From the Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine; the Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital; and the Department of Plastic Surgery, Noda Hospital.
Plast Reconstr Surg. 2021 Mar 1;147(3):470-478. doi: 10.1097/PRS.0000000000007689.
Pure skin perforator and superthin flaps have been reported and are becoming popular, as they allow one-stage thin skin reconstruction even from a thick donor site. However, currently reported elevation procedures use proximal-to-distal dissection requiring free-style perforator selection and primary thinning procedures. With distal-to-proximal dissection using the dermis as a landmark for dissection plane, it is expected that elevation of pure skin perforator or superthin flaps can be simplified.
Patients who underwent pure skin perforator or superthin flap transfers with the subdermal dissection technique were included. Flaps were designed based on location of pure skin perforators visualized on color Doppler ultrasound, and elevated just below the dermis under an operating microscope. Medical charts were reviewed to obtain clinical and intraoperative findings. Characteristics of the patients, flaps, and postoperative courses were evaluated.
Thirty-six flaps were transferred in 34 patients, all of which were elevated as true perforator flaps (superficial circumflex iliac artery perforator flap in 29 cases, other perforator flaps in seven cases). Mean ± SD flap thickness was 2.24 ± 0.77 mm (range, 1.0 to 4.0 mm). Skin flap size ranged from 3.5 × 2 cm to 27 × 8 cm. Time for flap elevation was 27.4 ± 11.6 minutes. All flaps survived without flap atrophy/contracture 6 months after surgery, except for two cases of partial necrosis.
The subdermal elevation technique allows straightforward and direct elevation of a pure skin perforator or superthin flap within 30 minutes on average without the necessity of primary thinning.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
已报道并正在流行纯皮穿支皮瓣和超薄皮瓣，因为它们即使在厚供区也可实现一期薄皮重建。然而，目前报道的提升术采用从近到远的解剖，需要自由式穿支选择和初次减薄术。如果采用从远到近的解剖，以真皮作为解剖平面的标志，预计纯皮穿支或超薄皮瓣的提升可以简化。
纳入接受皮下游离技术的纯皮穿支皮瓣或超薄皮瓣转移的患者。皮瓣根据彩色多普勒超声上观察到的纯皮穿支位置设计，并在手术显微镜下于真皮下方仅行皮下游离。回顾病历以获取临床和术中发现。评估患者、皮瓣和术后情况的特点。
34 例患者共转移 36 个皮瓣，均提升为真正的穿支皮瓣（29 例旋髂浅动脉穿支皮瓣，7 例其他穿支皮瓣）。平均皮瓣厚度为 2.24 ± 0.77mm（范围，1.0 至 4.0mm）。皮瓣大小范围为 3.5×2cm 至 27×8cm。皮瓣提升时间为 27.4 ± 11.6 分钟。除 2 例部分坏死外，所有皮瓣在术后 6 个月均无皮瓣萎缩/挛缩而存活。
皮下游离技术可在平均 30 分钟内直接、简便地提升纯皮穿支皮瓣或超薄皮瓣，无需初次减薄。
临床问题/证据水平：治疗性，IV。
