Li Guang-Shuai, Zan Tao, Li Qing-Feng, Li Haizhou, Dong Ming-Min, Liu Lin-Bo, Gu Bin, Li Hua, Ding Shuang, Zheng Yan, Liu Kai, Xie Yun
From the *Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou; and †Department of Plastic and Reconstructive Surgery, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Ann Plast Surg. 2015 Jul;75(1):29-33. doi: 10.1097/SAP.0000000000000214.
Prefabricated flap is an important technique to reconstruct massive face and neck skin defects. But its vascularization remains unpredictable and often leads to abnormal blood supply of the harvested flap, even necrosis. Flap supercharging and turbo supercharging techniques are effectively used to improve flap blood supply. However, few studies have been reported on the application of these techniques in prefabricated induced expanded flaps.
From March 2008 to September 2012, 13 patients who have face and neck soft tissue defects were treated with prefabricated cervicothoracic flap. To overcome insufficient blood supply, 5 of them received additional microvascular augmentation in which the second or third perforator of the internal mammary artery (IMAP) and its venae comitantes were anastomosed to facial or superficial temporal vessels, contrary to the remaining 8 patients. The following results were compared: flap viability, hospital stay, complications, frequency of dressing change, reoperation rate, and remaining scars.
No flap necrosis was observed in patients who received the supercharging procedure. By contrast, of the 8 patients who were not treated with supercharging technique, various degrees of flap necrosis occurred in 3 patients, 2 of whom received secondary operations. The frequency of dressing changes, the hospital stay, and hospital cost were reduced. Postoperative view showed better aesthetic restoration.
The IMAP-supercharged cervicothoracic flap technique offers a reliable method for massive face and neck reconstruction. We recommended that the IMAP should always be preserved in the flap as a saving option for potential flap congestion or arterial insufficiency.
预制皮瓣是修复大面积面颈部皮肤缺损的一项重要技术。但其血管化情况仍难以预测，常导致所取皮瓣血供异常，甚至坏死。皮瓣增压和涡轮增压技术可有效改善皮瓣血供。然而，关于这些技术在预制诱导扩张皮瓣中的应用报道较少。
2008年3月至2012年9月，13例面颈部软组织缺损患者接受了预制颈胸皮瓣修复。为克服血供不足，其中5例患者接受了额外的微血管增强手术，即将胸廓内动脉（IMAP）的第二或第三穿支及其伴行静脉与面动脉或颞浅血管吻合，其余8例患者未进行此操作。比较以下结果：皮瓣成活率、住院时间、并发症、换药频率、再次手术率及遗留瘢痕情况。
接受增压手术的患者未观察到皮瓣坏死。相比之下，8例未接受增压技术治疗的患者中，3例发生了不同程度的皮瓣坏死，其中2例接受了二次手术。换药频率、住院时间及住院费用均降低。术后外观显示美学修复效果更佳。
IMAP增压颈胸皮瓣技术为大面积面颈部重建提供了一种可靠的方法。我们建议在皮瓣中应始终保留IMAP，作为应对潜在皮瓣充血或动脉供血不足的备用选择。
