From the Department of Plastic and Reconstructive Surgery, Mie University, School of Medicine; the Departments of Plastic and Reconstructive Surgery and Otorhinolaryngology, Tokyo University, School of Medicine; the Department of Plastic Surgery, Tan Tock Seng Hospital; and the Academic Plastic Surgery Group, Queen Mary University of London.
Plast Reconstr Surg. 2018 Sep;142(3):351e-360e. doi: 10.1097/PRS.0000000000004698.
Recently, a superthin "pure skin perforator" flap without any subcutaneous tissue was proposed, but the vascularity is still unclear. The authors therefore investigated the vascularity of the proposed superficial circumflex iliac artery-pure skin perforator along with its clinical applications and findings on indocyanine green imaging.
The locations and dimension of 70 pure skin perforators on 40 flaps were investigated and classified into central-peripheral and mediolateral parts. Indocyanine green angiography was used to analyze the patterns of the vascular anatomy.
Twenty-seven of 29 cases (93.1 percent) presented with pure skin perforator vessels within the area 5 cm above and 1 cm below the inguinal ligament and 4 cm medial and 2 cm lateral from the anterior superior iliac spine. The total flap size averaged 39 ± 22 cm(2) (range, 3 to 90 cm(2)). A subanalysis of the relationship between the flap size and location of pure skin perforators within the single, double, and triple pure skin perforator flap subgroups did not reveal any significance. Indocyanine green angiography revealed three interesting perfusion patterns of pure skin perforator flap: a radial diffusion pattern, direct linking vessels in the intradermal layer, and intradermal arteriovenous shunts.
The location number of the pure skin perforators within the flap was not considered to be a crucial factor in the flap design and size in this study. This new knowledge regarding the pure skin perforator concept will allow surgeons to elevate a full-thickness skin flap safely.
最近，有人提出了一种没有任何皮下组织的超薄“纯皮穿支”皮瓣，但血管情况仍不清楚。因此，作者研究了所提出的旋髂浅动脉-纯皮穿支的血管分布情况及其在吲哚菁绿成像中的临床应用和发现。
研究了 40 个皮瓣中 70 个纯皮穿支的位置和尺寸，并将其分为中央-周围和中间-外侧部分。使用吲哚菁绿血管造影术来分析血管解剖结构的模式。
29 例中有 27 例（93.1%）在腹股沟韧带上方 5 厘米和下方 1 厘米以及前髂嵴上方 4 厘米和内侧 2 厘米的范围内存在纯皮穿支血管。皮瓣总面积平均为 39±22cm²（范围为 3 至 90cm²）。在单个、双个和三个纯皮穿支皮瓣亚组中，皮瓣大小与纯皮穿支位置之间的关系进行的亚组分析没有显示出任何意义。吲哚菁绿血管造影显示了三种有趣的纯皮穿支皮瓣的灌注模式：放射状扩散模式、真皮层内的直接连接血管和真皮内动静脉分流。
在本研究中，皮瓣内纯皮穿支的数量被认为不是皮瓣设计和大小的关键因素。关于纯皮穿支概念的新知识将使外科医生能够安全地抬起全厚皮瓣。
