Ooi Adrian S H, Butz Daniel R, Teven Chad M, Gottlieb Lawrence J
Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, S Maryland Ave, Chicago, IL, USA; Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Republic of Singapore.
Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, S Maryland Ave, Chicago, IL, USA.
J Plast Reconstr Aesthet Surg. 2018 Mar;71(3):402-409. doi: 10.1016/j.bjps.2017.08.029. Epub 2017 Sep 12.
Although perforator flaps from the pectoral branch of the thoraco-acromial (TA) axis have been well-described, there are few reports of perforator flaps based on the delto-acromial (DA) branches. We have found a reliable perforator coming off the DA branch of the TA axis, and have named a flap based on this vessel the delto-acromial perforator (DAP) flap. We describe our experience with the DAP flap together with a fresh cadaver anatomical study.
A retrospective review of all DAP flaps performed between December 2012 and January 2015 at our institution, with analysis of operative details, flap characteristics and surgical outcomes. We performed fresh cadaver dissection on 5 hemi-chest walls.
The main cutaneous perforator from the deltoid and/or acromial branches is found at the delto-pectoral groove, 8 cm lateral to the TA axis and 8 cm inferior to the acromio-clavicular joint. Five patients underwent DAP flap reconstruction. Three were pedicled and 2 were free flaps. Average pedicle length from the origin of the DA branch was 8 cm, with an arterial diameter of at least 1 mm and vein diameter 1.5 mm. All flaps survived completely. Cadaver dissection showed a consistent perforator arising from the common delto-acromial branch in 4 cadavers, and from the deltoid branch in 1 cadaver.
The DAP flap is a good addition to the armamentarium of reconstructive surgeons when a relatively thin fasciocutaneous flap with minimal hair is desired. It may be used for free tissue or locoregional transfer.
尽管来自胸肩峰（TA）轴胸肩峰支的穿支皮瓣已有详尽描述，但基于三角肌肩峰（DA）支的穿支皮瓣报道较少。我们发现了一条来自TA轴DA支的可靠穿支，并将基于该血管的皮瓣命名为三角肌肩峰穿支（DAP）皮瓣。我们将介绍我们使用DAP皮瓣的经验以及一项新鲜尸体解剖研究。
回顾性分析2012年12月至2015年1月在我们机构进行的所有DAP皮瓣手术，分析手术细节、皮瓣特征和手术结果。我们对5个半胸壁进行了新鲜尸体解剖。
在三角肌胸大肌沟、TA轴外侧8 cm和肩锁关节下方8 cm处发现来自三角肌和/或肩峰支的主要皮肤穿支。5例患者接受了DAP皮瓣重建。3例为带蒂皮瓣，2例为游离皮瓣。从DA支起始处算起的平均蒂长为8 cm，动脉直径至少1 mm，静脉直径1.5 mm。所有皮瓣均完全存活。尸体解剖显示，4具尸体的共同三角肌肩峰支有一致的穿支，1具尸体的穿支来自三角肌支。
当需要一个毛发较少的相对较薄的筋膜皮瓣时，DAP皮瓣是重建外科医生的一个很好的补充。它可用于游离组织或局部转移。
