New York, N.Y.; and New Orleans, La. From the Department of Plastic Surgery, New York University Langone Medical Center, and the Division of Plastic Surgery, Louisiana State University Health Sciences Center.
Plast Reconstr Surg. 2012 Jan;129(1):16e-23e. doi: 10.1097/PRS.0b013e3182363d9f.
The use of perforator flaps has allowed for the transfer of large amounts of soft tissue with decreased morbidity. For breast reconstruction, the deep inferior epigastric perforator flap, the superior and inferior gluteal artery perforator flaps, and the transverse upper gracilis flap are all options. The authors present an alternative source using posterior thigh soft tissue based on profunda artery perforators, termed the profunda artery perforator flap.
Preoperative imaging helps identify posterior thigh perforators from the profunda femoris artery. These are marked, and an elliptical skin paddle, approximately 27 × 7 cm, is designed 1 cm inferior to the gluteal crease. Dissection proceeds in a suprafascial plane until nearing the perforator, at which point subfascial dissection is performed. The flap has a long pedicle (approximately 7 to 13 cm), which allows more options when performing anastomosis at the recipient site. The long elliptical shape of the flap allows coning of the tissue to form a more natural breast shape.
All profunda artery perforator flaps have been successful. The donor site is well tolerated and scars have been hidden within the gluteal crease. Long-term follow-up is needed to evaluate for possible fat necrosis of the transferred tissue.
The authors present a new technique for breast reconstruction with a series of 27 flaps. This is an excellent option when the abdomen is not available because of the long pedicle, muscle preservation, ability to cone the tissue, and hidden scar.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
穿支皮瓣的应用允许转移大量软组织，同时降低发病率。对于乳房重建，可以选择使用深部下腹壁穿支皮瓣、臀上和臀下动脉穿支皮瓣以及横行股薄肌皮瓣。作者提出了一种基于股深动脉穿支的后大腿软组织的替代来源，称为股深动脉穿支皮瓣。
术前影像学有助于识别来自股深动脉的后大腿穿支。对这些穿支进行标记，设计一个大约 27×7cm 的椭圆形皮瓣，位于臀褶线下 1cm 处。在浅筋膜平面进行解剖，直到接近穿支，此时进行筋膜下解剖。皮瓣有一个较长的蒂（大约 7 到 13cm），这使得在受体部位进行吻合时可以有更多的选择。皮瓣的长椭圆形形状允许组织的锥形化，以形成更自然的乳房形状。
所有股深动脉穿支皮瓣均成功。供区耐受性良好，疤痕隐藏在臀褶内。需要长期随访以评估转移组织的可能脂肪坏死。
作者提出了一种新的乳房重建技术，共进行了 27 例皮瓣。由于长蒂、肌肉保留、组织锥形化的能力以及隐藏的疤痕，当腹部不可用时，这是一个极好的选择。
临床问题/证据水平：治疗性，V。
