Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, 200-00128 Rome, Italy; Research Unit of Plastic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 21-00128 Rome, Italy.
Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, 200-00128 Rome, Italy.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:227-235. doi: 10.1016/j.bjps.2024.01.055. Epub 2024 Feb 2.
Lack of adequate recipient vessels in certain anatomically unfavorable locations or in complex clinical situations is still a limitation to successful microsurgical transfer. To address such complex cases, advanced microsurgical techniques should be applied. In this paper, the authors describe their experience with the Extra-anatomical Pedicle Rerouting (EPR) technique, an alternative approach that was used in selected cases throughout the body to obtain healthy recipient vessels for microsurgical reconstruction in unfavorable clinical situations where suitable recipient vessels were difficult to find.
Fifteen patients with defects of variable etiology (oncological resection, trauma, previous surgeries) located in the trunk or upper and lower extremities received EPR free flap reconstruction at our Institution. Operative data, postoperative course, and complications were recorded. Clinical and photographic follow-ups were also documented.
A total of 15 flaps (6 antero-lateral thigh (ALT), 6 latissimus dorsi/thoracodorsal artery perforator flap (LD/TDAP), 3 deep inferior epigastric artery perforator flap (DIEP)) were transferred adopting the EPR technique for oncological (11) and post-traumatic (4) defects. According to the different clinical scenarios, the rerouted vessels were the thoraco-acromial, posterior circumflex humeral, thoracodorsal, deep inferior epigastric, lateral circumflex femoral, anterior tibial, and medial sural pedicles. Mean length of the rerouted vascular conduits was 6.53 cm. Mean operative time was 420 minutes. No major complications were registered. Minor wound dehiscence was observed and managed conservatively in 3 patients.
The EPR technique proved to be useful in a reliable and reproducible manner in different regions of the body as an alternative solution to obtain healthy recipient vessels in anatomically and surgically unfavorable clinical situations.
在某些解剖位置不利或复杂临床情况下，缺乏足够的受区血管仍然是成功进行显微外科转移的限制因素。为了解决这些复杂的病例，应应用先进的显微外科技术。本文作者描述了他们在解剖外蒂重新布线（EPR）技术方面的经验，该技术是一种替代方法，可在整个身体的选定病例中使用，以获得健康的受区血管，用于在难以找到合适受区血管的不利临床情况下进行显微重建。
本机构对 15 名患有不同病因（肿瘤切除、创伤、先前手术）的患者进行了 EPR 游离皮瓣重建，这些患者的缺陷位于躯干或上下肢。记录了手术数据、术后过程和并发症。还记录了临床和摄影随访。
共 15 个皮瓣（6 个前外侧股（ALT），6 个背阔肌/胸背动脉穿支皮瓣（LD/TDAP），3 个深部腹壁下动脉穿支皮瓣（DIEP））采用 EPR 技术转移，用于治疗 11 例肿瘤和 4 例创伤后缺陷。根据不同的临床情况，重新布线的血管是胸锁乳突肌、旋肱后、胸背、腹壁下、旋股外侧、胫前和腓肠内侧皮蒂。重新布线的血管平均长度为 6.53cm。平均手术时间为 420 分钟。未发生重大并发症。3 例患者出现轻微伤口裂开，保守治疗。
EPR 技术在不同身体部位被证明是一种可靠且可重复的方法，作为在解剖和手术位置不利的临床情况下获得健康受区血管的替代方法。
