From the Department of Plastic Surgery, Texas Children's Hospital; the Division of Plastic Surgery, Children's of Alabama, University of Alabama at Birmingham; Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center of Central Texas, and the Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin.
Plast Reconstr Surg. 2021 Feb 1;147(2):260e-264e. doi: 10.1097/PRS.0000000000007542.
Craniofacial free tissue transfer is sometimes complicated by insufficient pedicle length and/or paucity of recipient vessels. A saphenous vein graft can be used to reach the high-flow, large-caliber vessels of the neck, but because of the vein's taper and thick wall, there is often a mismatch. Following the principle of like-for-like, the authors prefer the descending branch of the lateral circumflex femoral vessels to achieve a more anatomical pedicle extension for free tissue transfer in complex craniofacial reconstruction. The authors' experience using the descending branch of the lateral circumflex femoral pedicle extender from 2010 to 2019 was reviewed. Indications, patient characteristics, reconstruction site, flap type, pedicle length, recipient vessels, and vascular complications were noted. The authors reviewed two strategies for implementation of the pedicle extender: in some cases, the flap was first transferred and allowed to perfuse on the descending branch of the lateral circumflex femoral vessels in the thigh, and then transferred to the recipient vessels (double-ischemia transfer); and in other cases, the flap and pedicle extender were transferred such that the flap underwent a single period of ischemia (single-ischemia transfer). The descending branch of the lateral circumflex femoral pedicle extender was used in 17 craniofacial cases. Indications included tumor, trauma, osteoradionecrosis, and congenital. Double-ischemia transfer was used in eight cases and single-ischemia transfer in nine. The longest pedicle extender in the series was 15 cm. Arterial thrombosis occurred in one case. This case series demonstrates that the descending branch of the lateral circumflex femoral pedicle extender is a viable option for complex craniofacial free tissue transfer cases. It provides ample length and excellent vessel match, following the like-for-like principle.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
颅面游离组织移植有时会因蒂部长度不足和/或受区血管不足而变得复杂。可以使用隐静脉移植物来达到颈部高流量、大口径的血管，但由于静脉的锥形和厚壁，通常存在不匹配的情况。根据相似原则，作者更喜欢使用旋股外侧动脉降支来实现游离组织移植中更具解剖学的蒂部延长，用于复杂颅面重建。作者回顾了 2010 年至 2019 年使用旋股外侧动脉降支游离组织移植的经验。记录了适应证、患者特征、重建部位、皮瓣类型、蒂部长度、受区血管和血管并发症。作者回顾了两种实施蒂部延长器的策略：在某些情况下，首先转移皮瓣，让其在大腿旋股外侧动脉降支上灌注，然后转移到受区血管（双缺血转移）；在其他情况下，同时转移皮瓣和蒂部延长器，使皮瓣经历一次缺血期（单缺血转移）。17 例颅面病例使用了旋股外侧动脉降支蒂部延长器。适应证包括肿瘤、创伤、骨放射性坏死和先天性疾病。8 例采用双缺血转移，9 例采用单缺血转移。该系列中最长的蒂部延长器为 15cm。1 例发生动脉血栓形成。该病例系列表明，旋股外侧动脉降支蒂部延长器是复杂颅面游离组织移植病例的可行选择。它提供了充足的长度和良好的血管匹配，符合相似原则。
临床问题/证据水平：治疗，IV。
