Yoshimatsu Hidehiko, Yamamoto Takumi, Hayashi Akitatsu, Iida Takuya
Tokyo, Japan.
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo.
Plast Reconstr Surg. 2016 Oct;138(4):910-922. doi: 10.1097/PRS.0000000000002607.
Most authors elevate the superficial circumflex iliac artery perforator flap from the lateral edge of the skin paddle, and begin by dissecting a perforator perfusing the skin paddle. In this article, the authors introduce a modified technique for elevation of a superficial circumflex iliac artery perforator flap, beginning with identification of the pedicle arteries, allowing inclusion of a variety of anatomical structures.
From August of 2012 to August of 2015, 27 patients with soft- and bony-tissue defects underwent reconstruction using proximal-to-distally elevated superficial circumflex iliac artery perforator flaps. There were 18 male and nine female patients, with an average age was 54.3 years.
The average size and pedicle length of the flap was 59 cm and 6 cm, respectively. Chimeric fabrication consisted of vascularized iliac bone in four patients, the sartorius muscle in three patients, vascularized lymph node in two patients, vascularized deep fascia in one patient, and the intercostal nerve in one patient. The superficial branch of the superficial circumflex iliac artery was used as the only pedicle in 20 cases, the deep branch of the superficial circumflex iliac artery was used as the only pedicle in three cases, and both branches were used as the pedicle in four cases. Flaps survived completely in all but three cases. In the cases with integrated nerves or fascia, satisfactory functional recovery was observed.
With its minimal donor-site morbidity and a wide variety of anatomical structures that can be procured with the skin paddle, the proximal-to-distally elevated superficial circumflex iliac artery perforator flap may be useful for reconstruction of defects of small to moderate size.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
大多数作者从皮瓣外侧缘掀起旋髂浅动脉穿支皮瓣，首先解剖一条为皮瓣供血的穿支。在本文中，作者介绍了一种改良的旋髂浅动脉穿支皮瓣掀起技术，从识别蒂动脉开始，可包含多种解剖结构。
2012年8月至2015年8月，27例软组织和骨组织缺损患者采用从近端向远端掀起的旋髂浅动脉穿支皮瓣进行重建。男性18例，女性9例，平均年龄54.3岁。
皮瓣平均大小和蒂长分别为59 cm和6 cm。嵌合构建包括4例带血管蒂的髂骨、3例缝匠肌、2例带血管蒂的淋巴结、1例带血管蒂的深筋膜和1例肋间神经。20例以旋髂浅动脉浅支作为唯一蒂，3例以旋髂浅动脉深支作为唯一蒂，4例以两支作为蒂。除3例皮瓣外，其余皮瓣均完全存活。在合并神经或筋膜的病例中，观察到功能恢复满意。
从近端向远端掀起的旋髂浅动脉穿支皮瓣供区并发症少，皮瓣可携带多种解剖结构，可能有助于中小面积缺损的重建。
临床问题/证据水平：治疗性，IV级。
