Istanbul Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul University, Istanbul, Turkey.
Microsurgery. 2014 Mar;34(3):188-96. doi: 10.1002/micr.22184. Epub 2013 Sep 13.
This study addresses the "pre-expanded perforator flap concept" by demonstrating a case series of relevant reconstructive procedures and evaluate the perforator vessel diameter changes that happen during the pre-expansion procedure.
Fourteen patients were treated with 15 flaps. One patient was treated with two pre-expanded internal mammary artery perforator flaps. In other cases, thoracodorsal, circumflex scapular, lumbar, intercostal, lateral circumflex femoral, and deep inferior epigastric artery perforator flaps were used. Technical details and rate of complications were noted. Evaluations of the flap pedicles were done both by hand held Doppler and by color Doppler ultrasound (CDU).
Flaps successfully served to resurface and release thick and rigid broad scar tissues and contractures in 11 of relevant 12 patients (in one patient with 50% flap loss, adequate contracture release could only be obtained with addition of a secondary split thickness skin graft to the residual flap) and provided a good source of tissue for anterior neck reconstruction of one patient and penis reconstruction of another patient. In six patients, perforator artery diameters were measured by CDU both before and after the expansion process and a significant increase secondary to the pre-expansion procedure was detected (Pre-expansion mean: 0.48 ± 0.08 mm; post-expansion mean: 0.65 ± 0.10 mm; P < 0.05). Flaps as large as 30 × 20 cm were harvested. Totally three partial flap necroses were experienced in 15 flap procedures.
Suprafascial pre-expansion of the perforator flaps seems to provide a solution to achieve broader and thinner perforator flaps with larger perforator arteries.
本研究通过展示一系列相关重建手术案例，提出了“预扩张穿支皮瓣概念”，并评估了预扩张过程中穿支血管直径的变化。
14 名患者接受了 15 个皮瓣的治疗。1 名患者接受了两个预扩张的内乳动脉穿支皮瓣治疗。在其他情况下，使用了胸背动脉、旋肩胛动脉、腰动脉、肋间动脉、外侧旋股动脉和腹壁下动脉穿支皮瓣。记录了技术细节和并发症发生率。通过手持多普勒和彩色多普勒超声（CDU）对皮瓣蒂进行了评估。
11 名相关患者中的 11 名（1 名患者有 50%皮瓣坏死，仅通过向残余皮瓣添加二次断层皮片才能获得充分的挛缩松解），皮瓣成功地用于覆盖和释放厚而僵硬的广泛瘢痕组织和挛缩，为 1 名患者的颈部前区重建和另 1 名患者的阴茎重建提供了良好的组织来源。在 6 名患者中，通过 CDU 在预扩张前后测量了穿支动脉直径，发现由于预扩张过程而导致显著增加（预扩张平均：0.48 ± 0.08mm；扩张后平均：0.65 ± 0.10mm；P < 0.05）。最大可以采集 30×20cm 的皮瓣。在 15 个皮瓣手术中，共有 3 例出现部分皮瓣坏死。
穿支皮瓣的皮下预扩张似乎为实现更宽、更薄的穿支皮瓣和更大的穿支动脉提供了一种解决方案。
