From the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; the Department of Oral and Maxillofacial Surgery, Mother and Childhood Hospital, Ministry of Health; and Jibal University for Medical Sciences, Jibla Hospital.
Plast Reconstr Surg. 2020 Jan;145(1):142e-152e. doi: 10.1097/PRS.0000000000006396.
The general aim of this study is to describe a new modification to the posterior tibial artery flap and its clinical application in head and neck reconstruction and to investigate the distribution of septocutaneous perforators of the posterior tibial artery. The specific aim of this study is to evaluate the effectiveness of this new modification to the posterior tibial artery flap and describe the flap survival rate and donor-site morbidity.
From November of 2017 to August of 2018, 85 consecutive patients underwent posterior tibial artery flap reconstruction of the head and neck region after tumor extirpation. All posterior tibial artery flaps were harvested with a long adipofascial extension, and donor-site defects were closed with a triangular full-thickness skin graft harvested adjacent to the flap. Special consideration was given to the harvesting technique, distribution of the posterior tibial artery septocutaneous perforators, flap outcomes, and associated donor-site morbidity.
Flap survival was 100 percent. The number of septocutaneous perforators varied from one to five per leg, with a mean of 2.61 ± 1.15, and the septocutaneous perforators were mostly clustered in the middle and distal thirds of the medial surface of the leg. The prevalence of the presence of one, two, three, four, and five septocutaneous perforators per leg was 7, 33, 27, 19, and 14 percent, respectively. Total and partial skin graft loss at the donor site was reported in two and six patients, respectively, who were managed conservatively. There was no statistically significant difference when comparing the preoperative and postoperative range of ankle movements (p > 0.05).
This new modification to the posterior tibial artery flap allows for the incorporation of more septocutaneous perforators into the flap, omits the need for a second donor site to close the donor-site defect, and provides sufficient tissue to fill the dead space after tumor resection and neck dissection.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究的总体目标是描述一种新的改良后胫后动脉皮瓣，并将其应用于头颈部重建，同时探讨胫后动脉穿支的分布。本研究的具体目标是评估这种新改良后胫后动脉皮瓣的有效性，并描述皮瓣的成活率和供区并发症。
2017 年 11 月至 2018 年 8 月，85 例头颈部肿瘤切除术后患者行后胫后动脉皮瓣重建。所有后胫后动脉皮瓣均带有长的脂肪筋膜延伸，供区缺损采用与皮瓣相邻的三角形全厚皮片闭合。特别注意皮瓣的采集技术、胫后动脉穿支的分布、皮瓣的结果以及相关供区并发症。
皮瓣成活率为 100%。每条腿的穿支数量从 1 到 5 个不等，平均为 2.61±1.15 个，穿支主要集中在小腿内侧中、远端三分之一。每条腿存在 1、2、3、4 和 5 个穿支的发生率分别为 7%、33%、27%、19%和 14%。两名患者供区出现完全性皮片坏死，六名患者供区出现部分皮片坏死，均予保守治疗。术前与术后踝关节活动范围比较，差异无统计学意义（P＞0.05）。
这种新的改良后胫后动脉皮瓣可以将更多的穿支纳入皮瓣，避免了在第二个供区关闭供区缺损的需要，并提供了足够的组织来填充肿瘤切除和颈部清扫后的死腔。
临床问题/证据水平：治疗，IV。
