Isbester Kelsey A, Ferrin Peter, Krakauer Kelsi N, Peters Blair R
From the Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, Oreg.
Department of Surgery, Oregon Health and Science University, Portland, Oreg.
Plast Reconstr Surg Glob Open. 2023 Sep 1;11(9):e5241. doi: 10.1097/GOX.0000000000005241. eCollection 2023 Sep.
Sensate flaps are increasingly used in diverse areas of plastic surgery. Concurrently, modern techniques in neuroma prevention have emerged, such as regenerative peripheral nerve interface (RPNI). Despite increasing use of sensate flaps, the combined use of donor-site neuroma prevention techniques has yet to be described. We report on the use of primary donor-site RPNI at the time of sensate anterolateral thigh (ALT) reconstructions. In ALT flaps, the vastus lateralis muscle can be segmentally devascularized from perforator dissection. These segments of devascularized vastus lateralis muscle can easily be used and repurposed as the free muscle grafts needed for RPNI, providing a physiologic target for the regenerating neurons. Donor-site neuroma has not been shown to be a significant issue at standard ALT flap donor sites. Sensate ALT flaps involve harvest of the lateral femoral cutaneous nerve and/or additional femoral sensory branches at a more proximal location close to the level of the anterior superior iliac spine, where injury to the lateral femoral cutaneous nerve may be associated with pain. In this series, eight patients underwent senate ALT flaps with the use of primary RPNI at the sensate ALT donor site. At a mean follow-up of 16.3 months (range 5-25 months), there was minimal to no nerve pain and no clinical evidence of donor-site neuroma. As sensate flap reconstructions are increasingly performed in plastic surgery and data on neuroma prevention techniques continue to grow, we propose consideration of their combined use.
感觉皮瓣在整形外科的各个领域应用越来越广泛。与此同时，诸如再生周围神经接口（RPNI）等预防神经瘤的现代技术也已出现。尽管感觉皮瓣的使用越来越多，但供区神经瘤预防技术的联合应用尚未见报道。我们报告了在感觉股前外侧（ALT）皮瓣重建时使用供区原位RPNI的情况。在ALT皮瓣中，股外侧肌可通过穿支解剖进行节段性去血管化。这些去血管化的股外侧肌节段可轻松用作RPNI所需的游离肌移植物，为再生神经元提供生理靶点。在标准ALT皮瓣供区，供区神经瘤尚未被证明是一个重大问题。感觉ALT皮瓣需要在靠近髂前上棘水平的更近端位置切取股外侧皮神经和/或其他股感觉支，在此处股外侧皮神经损伤可能会引起疼痛。在本系列研究中，8例患者在感觉ALT皮瓣供区使用了原位RPNI进行感觉ALT皮瓣手术。平均随访16.3个月（范围5 - 25个月），神经疼痛轻微或无疼痛，且无供区神经瘤的临床证据。随着整形外科中感觉皮瓣重建手术越来越多，且预防神经瘤技术的数据不断增加，我们建议考虑联合使用这些技术。
