Nascimento Ricardo, Costa Joana, Horta Ricardo, Silva Álvaro
Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Centro Hospitalar de São João, Porto, Portugal.
J Clin Orthop Trauma. 2017 Apr-Jun;8(2):139-141. doi: 10.1016/j.jcot.2017.03.006. Epub 2017 Mar 28.
The use of free flaps is considered the "gold standard" for reconstruction of head and neck defects. Locoregional flaps allows a better aesthetic result compared to free flaps, whenever there's an external skin defect. However the use of free flaps is not always adequate in the presence of preoperative comorbidities or previous surgeries. Since the description of the trapezius myocutaneous flap in the 1980's, many authors have published the results of the applicability of this flap in head and neck salvage reconstructive surgery. Nonetheless, the concern with trapezius muscle function remains an important issue. The onset of free-style dissection perforator flaps has attenuated this problem. The authors present a case of a 68 year old man with a posterior cervical wound after a cervical spine trauma, who underwent multiple spine surgeries, successfully treated with an island muscle-sparing trapezius flap. All the details of the dissection technique are outlined. The authors found the trapezius perforator flap to be a reliable and accessible to raise flap with a negligible donor-site morbidity. This flap can be used for occiput, nuchal and spinal areas injuries without the local morbidity related to other flap options.
游离皮瓣的应用被认为是头颈部缺损重建的“金标准”。对于存在外部皮肤缺损的情况，局部皮瓣与游离皮瓣相比能带来更好的美学效果。然而，在存在术前合并症或既往手术史的情况下，游离皮瓣的应用并不总是合适的。自20世纪80年代斜方肌肌皮瓣被描述以来，许多作者发表了该皮瓣在头颈部挽救性重建手术中适用性的结果。尽管如此，对斜方肌功能的关注仍然是一个重要问题。游离式解剖穿支皮瓣的出现减轻了这个问题。作者报告了一例68岁男性，颈椎创伤后出现颈后部伤口，此前接受过多次脊柱手术，成功采用保留肌肉的岛状斜方肌皮瓣进行治疗。文中概述了该解剖技术的所有细节。作者发现斜方肌穿支皮瓣是一种可靠且易于掀起的皮瓣，供区并发症极少。该皮瓣可用于枕部、项部和脊柱区域损伤，而不会出现与其他皮瓣选择相关的局部并发症。
