Iida Takuya, Yoshimatsu Hidehiko, Koshima Isao
From the Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
Ann Plast Surg. 2017 Oct;79(4):385-389. doi: 10.1097/SAP.0000000000001175.
Usually, anterolateral thigh (ALT) defects with width more than 8 cm cannot be closed directly. Although several methods of using local flaps exist, flap mobility of these methods is limited. We introduced a perforator-based propeller flap for such reconstruction. Their maximal mobility, which minimizes their size, is their greatest advantage. In addition, we present our technical refinements including double-axes propeller flap, the use of indocyanine green real-time angiography, and supercharged propeller flap for safer flap transfer.
Seven patients underwent perforator-based propeller flap reconstruction of ALT defects. Flaps were designed cranial or caudal to the defect according to the perforator locations. To maximize mobility, flaps were designed so that the perforator was located at the periphery and closer to the defect. After rotating the flap to the defect, indocyanine green angiography was performed to determine the need for supercharge.
In all cases, all flaps survived completely. Defect size ranged from 12 × 11 cm to 18 × 16 cm, and flap size ranged from 7 × 5 cm to 15 × 7 cm. The number of perforators in the flap was 1 in 3 cases and 2 in 4 cases. Supercharging was performed in 3 cases. Donor-site complications, including gait disturbance, were not observed.
This method achieves ALT defect closure with minimal donor-site morbidity and can provide prompt and aesthetically acceptable results. Indocyanine green real-time angiography and supercharging technique are also useful for safer and reliable flap transfer.
通常，宽度超过8 cm的大腿前外侧（ALT）缺损无法直接闭合。尽管存在几种使用局部皮瓣的方法，但这些方法的皮瓣活动度有限。我们引入了一种基于穿支的推进皮瓣用于此类重建。其最大的活动度（可将皮瓣尺寸最小化）是其最大优势。此外，我们还介绍了我们的技术改进，包括双轴推进皮瓣、吲哚菁绿实时血管造影的应用以及增压推进皮瓣，以实现更安全的皮瓣转移。
7例患者接受了基于穿支的推进皮瓣修复ALT缺损。根据穿支位置，在缺损的头侧或尾侧设计皮瓣。为了最大化活动度，皮瓣设计时使穿支位于周边且更靠近缺损。将皮瓣旋转至缺损处后，进行吲哚菁绿血管造影以确定是否需要增压。
所有病例中，所有皮瓣均完全存活。缺损大小从12×11 cm至18×16 cm不等，皮瓣大小从7×5 cm至15×7 cm不等。皮瓣中的穿支数量，3例为1个，4例为2个。3例进行了增压。未观察到包括步态障碍在内的供区并发症。
该方法能以最小的供区并发症实现ALT缺损的闭合，并能提供迅速且美观可接受的效果。吲哚菁绿实时血管造影和增压技术对于更安全可靠的皮瓣转移也很有用。
