Kondo Akatsuki, Dohi Teruyuki, Izumi Nikki, Ochi Tomohiro, Ogawa Rei
Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2021 Feb 17;9(2):e3404. doi: 10.1097/GOX.0000000000003404. eCollection 2021 Feb.
We previously reported cases of anterior-neck reconstruction using super-thin and perforator-supercharged skin-pedicled flaps harvested from the pectoral area and back. Here, we reconstructed a neck-scar contracture with a long skin-pedicled flap from the pectoral area that survived without congestion despite not being supercharged with a perforator, as planned. The patient, a 67-year-old man, was admitted to our hospital due to neck-scar contracture after a chemical burn 3 years previously. During surgery, the scar was resected above the platysma. A large, 19 × 6-cm skin-pedicled flap was elevated from the left pectoral area. We planned to supercharge the flap by anastomosing the second intercostal perforator to the flap periphery but could not confirm the perforator intraoperatively. To promote flap survival, we did not elevate the flap pedicle more than absolutely necessary and then manipulated the flap very carefully. The flap survived fully and the contracture was effectively released. Thin flaps are useful for reconstructing exposed areas such as the face, neck, and dorsum of the hands that require good outcomes in terms of both function and aesthetics. However, if the flap is too large, ischemia/congestion could arise in the periphery unless the blood flow is stabilized by attaching a perforator. In our case, supercharging was not possible and we had to resort to careful intraoperative maneuvers to ensure flap survival. This approach was successful and suggests that although supercharging of thin and large flaps is preferred, unexpectedly unsuperchargeable flaps can be rescued by careful and finely tuned surgical judgment and techniques.
我们之前报道过使用从胸部和背部切取的超薄及穿支血管增强型皮肤蒂皮瓣进行颈前重建的病例。在此，我们用一块来自胸部的长皮肤蒂皮瓣修复了颈部瘢痕挛缩，尽管未按计划用穿支血管进行增强，但该皮瓣存活且未出现充血。患者为一名67岁男性，3年前因化学烧伤后颈部瘢痕挛缩入院。手术中，在颈阔肌上方切除瘢痕。从左胸部切取了一块19×6厘米的大皮肤蒂皮瓣。我们原计划将第二肋间穿支血管吻合到皮瓣边缘以增强皮瓣血供，但术中未能确认该穿支血管。为促进皮瓣存活，我们尽可能减少皮瓣蒂部的游离，并小心操作皮瓣。皮瓣完全存活，挛缩得到有效松解。薄皮瓣对于修复面部、颈部和手背等外露部位很有用，这些部位在功能和美观方面都需要良好的效果。然而，如果皮瓣过大，除非通过连接穿支血管稳定血流，否则周边可能会出现缺血/充血。在我们的病例中，无法进行穿支血管增强，我们不得不依靠术中的仔细操作来确保皮瓣存活。这种方法是成功的，这表明尽管超薄及大皮瓣首选进行穿支血管增强，但对于意外无法进行增强的皮瓣，可通过仔细且精细调整的手术判断和技术挽救。
