Sadigh Parviz Lionel, Hsieh Ching-Hua, Feng Guan-Ming, Shih Hsiang-Shun, Jeng Seng-Feng
Kaohsiung, Taiwan From the Department of Plastic Surgery, E-Da Hospital; and the Department of Plastic Surgery, Chang Gung Memorial Hospital.
Plast Reconstr Surg. 2015 Feb;135(2):401e-412e. doi: 10.1097/PRS.0000000000000996.
Harvesting soft tissue from a previously transferred flap allows for flap reshaping and simultaneously raising tissue for a secondary procedure. This is done without increasing the number of donor sites and is therefore a very attractive reconstructive option.
Between March of 2011 and October of 2013, the authors performed 60 recycle flaps on 60 patients (three women and 57 men) who had undergone previous flap reconstruction (52 free and eight pedicled). The recycle flaps were raised as either random pattern or perforator flaps. Mean time between primary reconstruction and the recycle procedure was 28.3 months (range, 6 months to 20 years), and the mean age of our patients was 57 years (range, 21 to 78 years).
Of 60 recycle flaps raised for secondary reconstruction, 58 survived completely (97 percent). Two cases of total flap necrosis were encountered resulting from pedicle damage during attempted perforator dissection within a previously irradiated flap. Twenty-nine flaps were raised as random pattern flaps, 29 were raised as pedicled perforator flaps (20 with perforator skeletonization), and two were raised as free perforator flaps.
There are a number of ways to safely "recycle" the soft tissues used in a previous reconstruction. This provides new tissue for a secondary procedure while debulking and refining the primary flap. Raising perforator flaps from previously irradiated flaps is, however, technically challenging and carries a high risk of flap necrosis (40 percent in our series) and should be advised against.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
从先前转移的皮瓣获取软组织可实现皮瓣重塑，同时为二次手术获取组织。此操作无需增加供区数量，因此是一种极具吸引力的重建选择。
2011年3月至2013年10月期间，作者对60例曾接受皮瓣重建的患者（3例女性和57例男性）实施了60次再利用皮瓣手术（52例游离皮瓣和8例带蒂皮瓣）。再利用皮瓣以随意型皮瓣或穿支皮瓣的形式掀起。初次重建与再利用手术之间的平均时间为28.3个月（范围为6个月至20年），患者的平均年龄为57岁（范围为21至78岁）。
为二次重建掀起的60例再利用皮瓣中，58例完全存活（97%）。在先前接受过放疗的皮瓣内行穿支解剖时，因蒂部损伤导致2例皮瓣完全坏死。29例皮瓣以随意型皮瓣形式掀起，29例以带蒂穿支皮瓣形式掀起（20例进行了穿支骨骼化处理），2例以游离穿支皮瓣形式掀起。
有多种方法可安全地“再利用”先前重建中使用的软组织。这为二次手术提供了新组织，同时减小了初次皮瓣的体积并对其进行了修整。然而，从先前接受过放疗皮瓣掀起穿支皮瓣在技术上具有挑战性，且皮瓣坏死风险高（我们的系列中为40%），应避免使用。
临床问题/证据级别：治疗性，IV级
