Kim Tae Gon, Choi Man Ki
Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
Arch Plast Surg. 2018 Jul;45(4):319-324. doi: 10.5999/aps.2018.00542. Epub 2018 Jul 15.
Perforator flaps are becoming increasingly common, and as primary thinning techniques are being developed, the need for secondary contouring of flaps is decreasing. However, many reconstructive flap procedures still incorporate secondary debulking to improve the functional and aesthetic outcomes. Direct excision, liposuction, tissue shaving with an arthroscopic cartilage shaver, and skin grafting are the four major methods used for secondary debulking. Direct excision is primarily applied in flaps where the skin is redundant, even though the volume is not excessive. However, due to the limited range of excision, performing a staged excision is recommended. Liposuction can reduce the amount of subcutaneous tissue of the flap and protect the vascular pedicles. However, the main drawback of this method is its limited ability to remove fibrotic tissues, for which the use of a shaver may be more convenient. The main drawback of using a shaver is that it is difficult to simultaneously remove excess skin. Skin grafting enables the removal of sufficient excess tissue to recover the contour of the normal limb and to improve the color match, facilitating excellent aesthetic results.
穿支皮瓣越来越常见，随着主要的减薄技术不断发展，对皮瓣进行二次塑形的需求正在减少。然而，许多重建皮瓣手术仍采用二次减容来改善功能和美学效果。直接切除、抽脂、使用关节镜软骨刨刀进行组织削薄以及植皮是用于二次减容的四种主要方法。直接切除主要应用于皮肤冗余的皮瓣，即使体积不过大。然而，由于切除范围有限，建议进行分期切除。抽脂可以减少皮瓣的皮下组织量并保护血管蒂。然而，这种方法的主要缺点是去除纤维化组织的能力有限，对于纤维化组织，使用刨刀可能更方便。使用刨刀的主要缺点是难以同时去除多余的皮肤。植皮能够去除足够的多余组织，以恢复正常肢体的轮廓并改善颜色匹配，从而获得出色的美学效果。
