Pu Lee L Q
Division of Plastic Surgery, University of California at Davis, Sacramento, Calif.
Plast Reconstr Surg Glob Open. 2017 Feb 9;5(2):e1228. doi: 10.1097/GOX.0000000000001228. eCollection 2017 Feb.
The purpose of this study was to introduce a comprehensive approach to lower extremity free-tissue transfer and report the clinical outcome that has been achieved with this approach.
The comprehensive approach developed by the author includes patient selection, flap selection, selection of the recipient vessels, flap dissection, flap preparation, microvascular anastomosis, flap inset, immediate postoperative care, intermediate postoperative care, and further follow-up care. Each part of this approach has its own special considerations. In an 8-year period, 28 consecutive lower extremity free-tissue transfers were performed in 28 patients by the author. The clinical outcomes were recorded based on the success of free-tissue transfer, any reoperations related to the revision of microvascular anastomosis, and any partial or total flap loss during an 8-year follow-up.
All 28 lower extremity free-tissue transfers were performed successfully. All patients were discharged home once they tolerated dangling. No reoperations were needed for revision of microvascular anastomosis. No total or partial flap loss was encountered. Overall success of free-tissue transfer to the lower extremity in this series was 100%.
An ideal outcome of free-tissue transfer to the lower extremity can be accomplished with this comprehensive approach developed by the author. With good surgical judgment, adequate microsurgical skill, step-by-step intraoperative execution, and a protocol-driven clinical practice, the reconstructive surgeon should be able to improve his or her success for free-tissue transfer to the lower extremity.
本研究的目的是介绍一种下肢游离组织移植的综合方法，并报告采用该方法所取得的临床结果。
作者所开发的综合方法包括患者选择、皮瓣选择、受区血管选择、皮瓣解剖、皮瓣制备、微血管吻合、皮瓣植入、术后即刻护理、术后中期护理以及进一步的随访护理。该方法的每个部分都有其特殊的注意事项。在8年期间，作者对28例患者连续进行了28例下肢游离组织移植。基于游离组织移植的成功情况、与微血管吻合修复相关的任何再次手术以及8年随访期间的任何部分或全部皮瓣丢失情况记录临床结果。
所有28例下肢游离组织移植均成功完成。所有患者一旦能够耐受垂腿即可出院回家。无需进行微血管吻合修复的再次手术。未出现全部或部分皮瓣丢失情况。本系列下肢游离组织移植的总体成功率为100%。
采用作者所开发的这种综合方法能够实现下肢游离组织移植的理想结果。凭借良好的手术判断力、足够的显微外科技能、术中按部就班的操作以及基于方案的临床实践，重建外科医生应该能够提高其下肢游离组织移植的成功率。
