred in 14 patients for aesthetic purposes to restore established skin and soft-tissue deformities in the extremities. Twelve flaps were transferred to lower extremities and three to upper extremities. After recreating tissue deficiencies, flaps were precisely designed and elevated with elaborate flap insetting and thickness control. Patient-assessment questionnaires were administered after surgery, and aesthetic results were evaluated using photographs by independent observers. Photographic gradings were assessed statistically using the generalised estimating equation. Eight deep inferior epigastric artery perforator free flaps and seven thoracodorsal artery perforator free flaps were used in the 14 patients. Flap sizes ranged from 8 × 14 to 14 × 38 cm, and all flaps survived well. The patient satisfaction rate was high, and aesthetic improvements were confirmed by conducting objective photographic evaluations. Statistically significant changes were detected during the photographic evaluation (p < 0.05). Secondary reconstruction using a customised free perforator flap to achieve aesthetic improvements is a valuable option for the restoration of established skin and soft-tissue deformities in the extremities.
穿支皮瓣手术使外科医生能够根据个体需求定制皮瓣，减少供区的发病率。该技术允许在各种显微重建领域获得更好的美学效果，但关于四肢畸形的美容表面重建和轮廓修复的报道很少。作者介绍了他们使用游离穿支皮瓣为美容目的选择性重建四肢已建立的畸形的经验。通过问卷调查和照片分级评估美学效果。从 2006 年 3 月至 2010 年 6 月，14 例患者共接受了 15 次游离皮瓣转移手术，用于修复四肢已建立的皮肤和软组织畸形，以达到美容目的。12 个皮瓣转移到下肢，3 个皮瓣转移到上肢。在重建组织缺损后，精确设计皮瓣，并进行精心的皮瓣插入和厚度控制。术后对患者进行问卷调查，由独立观察者通过照片评估美学效果。使用广义估计方程对照片分级进行统计学评估。在 14 例患者中使用了 8 个腹壁下动脉穿支游离皮瓣和 7 个胸背动脉穿支游离皮瓣。皮瓣大小为 8×14 至 14×38cm，所有皮瓣均存活良好。患者满意度高，通过进行客观的照片评估确认了美学改善。在照片评估中发现了统计学上显著的变化（p<0.05）。使用定制的游离穿支皮瓣进行二次重建，以实现美容改善，是修复四肢已建立的皮肤和软组织畸形的一种有价值的选择。
