Chaput B, Gandolfi S, Ho Quoc C, Chavoin J-P, Garrido I, Grolleau J-L
Plastic and reconstructive surgery unit, faculty of medicine, university Toulouse Rangueil, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
Plastic and reconstructive surgery unit, faculty of medicine, university Toulouse Rangueil, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
Ann Chir Plast Esthet. 2014 Feb;59(1):65-9. doi: 10.1016/j.anplas.2013.05.004. Epub 2013 Jul 24.
In recent years, perforator flaps have become an indispensable tool for the reconstruction process. Most recently, "propeller" perforator flaps allow each perforator vessels to become a flap donor site. Once the perforator of interest is identified by acoustic Doppler, the cutaneous or fascio-cutaneous island is designed and then customized according to the principle of "perforasome". So, the flap can be rotated such a propeller, up to 180°. Ideally the donor site is self-closing, otherwise it can be grafted at the same time. Through a skin necrosis secondary to a contrast medium extravasation of the cubital fossa in a 47-year-old man, we describe the use of propeller perforator flap based on a perforator of the radial collateral artery (RCAP). The perforator was identified preoperatively by acoustic Doppler then the flap was adapted bespoke to cover the loss of substance. Ultimately, the result was very satisfying. Well experienced for lower-extremity reconstruction, perforator-based propeller flap are still few reported for upper limb. It is likely that in the future, propeller flap supersede in many indication not only free flaps and locoregional flaps but also, leaving no room for uncertainties of the vascular network, the classic random flaps.
近年来，穿支皮瓣已成为重建过程中不可或缺的工具。最近，“螺旋桨”穿支皮瓣使每个穿支血管都能成为皮瓣供区。一旦通过超声多普勒确定了感兴趣的穿支，就根据“穿支体”原则设计并定制皮肤或筋膜皮岛。这样，皮瓣就可以像螺旋桨一样旋转，角度可达180°。理想情况下，供区可自行闭合，否则可同时进行植皮。通过一名47岁男性因肘窝造影剂外渗继发皮肤坏死的病例，我们描述了基于桡侧副动脉（RCAP）穿支的螺旋桨穿支皮瓣的应用。术前通过超声多普勒确定穿支，然后定制皮瓣以覆盖组织缺损。最终，结果非常令人满意。穿支蒂螺旋桨皮瓣在下肢重建方面经验丰富，但在上肢的报道仍较少。未来，螺旋桨皮瓣很可能在许多适应症中取代游离皮瓣和局部皮瓣，而且由于不存在血管网的不确定性，还会取代经典的随意皮瓣。
