Lee Kyeong-Tae, Wiraatmadja Elrica Sapphira, Mun Goo-Hyun
From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Plast Surg. 2015 May;74(5):565-72. doi: 10.1097/SAP.0b013e3182a6363c.
The reconstruction of complicated defects with 3-dimensional deficits remains challenging. The reconstruction of these defects requires not only coverage of surface but also appropriate obliteration of dead space, and muscle-chimeric perforator flaps can be a valuable option. Here, we present our experience with free latissimus dorsi (LD) muscle-chimeric thoracodorsal artery perforator (TDAP) flaps for the treatment of complicated defects.
A retrospective chart review was performed for patients who underwent a free LD muscle-chimeric TDAP flap procedure for the treatment of complicated wounds with 3-dimensional tissue deficits between March 2005 and October 2012. The surgical technique, clinical outcomes, and postoperative complications were evaluated.
A total of 24 cases were included. All flaps survived and no partial flap losses were encountered. Large skin flaps of 115 cm average size were elevated, with an average of 38-cm muscle segments. The total length of pedicle was 12.2 cm on average, with 7.3 cm of common pedicle, 4.9 cm of skin paddle, and 3.4 cm of muscle segments. Muscle segments could be inset in the underlying dead space with spatial freedom. The mean follow-up period was 34.1 months. Wounds successfully healed in all cases without significant postoperative complications. The donor-site complication rate of the chimeric flap group was similar to that of the simple TDAP group.
The use of LD muscle-chimeric TDAP flaps with Y-pedicle configurations allowed efficient positioning of both skin and muscle components for their specific purposes and successful healing of complicated wounds. The muscle components of chimeric flaps acted as "filler flaps" and were an effective addition to the perforator flap technique for the reconstruction of complicated defects without the addition of significant donor-site morbidity.
重建存在三维缺损的复杂创面仍具有挑战性。此类缺损的重建不仅需要覆盖创面表面，还需要适当消除死腔，而肌肉嵌合穿支皮瓣可能是一种有价值的选择。在此，我们介绍应用游离背阔肌（LD）肌肉嵌合胸背动脉穿支（TDAP）皮瓣治疗复杂创面的经验。
对2005年3月至2012年10月期间接受游离LD肌肉嵌合TDAP皮瓣手术治疗伴有三维组织缺损的复杂创面的患者进行回顾性病历分析。评估手术技术、临床结果及术后并发症。
共纳入24例患者。所有皮瓣均存活，未出现部分皮瓣坏死。平均掀起面积为115 cm的大皮瓣，平均包含38 cm的肌肉段。蒂的总长度平均为12.2 cm，其中共同蒂长7.3 cm，皮岛长4.9 cm，肌肉段长3.4 cm。肌肉段可在深部死腔内灵活植入。平均随访期为34.1个月。所有病例创面均成功愈合，无明显术后并发症。嵌合皮瓣组的供区并发症发生率与单纯TDAP组相似。
采用Y形蒂的LD肌肉嵌合TDAP皮瓣能够有效地将皮肤和肌肉成分分别用于特定目的，使复杂创面成功愈合。嵌合皮瓣的肌肉成分起到“填充皮瓣”的作用，是对穿支皮瓣技术的有效补充，用于重建复杂缺损，且不会增加明显的供区并发症。
