Kwon Jae Hyun, Lee Kyeong-Tae, Lim So Young, Pyon Jai-Kyung, Bang Sa-Ik, Oh Kap Sung, Mun Goo-Hyun
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Seoul, South Korea.
Microsurgery. 2017 Feb;37(2):105-111. doi: 10.1002/micr.22427. Epub 2015 May 9.
Although an increase in flap perfusion by incorporating multiple perforators has been demonstrated with free perforator flaps, whether the same efficacy can be achieved with pedicled flaps remains unclear, due to concerns regarding pedicle tension or kinking during flap transposition. The aim of this report was to investigate the reliability of multiple perforator-based pedicled flaps in a series of clinical cases.
Twenty-six patients undergoing soft tissue reconstruction using multiple perforator-based pedicled flaps from 2008 to 2012 were reviewed. The causes of the defects were oncologic (n = 15) or chronic wounds (n = 11). The defect sites were the trunk (n = 19), lower extremities (n = 4), head and neck (n = 2), and upper extremities (n = 1). Diverse flap types were used, including the superior gluteal artery perforator flap, the lateral femoral circumflex artery perforator flap, the medial femoral circumflex artery perforator flap, and the thoracodorsal artery perforator flap. The flaps were transposed in a rotation-and-advancement manner after skeletonizing each perforator and proximally dissecting the pedicle. The donor site was closed primarily.
Mean flap size was 125.2 cm , and the mean number of perforators used was 2.3 (2-5). The mean angle of pivotal rotation for flap transposition was 132.8°. No rotation-related problems including pedicle kinking or twisting developed, and all flaps survived completely. No significant donor-site morbidity was observed. The mean follow-up period was 38.1 months.
This report suggests that through meticulous dissection of pedicles of sufficient length, the multiple perforator-based pedicled flaps can be successfully transposed while minimizing the risk of pedicle tethering. © 2015 Wiley Periodicals, Inc. Microsurgery 37:105-111, 2017.
尽管游离穿支皮瓣通过纳入多个穿支已被证明可增加皮瓣灌注，但对于带蒂皮瓣是否能达到相同效果仍不清楚，这是因为担心皮瓣转移过程中蒂部张力或扭转问题。本报告的目的是在一系列临床病例中研究基于多个穿支的带蒂皮瓣的可靠性。
回顾了2008年至2012年期间26例使用基于多个穿支的带蒂皮瓣进行软组织重建的患者。缺损原因包括肿瘤性（n = 15）或慢性伤口（n = 11）。缺损部位为躯干（n = 19）、下肢（n = 4）、头颈部（n = 2）和上肢（n = 1）。使用了多种皮瓣类型，包括臀上动脉穿支皮瓣、旋股外侧动脉穿支皮瓣、旋股内侧动脉穿支皮瓣和胸背动脉穿支皮瓣。在分别显露每个穿支并向近端解剖蒂部后，以旋转推进方式转移皮瓣。供区直接缝合关闭。
皮瓣平均大小为125.2平方厘米，平均使用的穿支数量为2.3个（2 - 5个）。皮瓣转移的平均枢轴旋转角度为132.8°。未出现包括蒂部扭转或扭曲在内的与旋转相关的问题，所有皮瓣均完全存活。未观察到明显的供区并发症。平均随访期为38.1个月。
本报告表明，通过对足够长度的蒂部进行细致解剖，基于多个穿支的带蒂皮瓣能够成功转移，并将蒂部束缚风险降至最低。© 2015威利期刊公司。显微外科学37:105 - 111，2017。
