Kim Sang Wha, Youn Dong Geun, Kim Jeong Tae, Kim Youn Hwan
Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea.
Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul, Korea.
Microsurgery. 2018 Jan;38(1):46-50. doi: 10.1002/micr.22504. Epub 2015 Sep 30.
Chimeric flaps are often used in reconstructive fields for multiple defects, different functional defects, and extensive defects. In this article, we present the results of the use of thoracodorsal artery perforator (TDAp) chimeric flaps including a latissimus dorsi (LD) or serratus anterior (SA) muscle to prevent pedicle compression for lower extremity reconstruction.
Nineteen TDAp chimeric flaps were used to prevent pedicle compression. Seven were female and 12 male. Patients' age ranged from 32 to 73 years. After harvesting TDAp skin flap, LD or SA muscle could be harvested along with the thoracodorsal vessels. Skin flap was incorporated into the main defect and muscle cuffs were positioned along the vascular pedicle.
In 11 cases, there were two components, a skin flap and a muscle flap, and the other 8 were three components, a skin flap and two muscle flaps. The dimensions of the skin flaps ranged from 8 × 5 to 18 × 10 cm, and the muscle flaps ranged from 3 × 2 cm to 8 × 6 cm. The recipient vessel was anterior tibial artery or dorsalis pedis artery. All flap survived. Five cases suffered minor complications including donor site wound disruption, skin flap wound disruption, partial loss of the skin flap, and partial loss of the SA muscle flap. The mean follow-up was 13.9 months. All the patients were able to wear shoes without debulking procedures.
The TDAp chimeric flaps including LD or SA muscle flaps were useful for covering the vascular pedicle and relieved vascular compression during lower extremity reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery, 38:46-50, 2018..
嵌合皮瓣常用于修复多个缺损、不同功能缺损及大面积缺损。在本文中，我们展示了使用胸背动脉穿支（TDAp）嵌合皮瓣（包括背阔肌（LD）或前锯肌（SA））预防蒂部受压以进行下肢重建的结果。
使用19个TDAp嵌合皮瓣预防蒂部受压。其中女性7例，男性12例。患者年龄在32至73岁之间。切取TDAp皮瓣后，可连同胸背血管一并切取LD或SA肌。将皮瓣纳入主要缺损处，肌袖沿血管蒂放置。
11例为两个组分，即一个皮瓣和一个肌瓣；另外8例为三个组分，即一个皮瓣和两个肌瓣。皮瓣尺寸为8×5至18×10厘米，肌瓣尺寸为3×2至8×6厘米。受区血管为胫前动脉或足背动脉。所有皮瓣均存活。5例出现轻微并发症，包括供区伤口裂开、皮瓣伤口裂开、皮瓣部分坏死及SA肌瓣部分坏死。平均随访时间为13.9个月。所有患者无需进行减容手术即可穿鞋。
包括LD或SA肌瓣的TDAp嵌合皮瓣有助于覆盖血管蒂并缓解下肢重建过程中的血管受压。©2015威利期刊公司。显微外科学，38:46 - 50，2018。
