Parkville, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne.
Plast Reconstr Surg. 2012 Jul;130(1):130-134. doi: 10.1097/PRS.0b013e31824ecaff.
Perforator flap nomenclature continues to evolve, with many classification schemes reported. Each of them focuses on the fascial penetration pattern of perforators, which has no impact on flap perfusion. With the advent of advanced imaging technologies, the subcutaneous course of perforators can be highlighted for the first time, offering new insight into flap design.
The current study presents the authors' technique for imaging local perforator flaps with computed tomographic angiography, utilizing a standard technique for perforator imaging with computed tomographic angiogram, regardless of whether the flap is a local or free flap, and regardless of body region. This technique has been used in more than 1000 image-guided perforator flaps, with the current study highlighting three such cases in different body regions.
With the use of preoperative imaging, flap design can be based on the subcutaneous ramification of individual perforators. Several ramification patterns are presented and potential improvements to nomenclature schemes suggested.
: With the use of preoperative imaging, "image-guided" perforator flaps that are truly axial-pattern in terms of their arterial supply can be designed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic: V.
穿支皮瓣命名法不断发展，已有多种分类方案报道。它们中的每一种都侧重于皮穿支的筋膜穿透模式，而这对皮瓣灌注没有影响。随着先进成像技术的出现，穿支的皮下走行首次得到凸显，为皮瓣设计提供了新的视角。
本研究提出了应用 CT 血管造影术对局部穿支皮瓣进行成像的技术，该技术采用标准的 CT 血管造影术穿支成像技术，无论皮瓣是局部皮瓣还是游离皮瓣，也无论身体部位如何，均可应用该技术。该技术已应用于 1000 多个图像引导穿支皮瓣中，目前的研究强调了三个不同身体部位的此类病例。
应用术前影像学，可以根据单个穿支的皮下分支进行皮瓣设计。本文提出了几种分支模式，并对命名方案提出了潜在的改进建议。
应用术前影像学，可以设计出真正在动脉供应方面呈轴型模式的“影像引导”穿支皮瓣。
临床问题/证据水平：诊断，V 类。
