Arkudas Andreas, Horch Raymund E, Regus Susanne, Meyer Alexander, Lang Werner, Schmitz Marweh, Boos Anja M, Ludolph Ingo, Beier Justus P
Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Federal Republic of Germany.
Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Federal Republic of Germany.
J Plast Reconstr Aesthet Surg. 2018 Mar;71(3):394-401. doi: 10.1016/j.bjps.2017.08.025. Epub 2017 Sep 13.
Defect reconstruction of the trunk can be performed using microsurgical free flap transplantation. In cases of missing or inappropriate recipient vessels, microsurgical defect reconstruction of the trunk can be achieved by combining free flaps with arteriovenous loops. Here we present our 5-year experience of trunk reconstruction using AV loops and free flaps in a retrospective evaluation. We analyzed 32 cases of trunk reconstruction using a combined approach of free flap transplantation and arteriovenous loops between 2011 and 2016 regarding postoperative complications and perioperative course. Twenty-one patients suffered from sternal defects, 4 from presacral defects, 3 patients presented with lateral chest wall defects, 2 patients suffered from lumbosacral defects, 1 patient had a gluteal defect and 1 patient a defect at the clavicle. In all cases, free flap transplantation and arteriovenous loop creation were performed in a two-stage procedure. There were 8 thromboses of the arteriovenous loops with 4 flap failures. Only 1 flap loss was located in the sternal region, whereas one presacral flap and both lumbosacral flaps were lost. Reconstruction of large soft tissue defects of the trunk by a combined approach with an arteriovenous loop creation and consecutive free flap transplantation represents a reliable procedure in ventral and posterior cranial localization, whereas in the caudal posterior region, AV loop thrombosis can occur. Therefore, to minimize flap loss, a two-stage procedure should be performed.
躯干缺损重建可采用显微外科游离皮瓣移植术。在受区血管缺失或不合适的情况下，可通过游离皮瓣与动静脉袢联合应用来实现躯干的显微外科缺损重建。在此，我们通过回顾性评估展示了我们在使用动静脉袢和游离皮瓣进行躯干重建方面的5年经验。我们分析了2011年至2016年间采用游离皮瓣移植与动静脉袢联合方法进行躯干重建的32例患者的术后并发症及围手术期过程。21例患者存在胸骨缺损，4例为骶前缺损，3例表现为侧胸壁缺损，2例有腰骶部缺损，1例为臀区缺损，1例为锁骨处缺损。在所有病例中，游离皮瓣移植和动静脉袢的构建均分两期进行。动静脉袢发生8次血栓形成，导致4例皮瓣失败。仅1例皮瓣丢失位于胸骨区域，而1例骶前皮瓣和2例腰骶部皮瓣均丢失。通过动静脉袢构建及后续游离皮瓣移植联合方法重建躯干的大软组织缺损，在腹侧和后颅部位置是一种可靠的手术方法，而在尾侧后部区域，可能会发生动静脉袢血栓形成。因此，为使皮瓣丢失最少，应采用两期手术。
