Department of Plastic Surgery, Armed Forces Capital Hospital, Bundang-gu, Seongnam-City, Gyeonggi-do.
Ewha Medical Academy, Ewha Womans University Medical Center, Seoul.
J Craniofac Surg. 2023 Oct 1;34(7):2161-2162. doi: 10.1097/SCS.0000000000009349. Epub 2023 May 29.
The aim of this study was to introduce teaching models for correct rhombic flaps. For the line of maximal extensibility (LME) and flap design, surgical fabric (model 1), scored corrugated cardboard (model 2), and scored polyethylene sheet (model 3) were used. For choosing the correct flaps, a silicone face (model 4) was used. Seven participants in the Plastic Surgery Department were recruited for the workshop. In models 1 to 3, a 2-cm diameter circle and relaxed skin tension line were indicated. Participants were requested to design Limberg flaps. Each flap was elevated, transposed, and fixed with sutures (model 1) or cellophane tape (models 2 and 3). In model 4, a 1-cm diameter circle was indicated on the cheek. Participants were requested to design correct Limberg flaps. Although participants were not provided an article describing how to create correct Limberg flaps, they eventually created correct flaps through trial and error. Participants drew 2 parallel lines tangential to the defect and following the LME, perpendicular to the relaxed skin tension lines, which are the same as the scoring marks. They then drew 2 other sides of 2 possible parallelograms by tilting them medially and laterally with angles of 60 and 120 degrees each. Thus, 4 possible Limberg flaps to close the defect were drawn. Among the 8 possible flaps, 4 flaps that did not follow the LME were eliminated. Scored polyethylene sheet had the best extensibility and least distortion among the 3 models. Through this workshop, participants learned to design rhombic flaps correctly, using 2 parallel LMEs.
本研究旨在介绍正确菱形皮瓣的教学模式。为了设计直线最大伸展线（LME）和皮瓣，我们使用了手术用织物（模型 1）、有划痕的波纹纸板（模型 2）和有划痕的聚乙烯薄片（模型 3）。为了选择正确的皮瓣，我们使用了硅橡胶脸模（模型 4）。我们招募了整形外科的 7 名参与者参加了这个工作坊。在模型 1 到 3 中，我们标记了一个 2 厘米直径的圆圈和放松皮肤张力线。参与者被要求设计 Limberg 皮瓣。每个皮瓣被提升、转移并缝合固定（模型 1）或用玻璃纸胶带固定（模型 2 和 3）。在模型 4 中，我们在脸颊上标记了一个 1 厘米直径的圆圈。参与者被要求设计正确的 Limberg 皮瓣。尽管参与者没有提供描述如何创建正确 Limberg 皮瓣的文章，但他们通过反复试验最终成功创建了正确的皮瓣。参与者先沿着缺陷画两条与 LME 相切的平行线，然后垂直于放松皮肤张力线，这些线与划痕标记相同。然后，他们将两条线向内和向外倾斜 60 度和 120 度，画出两个可能的平行四边形的另外两条边。这样，就画出了 4 个可能用来闭合缺陷的 Limberg 皮瓣。在 8 个可能的皮瓣中，有 4 个不遵循 LME 的皮瓣被排除。在这 3 个模型中，有划痕的聚乙烯薄片的延展性最好，变形最小。通过这个工作坊，参与者学会了使用两条平行的 LME 正确设计菱形皮瓣。
