垂直腹直肌肌皮瓣转移至游离腓骨瓣用于全骶骨切除术重建。
Vertical rectus abdominis musculocutaneous flow-through flap to a free fibula flap for total sacrectomy reconstruction.
机构信息
Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
出版信息
Microsurgery. 2013 Jan;33(1):32-8. doi: 10.1002/micr.21990. Epub 2012 Mar 31.
PURPOSE
The purpose of this report of a small series was to describe the technique of total sacrectomy reconstruction using a pedicled vertical rectus abdominis musculocutaneous (VRAM) flow-through flap anastomosed to a free fibula flap.
METHODS
We reviewed all consecutive total sacrectomy reconstructions performed from 2009 to 2011. Surgical technique and patient outcomes were assessed.
RESULTS
Total sacrectomy reconstructions included three two-stage and three-stage VRAM flow-through flap to free fibula flap patients all of which ambulated by discharge. Flap survival was 100%. Pelvic ring defects were reconstructed with A-frame fibula flap struts anastomosed to the distal epigastric vessels of pedicled trans-pelvic VRAM flaps. Complications such as wound healing, infection or hardware failure were not observed. Bony union occurred at an average 2.7 ± 0.6 months.
CONCLUSIONS
Total sacrectomy reconstruction using a VRAM flow-through flap anastomosed to a two-strut free fibular flap allows initial assessment of the recipient vessels during the first and ensuing operative stages, satisfies the bone and soft tissue requirements of the defect, and provides a durable, functionally optimized reconstruction.
目的
本小型系列报告的目的是描述使用带蒂垂直腹直肌肌皮瓣（VRAM）血流通过吻合游离腓骨瓣进行全骶骨切除术重建的技术。
方法
我们回顾了 2009 年至 2011 年期间连续进行的所有全骶骨切除术重建。评估了手术技术和患者结果。
结果
全骶骨切除术重建包括三个两期和三个三期 VRAM 血流通过瓣至游离腓骨瓣患者，所有患者均在出院时可行走。皮瓣存活率为 100％。骨盆环缺损采用 A 形腓骨瓣支柱与带蒂跨骨盆 VRAM 瓣的远端上腹血管吻合重建。未观察到伤口愈合、感染或硬件失败等并发症。骨愈合发生在平均 2.7 ± 0.6 个月。
结论
使用 VRAM 血流通过瓣吻合双支柱游离腓骨瓣进行全骶骨切除术重建可在第一和随后的手术阶段期间对受者血管进行初步评估，满足缺损的骨和软组织要求，并提供持久、功能优化的重建。
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