Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.
Division of Plastic Surgery, University of California Davis, Sacramento, California, USA.
Facial Plast Surg Aesthet Med. 2020 Nov/Dec;22(6):441-448. doi: 10.1089/fpsam.2020.0040. Epub 2020 Jul 13.
The strategic option between vascular supercharge and flap prefabrication in the fabrication of multipedicle flaps for difficult head and neck reconstruction has not been reported. To summarize our 13-year experience in the design of multipedicle pre-expanded perforator flaps for extensive head and neck defect reconstruction, with vascular supercharge and flap prefabrication, either solely or in combination. To discuss the strategy for judicious selection between these techniques in the design of multipedicle flaps at different donor sites. A retrospective study was performed in patients with severe head and neck deformities and treated with multipedicle pre-expanded perforator flaps between May 2005 and May 2018. Intraoperative indocyanine green angiography was utilized for visualization of flap perfusion and analysis of the hemodynamics of pre-existing perforator and prefabricated vessels. The main outcomes measured were (1) features of deformities, (2) multipedicle flap designs, and (3) postoperative complications and long-term functional and aesthetic outcomes. Seventy-five multipedicle pre-expanded perforator flaps were harvested, including 44 supercharged, 26 prefabricated, and 5 tripedicle, combining both techniques, with sizes ranging from 22 × 12 to 45 × 27 cm. Hemodynamic analysis demonstrated slower arterial inflow (0.60 ± 0.29 U/s vs. 2.65 ± 1.29 U/s, < 0.05) and venous outflow (0.10 U/s vs. 0.23 ± 0.11 U/s) in prefabricated vessels, compared to the pre-existing perforator, namely the internal mammary arterial perforator. Partial necroses were observed in three patients with only one requiring skin grafting. The aesthetic and functional outcomes were satisfying after reconstruction. Multipedicle pre-expanded perforator flaps fabricated by vascular supercharge and flap prefabrication, either solely or in combination in various donor sites, are powerful reconstructive tools for extensive head and neck defects. For a more reliable design, vascular supercharging should be considered a priority strategy, and flap prefabrication an alternative when suitable supercharging vessels are unavailable.
在制造用于困难的头颈部重建的多蒂皮瓣时，血管增压与皮瓣预制之间的策略选择尚未报道。总结我们在设计用于广泛头颈部缺损重建的多蒂预制扩张穿支皮瓣方面的 13 年经验，包括单独或联合使用血管增压和皮瓣预制。讨论在不同供区设计多蒂皮瓣时，在这些技术之间进行明智选择的策略。对 2005 年 5 月至 2018 年 5 月期间接受多蒂预制扩张穿支皮瓣治疗的严重头颈部畸形患者进行回顾性研究。术中吲哚菁绿血管造影用于皮瓣灌注的可视化和分析现有的穿支和预制血管的血液动力学。主要测量的结果包括（1）畸形特征，（2）多蒂皮瓣设计，以及（3）术后并发症和长期功能和美学结果。共采集了 75 个多蒂预制扩张穿支皮瓣，包括 44 个增压，26 个预制和 5 个三蒂，结合两种技术，大小范围为 22×12 至 45×27cm。血液动力学分析显示，与现有的穿支（即内乳动脉穿支）相比，预制血管的动脉流入（0.60±0.29 U/s 对 2.65±1.29 U/s，<0.05）和静脉流出（0.10 U/s 对 0.23±0.11 U/s）较慢。三名患者仅观察到部分坏死，其中一名需要植皮。重建后，美学和功能结果令人满意。在各种供区，单独或联合使用血管增压和皮瓣预制制造的多蒂预制扩张穿支皮瓣是广泛头颈部缺损的强大重建工具。为了更可靠的设计，应优先考虑血管增压策略，当没有合适的增压血管时，可选择皮瓣预制。
