Balakrishnan Dr T M, Muthiah Dr Muralidhasan, Ramachandran Dr Vishnusundar, Jaganmohan Dr J
Department of Plastic Reconstructive and Faciomaxillary surgery, Madras Medical College, Chennai, India.
JPRAS Open. 2020 May 21;25:30-39. doi: 10.1016/j.jpra.2020.05.001. eCollection 2020 Sep.
Perforator-based flap-in-flap (PBFIF) refers to the construct of one flap within another based on a perforator. Primary flap-in-flap is the simultaneous construct of two flaps, one within the other. It is particularly useful in cases where despite perfect planning, the flap does not fit congruently into recesses of the defect. It facilitates tension-free flap inset without the need for secondary movement from adjacent areas. Secondary flap-in-flap is the construction of a flap within a previously transferred settled flap. It is particularly useful in cases of wound dehiscence and partial necrosis, which results in a defect-warranting flap cover, when other flap options are either not feasible or other options have been exhausted.
To assess the outcome and define the biogeometry of primary and secondary PBFIFs, which were used in postexcisional head and neck soft tissue defects.
Eight patients who underwent flap-in-flap head and neck reconstruction from January 2014 to January 2016 (four cases of primary PBFIF with nasolabial flaps, and four cases of secondary PBFIF with pectoralis major myocutaneous flaps) were retrospectively studied. All were nonsmokers with no associated comorbidities. At the end of the follow-up period, two independent observers and the patient assessed the outcome based on the Institutional Reconstruction Assessment Score (IRAS).
All flaps settled well with a mean follow-up of 16.75 months. All flaps were used for the reconstruction of postexcisional defects only. None of the patients had any loco regional recurrences. The mean IRAS obtained in 8 patients was 3.5 (primary PBFIF=3.87 and secondary PBFIF= 3.12). None of the flaps resulted in the late distortion of adjacent anatomical landmarks by hypertrophy or contracture of scars.
Flap-in-flap reconstruction (whether primary or secondary) is a useful technique to cover defects where reconstruction without anatomical distortion is required (e.g., face). It is a useful option for a tension-free flap inset. Flap-in-flap reconstruction is a relatively easy adjunct in the salvage reconstructive armamentarium of plastic surgeons.
基于穿支血管的套叠皮瓣（PBFIF）是指基于穿支血管构建一个皮瓣套在另一个皮瓣内。原发性套叠皮瓣是同时构建两个皮瓣，一个套在另一个内。在某些情况下，尽管术前规划完善，但皮瓣仍无法完全贴合缺损的凹陷处，此时该技术特别有用。它有助于无张力地植入皮瓣，无需从相邻区域进行二次移动。继发性套叠皮瓣是在先前转移并已固定的皮瓣内构建一个皮瓣。当伤口裂开和部分坏死导致需要皮瓣覆盖缺损，而其他皮瓣选择不可行或已用尽时，该技术特别有用。
评估原发性和继发性PBFIF用于切除术后头颈部软组织缺损的效果，并确定其生物几何学特征。
回顾性研究2014年1月至2016年1月期间接受套叠皮瓣头颈部重建的8例患者（4例原发性PBFIF采用鼻唇沟皮瓣，4例继发性PBFIF采用胸大肌肌皮瓣）。所有患者均不吸烟，无相关合并症。随访期末，两名独立观察者和患者根据机构重建评估评分（IRAS）对结果进行评估。
所有皮瓣均顺利愈合，平均随访16.75个月。所有皮瓣仅用于切除术后缺损的重建。所有患者均无局部区域复发。8例患者的平均IRAS为3.5（原发性PBFIF = 3.87，继发性PBFIF = 3.12）。无一例皮瓣因瘢痕增生或挛缩导致相邻解剖标志的晚期变形。
套叠皮瓣重建（无论是原发性还是继发性）是一种用于覆盖需要无解剖结构变形重建的缺损（如面部）的有用技术。它是无张力植入皮瓣的有用选择。套叠皮瓣重建是整形外科医生挽救性重建手段中相对容易的辅助方法。
