Seoul, South Korea From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Plast Reconstr Surg. 2011 Sep;128(3):140e-150e. doi: 10.1097/PRS.0b013e318221dc3e.
Thoracodorsal artery perforator flaps are useful for covering extensive defects because of their generous donor-site dimensions. However, large flaps increase the risk of partial flap necrosis, and a reliable means of sizing thoracodorsal artery perforator flaps has not been devised. The authors reviewed a series of large thoracodorsal artery perforator flap transfers performed under various reconstructive conditions to evaluate surgical outcomes and placed emphasis on flap design and harvesting technique.
A consecutive series of large thoracodorsal artery perforator flaps (>20 cm long) performed between November of 2005 and March of 2010 were included in this study. Patient charts, operative records, and photographs were reviewed.
A total of 20 flaps with an average size of 25 × 11 cm in 20 patients were identified; the largest flap measured 32 × 13 cm. The average number of perforators included was 2.6 per flap (range, one to four). Four different harvesting techniques were used, depending on perforator numbers and locations. All large flaps survived without sizable partial flap necrosis. Complications included wound dehiscence in one donor and two recipient sites; all healed after wound repair. Tip necrosis of a small area developed but healed with conservative wound care.
This study reports the clinical safety of large thoracodorsal artery perforator flaps with customized thickness control, which can be reliably harvested beyond 20 cm in length by carefully considering perforator numbers and locations. To optimize tissue perfusion in these large flaps, effort is required to capture multiple perforators from various sources and to obtain an ideal arrangement.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
由于供区尺寸较大，胸背动脉穿支皮瓣在覆盖大面积缺损方面非常有用。然而，较大的皮瓣增加了部分皮瓣坏死的风险，并且尚未设计出可靠的胸背动脉穿支皮瓣测量方法。作者回顾了一系列在不同重建条件下进行的大型胸背动脉穿支皮瓣转移手术，以评估手术结果，并强调皮瓣设计和采集技术。
本研究纳入了 2005 年 11 月至 2010 年 3 月期间进行的一系列大型胸背动脉穿支皮瓣（>20cm 长）。回顾了患者的病历、手术记录和照片。
共确定了 20 例患者的 20 个皮瓣，平均大小为 25×11cm，最大皮瓣为 32×13cm。每个皮瓣平均包含 2.6 个穿支（范围为 1 至 4 个）。根据穿支数量和位置，采用了四种不同的采集技术。所有大型皮瓣均存活，无明显部分皮瓣坏死。并发症包括 1 个供区和 2 个受区的伤口裂开，均经伤口修复后愈合。小面积尖端坏死，但经保守伤口护理后愈合。
本研究报告了使用定制厚度控制的大型胸背动脉穿支皮瓣的临床安全性，通过仔细考虑穿支数量和位置，可以可靠地采集超过 20cm 长度的皮瓣。为了优化这些大型皮瓣的组织灌注，需要努力从不同来源捕获多个穿支，并获得理想的排列。
临床问题/证据水平：治疗，IV。
