Marr Kirsten L, Varga Aaron, Dumestre Danielle O
Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Plast Reconstr Surg Glob Open. 2021 Nov 24;9(11):e3933. doi: 10.1097/GOX.0000000000003933. eCollection 2021 Nov.
Cervical and thoracic spine reconstruction can be a difficult area to provide stable soft tissue coverage. Historically, trapezius myocutaneous flaps and trapezius muscle turnover flaps have proven to be reliable and versatile methods for the reconstruction of these areas. However, sequelae such as restriction of shoulder movement have been reported, as well as unsightly "humpback" contour deformities from turnover flap bulk. The use of the trapezius muscle for coverage has evolved to include descriptions of a trapezius perforator flap to address some of the issues of donor site morbidity, as it is described as a muscle-sparing technique. Although described as "muscle-sparing," these approaches nonetheless involve sacrifice of trapezius muscle overlying the pedicle as that musculature is "deroofed" and divided off the pedicle during dissection. In this article, we present a detailed technical description of our novel technique to the trapezius perforator flap using a dorsal scapular artery flap for spinal reconstruction that is truly, completely muscle-sparing. This technique may prove useful for those patients in which even minimal disruption of trapezius muscle fibers is undesirable.
颈椎和胸椎重建区域的软组织稳定覆盖可能具有挑战性。过去，斜方肌肌皮瓣和斜方肌翻转皮瓣已被证明是重建这些区域可靠且通用的方法。然而，已有报道称存在诸如肩部活动受限等后遗症，以及翻转皮瓣臃肿导致的难看的“驼背”轮廓畸形。利用斜方肌进行覆盖的方法不断发展，包括对斜方肌穿支皮瓣的描述，以解决一些供区并发症问题，因为它被描述为一种保留肌肉的技术。尽管被描述为“保留肌肉”，但这些方法在解剖过程中仍涉及牺牲覆盖在蒂部上方的斜方肌，因为在解剖时该肌肉组织被“掀开”并从蒂部分离。在本文中，我们详细介绍了一种新技术，即使用肩胛背动脉皮瓣进行脊柱重建的斜方肌穿支皮瓣，该技术真正、完全保留肌肉。对于那些即使斜方肌纤维受到最小程度破坏也不可取的患者，该技术可能会很有用。
