Neusner Alexander D, Pribaz Julian J, Guo Lifei
Division of Plastic and Reconstructive Surgery, Lahey Hospital & Medical Center, Burlington, Mass.
Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Tampa, Fla.
Plast Reconstr Surg Glob Open. 2022 Jun 15;10(6):e4384. doi: 10.1097/GOX.0000000000004384. eCollection 2022 Jun.
The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool. Although still requiring microsurgical skills, these flaps are of particular benefit in patients with few or poor quality recipient vessels, in those who cannot tolerate antiplatelet therapy, and in those who cannot tolerate the often-extended anesthesia time necessitated by microvascular anastomosis. Furthermore, pedicled flaps may significantly reduce total cost of a reconstruction procedure with similar outcomes. In this case series, we report challenging scenarios where microsurgical approaches may have been typical choices but were instead reconstructed by pedicled options with desired outcomes. Difficult soft tissue defects were successfully reconstructed with a variety of pedicled flaps. Soft tissue transfers to the abdomen, flank, shoulder, and back are presented. None of the reconstructions required microvascular anastomosis.
自整形外科早期以来，带蒂皮瓣一直是软组织重建的主要手段。手术技术和技能的进步导致带蒂皮瓣的使用减少，转而青睐日益流行的游离组织移植。尽管如此，无需微血管吻合的区域皮瓣仍然是一种有价值的重建工具。虽然这些皮瓣仍需要显微外科技术，但对于受区血管数量少或质量差的患者、不能耐受抗血小板治疗的患者以及不能耐受微血管吻合所需的通常较长麻醉时间的患者，这些皮瓣具有特别的益处。此外，带蒂皮瓣在取得相似效果的情况下可显著降低重建手术的总成本。在本病例系列中，我们报告了一些具有挑战性的情况，在这些情况下，显微外科方法可能是典型的选择，但取而代之的是采用带蒂皮瓣进行重建，并取得了理想的效果。通过各种带蒂皮瓣成功地重建了复杂的软组织缺损。展示了向腹部、侧腹、肩部和背部的软组织转移。所有重建均无需微血管吻合。
