From the Department of Plastic Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India.
Ann Plast Surg. 2020 Jan;84(1):76-84. doi: 10.1097/SAP.0000000000001952.
The purpose of this article is to develop a new method for elevating the pedicled terminal pectoral perforator flaps (PTPPFs) and to resolve the difficulties and controversies that shroud the anatomy of terminal pectoral perforators from the pectoral branch of the thoracoacromial axis.
Anatomical study was conducted to assess the feasibility of perforator flaps based on the terminal perforators of the pectoral branch of the thoracoacromial vessel axis. The knowledge that gleaned from this anatomical study was applied in the clinical scenario. A clinical retrospective study was conducted to evaluate the outcome of PTPPFs for the reconstruction of postexcisional head and neck defects.
Thirty cadaveric specimens were examined for the anatomy of the terminal musculocutaneous pectoral branch perforators. Thirty-two cases (22 males, 10 females) of various head and neck postexcision defects were reconstructed with the PTPPFs in a single-stage manner. Pectoralis major muscle with its innervation was spared in all cases. All the secondary defects were closed primarily.
The maximum cutaneous paddle size was 156 cm harvested on a single best terminal pectoral branch perforator. The average size of the cutaneous paddle harvested was 73.47 cm. The flap complications noted (9.3%) were trivial, and all the flaps survived well. The average institutional computed score for esthetic and functional recovery at the donor and reconstructed site done by 2 independent observers were 4.56 and 3.78, respectively.
The recruitment of the chest skin on the terminal pectoral branch perforators resulted in a long pedicle flap with adequate qualities like color match, texture match, and pliability. This flap shall serve as a primary option for pedicle and free flap head and neck reconstructions.
本文旨在提出一种新的方法来提升带蒂的末端胸肌穿支皮瓣（PTPPF），并解决源于胸肩峰动脉胸肌支的末端胸肌穿支解剖学的困难和争议。
通过对胸肩峰动脉胸肌支终末穿支的解剖学研究，评估基于穿支皮瓣的可行性。从这项解剖学研究中获得的知识被应用于临床情况。进行了一项临床回顾性研究，以评估用于重建头颈部切除后缺损的 PTPPF 的结果。
检查了 30 具尸体标本的末端肌皮胸肌分支穿支的解剖结构。以单阶段方式用 PTPPF 重建了 32 例（22 名男性，10 名女性）不同头颈部切除后缺损的患者。所有病例均保留了胸大肌及其神经支配。所有的次级缺损均直接闭合。
从单个最佳末端胸肌分支穿支收获的最大皮瓣大小为 156cm2。收获的皮瓣平均大小为 73.47cm2。注意到的皮瓣并发症（9.3%）是轻微的，所有皮瓣均存活良好。由 2 名独立观察者对供区和重建部位的机构计算评分进行的平均美学和功能恢复评分分别为 4.56 和 3.78。
募集末端胸肌分支穿支的胸部皮肤可形成具有足够质量的长蒂皮瓣，如颜色匹配、质地匹配和柔韧性。该皮瓣将作为头颈部带蒂和游离皮瓣重建的首选方案。
