用于手部和手指重建的螺旋桨穿支皮瓣：一项系统评价
Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review.
作者信息
Bovill John, Huffman Samuel, Cach Gina, Haffner Zoe, Deldar Romina, Abu El Hawa Areeg A, Sgromolo Nicole, Giladi Aviram M
机构信息
Georgetown University School of Medicine, Washington, Dist. of Columbia, United States.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, Dist. of Columbia, United States.
出版信息
J Hand Microsurg. 2024 May 14;16(2):100035. doi: 10.1055/s-0043-1768482. eCollection 2024 Jun.
BACKGROUND
Propeller perforator flaps (PPFs) have increased in popularity due to the freedom in design and ability to cover a variety of defects without sacrificing the major vessels. Present reports of PPFs for upper limb reconstruction have not provided guidance for hand reconstruction, specifically. This study aims to review the current literature and evaluate techniques for use of PPFs in hand reconstruction.
METHODS
A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published from 1991 to 2021. The database search was queried for records using appropriate Medical Subject Headings (MeSH) terms. Studies reporting PPFs were limited to English language and excluded lower extremity or upper extremity reconstruction not specific to defects in the hand or digits. Study characteristics, patient demographics, indications, preoperative testing, flap characteristics, flap survival, and complication rates were collected.
RESULTS
Out of the initial 1,348 citations yielded, 71 underwent full-text review. Ultimately, 25 unique citations were included encompassing 12 retrospective reviews (48%), 3 prospective cohort studies (10%), and 10 case series (40%). In review, 525 patients underwent reconstruction with a total of 613 propeller flaps performed to repair defects of the hand, digits, or both with use of 18 unique flap types. Overall flap survival was 97.8%. Acute wounds accounted for 72.9% of performed reconstructions. The mean flap coverage was 14.7 cm. Complications occurred in 19.8% of cases, with venous congestion and partial flap necrosis occurring in 5.5 and 6.5% of cases, respectively, leading to a flap failure rate of 2.1%.
CONCLUSION
PPFs are a reliable option for hand or digital reconstruction, allowing surgeons to cover a variety of defects without sacrificing local vasculature. Despite nearly a 20% reported complication rate, nearly all flaps with venous congestion and partial flap necrosis included in these articles resolved without the need for secondary intervention, retaining an excellent overall flap survival.
背景
螺旋桨穿支皮瓣（PPFs）因其设计的灵活性以及在不牺牲主要血管的情况下覆盖各种缺损的能力而越来越受欢迎。目前关于上肢重建中使用PPF的报道尚未专门为手部重建提供指导。本研究旨在回顾当前文献并评估PPF在手部重建中的应用技术。
方法
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对1991年至2021年发表的文章进行了全面的文献综述。使用适当的医学主题词（MeSH）检索数据库中的记录。报告PPF的研究限于英文，排除了下肢或上肢重建但非特定于手部或手指缺损的研究。收集了研究特征、患者人口统计学、适应证、术前检查、皮瓣特征、皮瓣存活情况和并发症发生率。
结果
在最初获得的1348篇文献中，71篇进行了全文审查。最终，纳入了25篇独特的文献，包括12篇回顾性综述（48%）、3篇前瞻性队列研究（10%）和10篇病例系列（40%）。经审查，525例患者接受了重建，共进行了613例螺旋桨皮瓣手术，以修复手部、手指或两者的缺损，使用了18种独特的皮瓣类型。皮瓣总体存活率为97.8%。急性伤口占所进行重建的72.9%。平均皮瓣覆盖面积为14.7平方厘米。19.8%的病例发生了并发症，静脉淤血和部分皮瓣坏死分别发生在5.5%和6.5%的病例中，导致皮瓣失败率为2.1%。
结论
PPF是手部或手指重建的可靠选择，使外科医生能够在不牺牲局部血管的情况下覆盖各种缺损。尽管报道的并发症发生率近20%，但这些文章中几乎所有出现静脉淤血和部分皮瓣坏死的皮瓣均无需二次干预即可恢复，皮瓣总体存活率良好。
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