Rome, Italy From the Plastic, Reconstructive, and Aesthetic Surgery Unit, Campus Bio-Medico of Rome University.
Plast Reconstr Surg. 2013 Aug;132(2):451-460. doi: 10.1097/PRS.0b013e3182958897.
Free-style local perforator flaps can be harvested from any region of the body where an appropriate and detectable perforator vessel is present. Their use allows the surgeon to perform a "like with like" reconstruction by mobilizing surrounding tissues on a consistent vascular source. The authors report their experience with V-Y free-style perforator flaps in reconstruction of soft-tissue defects subsequent to skin cancer excision.
Forty elective defects in different regions of the body were reconstructed with V-Y advancement local perforator flaps raised in a free-style fashion. There were 23 male patients and 17 female patients. Mean age at surgery was 63 years. All defects resulted from skin cancer ablation. Mean defect size was 5×3.7 cm. Mean flap dimensions were 8.8×4.2 cm. The flaps were based on one (n=10), two (n=18), or three (n=12) perforators.
Mean operative time was 93 minutes. Thirty-seven flaps (92.5 percent) healed uneventfully. In three flaps (7.5 percent), moderate venous insufficiency occurred, leading to partial flap necrosis that required surgical revision. In three cases (7.5 percent), the flap was converted to a rotation/hatchet perforator-based peninsular flap. Slight venous stasis was the most common postoperative finding registered (eight flaps; 20 percent). All flaps achieved adequate and durable reconstruction with excellent contour, with a follow-up ranging between 6 months and 2 years.
Free-style local perforator flaps advanced in V-Y fashion proved to be a valid and reliable solution to restore function and aesthetics of the operated site after skin cancer excision.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
游离式局部穿支皮瓣可从身体任何有合适且可探测穿支血管的部位获取。这些皮瓣的使用可以让外科医生通过利用一致的血管来源来移动周围组织，从而进行“以相似组织重建相似组织”的手术。作者报告了他们使用 V-Y 游离式穿支皮瓣修复皮肤癌切除后继发的软组织缺损的经验。
以游离式方式掀起 V-Y 推进式游离穿支皮瓣，对身体不同部位的 40 个择期缺损进行了重建。其中 23 例为男性，17 例为女性。手术时的平均年龄为 63 岁。所有缺损均由皮肤癌切除导致。平均缺损大小为 5×3.7cm。平均皮瓣尺寸为 8.8×4.2cm。皮瓣基于一个（n=10）、两个（n=18）或三个（n=12）穿支血管。
平均手术时间为 93 分钟。37 个皮瓣（92.5%）愈合顺利。在 3 个皮瓣（7.5%）中，出现中度静脉功能不全，导致部分皮瓣坏死，需要手术修正。在 3 例中（7.5%），皮瓣被转换为旋转/斧凿穿支半岛皮瓣。最常见的术后发现是轻微的静脉淤滞（8 个皮瓣；20%）。所有皮瓣均实现了足够且持久的重建，具有良好的轮廓，随访时间为 6 个月至 2 年。
V-Y 推进式游离式局部穿支皮瓣被证明是一种有效的、可靠的解决方案，可以在皮肤癌切除后恢复手术部位的功能和美观。
临床问题/证据水平：治疗性，IV。
