Istanbul, Bursa, Diyarbakir, and Manisa, Turkey From the Department of Reconstructive and Aesthetic Surgery, Microsurgery, Faculty of Medicine, Bezmialem Vakif University; private practice; and the Departments of Plastic and Reconstructive Surgery of Dicle University Faculty of Medicine, Celal Bayar University Faculty of Medicine, Istanbul University Cerrahpasa Medical Faculty, Bakirkoy Acibadem Hospital, University of Acibadem, and Bezm-i Alem Valide Sultan Vakif Gureba Training and Research Hospital.
Plast Reconstr Surg. 2011 Sep;128(3):158e-165e. doi: 10.1097/PRS.0b013e318221ddd0.
Although thoracodorsal artery perforator flaps have not gained popularity in the reconstructive era, the results of recent studies regarding the vascularity of thoracodorsal artery perforator flaps are promising. In the present study, the authors aimed to determine the clinical outcomes of free multiple-perforator versus single-perforator thoracodorsal artery perforator flaps.
Eighty-seven patients with various defects underwent reconstruction with free thoracodorsal artery perforator flaps. The flap was used for upper extremity reconstruction in 43 patients (49.4 percent), for head and neck reconstruction in 16 patients (18.4 percent), and for lower extremity reconstruction in 28 patients (32.2 percent). Of the 87 flaps, 48 (55.2 percent) were based on a single perforator, whereas 39 flaps (44.8 percent) were based on multiple perforators. The single- and multiple-perforator-based thoracodorsal artery perforator flaps were compared regarding clinical outcomes and morbidity.
The morbidity rate was found to be significantly higher in the single-perforator-based group. Of the patients in the single-perforator group, seven patients had transient venous congestion, five were heparinized and treated with leeches for permanent venous congestion, six had partial necrosis, and one had total necrosis. In the multiple-perforator-based group, two patients had transient venous congestion, and no partial or total necrosis was observed.
Despite the fact that dominant perforators may often be absent, this study showed that a multiple-perforator-based thoracodorsal artery perforator flap may be more reliable with safe vascularity compared with a single-perforator-based flap.
尽管胸背动脉穿支皮瓣在重建时代并未普及，但最近有关胸背动脉穿支皮瓣血管分布的研究结果令人鼓舞。本研究旨在探讨游离多穿支与单穿支胸背动脉穿支皮瓣的临床效果。
87 例不同缺损患者采用游离胸背动脉穿支皮瓣进行重建。皮瓣用于上肢重建 43 例（49.4%），头颈部重建 16 例（18.4%），下肢重建 28 例（32.2%）。87 个皮瓣中，48 个（55.2%）基于单个穿支，39 个（44.8%）基于多个穿支。比较单穿支和多穿支胸背动脉穿支皮瓣的临床效果和并发症。
单穿支组的并发症发生率明显较高。单穿支组中，7 例患者出现短暂性静脉淤血，5 例患者因永久性静脉淤血而接受肝素化和水蛭治疗，6 例患者出现部分坏死，1 例患者出现完全坏死。多穿支组中，2 例患者出现短暂性静脉淤血，无部分或完全坏死。
尽管优势穿支可能经常不存在，但本研究表明，多穿支胸背动脉穿支皮瓣与单穿支皮瓣相比，可能具有更可靠的安全性和血管分布。
