Chaput Benoit, Mojallal Ali, Bertheuil Nicolas, Carloni Raphael, Grolleau Jean Louis, Sinna Raphael, Bekara Farid, Herlin Christian
Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France.
Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital, Lyon, France.
J Reconstr Microsurg. 2016 Oct;32(8):639-42. doi: 10.1055/s-0036-1584807. Epub 2016 Jul 1.
Background The recent development of perforator flaps has changed the reconstructive strategy for common integumental defects and has refocused the attention of microsurgeons to donor site morbidity. We asked a representative panel of microsurgeons about the free flap they would use to cover a common integumental defect on their own body to investigate the best free-flap donor sites. Methods In total, 100 practitioners participated in the "FreeFlap4U" study, representing 77.3% of the French national plastic surgery teams practicing microsurgery. To assess changing attitudes, we also compared microsurgeons below 40 years of age (called junior microsurgeons, JMs) with those above 40 years of age (called senior microsurgeons, SMs). Results Perforator flaps were preferred for the first line (JMs) and second line (JMs and SMs) of treatment compared with other flaps. JMs emphasized lower donor site morbidity, whereas SMs favored reliability (p = 0.013) and considered perforator flaps as a second-line treatment. Radial forearm and transverse rectus abdominis flaps were largely dismissed due to high morbidity. Some microsurgeons were influenced by the potential secondary benefit of the integument sample at the donor site. Conclusions Microsurgeons interviewed clearly moved toward perforator flaps, such as the anterolateral thigh, thoracodorsal artery perforator, and superficial circumflex iliac artery types, to cover common integumental defects. In the coming years, we believe that this choice, emitted by the microsurgeons for themselves, will be applied extensively by these surgeons for their patients.
穿支皮瓣的最新进展改变了常见体表缺损的重建策略，并使显微外科医生重新关注供区并发症。我们询问了一组具有代表性的显微外科医生，他们会选择哪种游离皮瓣来覆盖自己身体上的常见体表缺损，以探究最佳的游离皮瓣供区。方法：共有100名从业者参与了“FreeFlap4U”研究，占法国从事显微外科的全国整形外科团队的77.3%。为了评估态度的变化，我们还比较了40岁以下的显微外科医生（称为初级显微外科医生，JMs）和40岁以上的显微外科医生（称为高级显微外科医生，SMs）。结果：与其他皮瓣相比，穿支皮瓣在一线治疗（JMs）和二线治疗（JMs和SMs）中更受青睐。JMs强调较低的供区并发症，而SMs则更看重可靠性（p = 0.013），并将穿支皮瓣视为二线治疗方法。由于并发症发生率高，桡动脉前臂皮瓣和腹直肌横断皮瓣大多被摒弃。一些显微外科医生受到供区皮肤样本潜在的次要益处的影响。结论：接受采访的显微外科医生明显倾向于选择穿支皮瓣，如股前外侧皮瓣、胸背动脉穿支皮瓣和旋髂浅动脉型皮瓣，来覆盖常见体表缺损。我们相信，在未来几年，显微外科医生为自己做出的这种选择将被广泛应用于他们的患者。
