Lenglet M, Dast S, Dessena L, Herlin C, Chaput B, Havet E, Sinna R
Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens Picardie, Salouel, 80054 Amiens cedex, France.
Service de chirurgie plastique et craniofaciale, CHU de Montpellier, 34090 Montpellier, France.
Ann Chir Plast Esthet. 2017 Aug;62(4):327-331. doi: 10.1016/j.anplas.2017.01.001. Epub 2017 Mar 28.
In recent years, the indications of latissimus dorsi myocutaneous flap decreased in favor of its version preserving muscle: the thoracodorsal artery perforator flap (TDAP). The intramuscular dissection reduce donor site morbidity but also allows an extension of the pedicle compared to conventional latissimus dorsi flap pedicle. The purpose of this study was to quantify objectively elongation of the pedicle when the perforator is dissected through the muscle.
Sixteen TDAP flap were dissected in 9 cadavers. The pedicle was divided into 4 distinct parts: (1) hypodermis, (2) subcutaneous fat, (3) intramuscular, (4) conventional pedicle.
The length of the pedicle is significantly increased when the pedicle is dissected through the muscle. This extends the theoretical length from 5.25cm up to 9.19cm if the dissection is extended to the deep fat. Indeed, this results in a potentially exploitable TDAP pedicle length of 20.66cm.
The dissection of the perforator allows an extension of the pedicle of about 5 or 9cm if we continue the dissection in the subcutaneous fat. A long pedicle may be interesting in lower limb reconstructive surgery and facial reconstruction where microsurgery is not feasible.
近年来，背阔肌肌皮瓣的应用指征有所减少，转而倾向于保留肌肉的术式：胸背动脉穿支皮瓣（TDAP）。与传统背阔肌皮瓣蒂部相比，肌肉内解剖不仅能降低供区并发症，还能延长蒂部。本研究的目的是客观量化穿支经肌肉解剖时蒂部的延长情况。
在9具尸体上解剖了16个TDAP皮瓣。蒂部分为4个不同部分：（1）皮下组织，（2）皮下脂肪，（3）肌肉内部分，（4）传统蒂部。
当蒂部经肌肉解剖时，其长度显著增加。如果解剖延伸至深部脂肪，理论长度从5.25cm延长至9.19cm。实际上，这使得TDAP皮瓣蒂部的潜在可用长度达到20.66cm。
如果在皮下脂肪层继续解剖，穿支的解剖可使蒂部延长约5cm或9cm。在显微外科手术不可行的下肢重建手术和面部重建中，长蒂部可能具有重要意义。
