Van Kouwenberg Emily A, Chiu David T W
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, N.Y.
Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, N.Y.
Plast Reconstr Surg Glob Open. 2020 Mar 20;8(3):e2584. doi: 10.1097/GOX.0000000000002584. eCollection 2020 Mar.
Adipose tissue-preserved skin grafts (ATPSGs) are full-thickness skin grafts with inclusion of a thin layer of adipose tissue. ATPSGs are recommended for reconstruction of anatomic areas that are cosmetically sensitive and for areas that functionally benefit from additional soft tissue thickness compared to traditional skin grafts. Careful intraoperative technique and postoperative care are mandatory for ATPSG success, given the expected higher metabolic demands compared to traditional grafts. A strict postoperative protocol is especially important after reconstruction of lower extremity defects.
Detailed descriptions of intraoperative and postoperative care for ATPSG reconstructions are provided. A case is presented displaying lower extremity reconstruction with an ATPSG. The intraoperative technique includes meticulous hemostasis of the recipient site, atraumatic handling of recipient skin edges, anatomical epidermal-to-epidermal reapproximation, avoidance of tissue strangulation during inset, and careful bolster placement. The postoperative protocol after lower extremity reconstruction includes strict elevation, non-weight-bearing status, and eventual dangle protocol.
An 85-year-old woman was treated with an ATSG for a middle-third leg resection of squamous cell carcinoma resulting in a 9 × 5 cm defect. The strict postoperative protocol was initiated, but the patient was noncompliant with elevation and weight-bearing restrictions. She had postoperative congestion and epidermolysis that was treated with local wound care without need for additional surgery.
There are many benefits to ATPSG reconstruction when chosen for the appropriate candidate. The meticulous technique and strict adherence to the postoperative protocol are crucial when these reconstructions are performed. Detailed descriptions of intraoperative and postoperative recommendations to optimize outcomes after ATPSG are presented.
脂肪组织保留皮肤移植（ATPSG）是包含一层薄脂肪组织的全厚皮肤移植。与传统皮肤移植相比，ATPSG推荐用于美容敏感的解剖区域重建以及从额外软组织厚度中获得功能益处的区域重建。鉴于与传统移植相比预期的更高代谢需求，ATPSG成功需要术中仔细操作技术和术后护理。在下肢缺损重建后，严格的术后方案尤为重要。
提供了ATPSG重建术中及术后护理的详细描述。展示了一例用ATPSG进行下肢重建的病例。术中技术包括受区细致止血、受区皮肤边缘无创伤处理、解剖学上表皮对表皮重新对合、植入时避免组织绞窄以及仔细放置支撑物。下肢重建后的术后方案包括严格抬高、不负重状态以及最终的垂挂方案。
一名85岁女性因小腿中段鳞状细胞癌切除接受ATSG治疗，导致9×5厘米缺损。启动了严格的术后方案，但患者不遵守抬高和负重限制。她出现术后充血和表皮松解，经局部伤口护理治疗，无需额外手术。
为合适的患者选择ATPSG重建有很多益处。进行这些重建时，细致的技术和严格遵守术后方案至关重要。本文介绍了优化ATPSG术后效果的术中及术后建议的详细描述。
