Mochizuki Yasushi, Ueda Kazuki, Horikiri Masaru, Kajikawa Akiyoshi
Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan.
Department of Plastic and Reconstructive Surgery, St. Marianna Medical University, Kanagawa, Japan.
JPRAS Open. 2017 Dec 2;15:46-50. doi: 10.1016/j.jpra.2017.11.001. eCollection 2018 Mar.
A 60-year-old male displayed sudden shrinkage of a left free rectus abdominis musculocutaneous flap, which had been grafted to his left maxilla 15 years previously. No post-reconstructive irradiation had been performed, and no late occlusion of the vascular anastomosis, local infection, recurrence of the maxillary cancer, or body weight loss was observed. However, the shrinkage amounted to approximately 50%. This is considerably more than previously reported cases of shrinkage of various free flaps, which ranged between 10% and 25%. The resultant depression was successfully augmented with a right free deep inferior epigastric artery perforator flap. The residual fat volume of the previously grafted shrunken flap was revealed to be compatible with that of the newly harvested contralateral perforator flap. Thus, the volume of the previously grafted flap may reflect the status of the intact contralateral donor site, although the mechanism of sudden flap shrinkage is unclear.
一名60岁男性的左下腹直肌肌皮瓣出现突然萎缩，该皮瓣于15年前移植至其左上颌骨。术后未进行放疗，未观察到血管吻合口晚期闭塞、局部感染、上颌癌复发或体重减轻。然而，萎缩程度约为50%。这比先前报道的各种游离皮瓣萎缩病例（萎缩率在10%至25%之间）要高得多。采用右侧腹壁下深动脉穿支游离皮瓣成功修复了由此产生的凹陷。结果发现，先前移植的萎缩皮瓣剩余脂肪量与新切取的对侧穿支皮瓣的脂肪量相当。因此，尽管皮瓣突然萎缩的机制尚不清楚，但先前移植皮瓣的体积可能反映了完整对侧供区的状况。
