Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan.
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2014 Dec;67(12):1740-3. doi: 10.1016/j.bjps.2014.08.005. Epub 2014 Aug 14.
The posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer.
股后皮瓣是臀部重建的主力皮瓣。皮瓣的主要血管蒂通常是臀下动脉的降支，但在肉瘤切除时存在被切断的风险。我们报告了一例成功的游离股后皮瓣静脉增粗重建术，该手术用于重建因肉瘤切除导致的臀下区缺损，术中未使用臀下动脉降支。一名 77 岁男性在臀下区接受了肉瘤切除术，术中牺牲了臀下动脉降支。我们在股二头肌长头处发现了一个相当大的穿支，并以此穿支为基础，采用游离方式切取股后皮瓣。皮瓣转移后逐渐出现充血外观，因此我们将第二个穿支的静脉与受区坐骨神经的伴行静脉吻合。皮瓣完全存活，术后过程顺利。我们认为，游离方式和穿支增粗技术的联合应用可以提高带蒂穿支皮瓣转移的通用性和安全性。
