Ahmad Quazi Ghazwan, Shankhdhar Vinay Kant
Plastic, Reconstructive and Microvascular Services, Tata Memorial Hospital, Mumbai, India.
Indian J Surg Oncol. 2010 Apr;1(2):120-4. doi: 10.1007/s13193-010-0025-7. Epub 2010 Nov 21.
The head and neck region is important both functionally and aesthetically and its reconstruction poses a formidable challenge for plastic surgeons. A perforator flap is a flap of skin or subcutaneous tissue supplied by a vessel that perforates the deep fascia to gain access to flap. With improvement in our knowledge of the anatomy of blood supply to the skin, the perforator flaps have opened a whole new horizon for the plastic surgeon to choose flaps with better function and cosmesis. The locally available perforators enable flaps to be designed with excellent match in tissue characteristics. Perforator flaps limit donor site morbidity and as they are islanded complete insetting is possible in a single stage. The principal perforator flaps such as facial artery perforator flap, platysma flap and its variant the submental flap and supra-clavicular artery flap used in the head and neck reconstruction are discussed. The more commonly used flaps are the free radial artery forearm flap and the anterolateral thigh flap while the novel ones are the thoracodorsal artery perforator flap, medial sural artery perforator flap and the toe-web flap for commissure reconstruction. The indications, reach and drawbacks of these flaps have been discussed in this review.
头颈部在功能和美学方面都很重要，其重建对整形外科医生来说是一项艰巨的挑战。穿支皮瓣是一种由穿过深筋膜以获取皮瓣血供的血管供应的皮肤或皮下组织皮瓣。随着我们对皮肤血液供应解剖学认识的提高，穿支皮瓣为整形外科医生选择功能和美容效果更好的皮瓣开辟了全新的视野。局部可用的穿支血管使皮瓣能够根据组织特征进行设计，实现极佳的匹配。穿支皮瓣减少了供区并发症，而且由于它们是岛状皮瓣，能够在一期完成完全植入。本文讨论了用于头颈部重建的主要穿支皮瓣，如面动脉穿支皮瓣、颈阔肌皮瓣及其变异体颏下皮瓣和锁骨上动脉皮瓣。更常用的皮瓣是游离桡动脉前臂皮瓣和股前外侧皮瓣，而新型皮瓣有胸背动脉穿支皮瓣、腓肠内侧动脉穿支皮瓣和用于口角重建的趾蹼皮瓣。本综述讨论了这些皮瓣的适应证、应用范围和缺点。
