Sơn Trần T, Việt Dung Phạm T, Hồng Thuý Tạ T, Nhật Phạm K, Sekido Mitsuru, Nghĩa Phan T
Department of Plastic and Reconstructive Surgery, Hanoi Medical University, No 1 Ton That Tung, Kim Lien, Dong Da, Ha Noi 116177, Vietnam.
Department of Plastic Reconstructive and Aesthetic Surgery, University of Medicine and Pharmacy, Hanoi National University, No 144 Xuan Thuy, Dich Vong Hau, Cau Giay, Ha Noi 123105, Vietnam.
J Surg Case Rep. 2025 Apr 8;2025(4):rjaf201. doi: 10.1093/jscr/rjaf201. eCollection 2025 Apr.
Complex soft tissue defects in the lower limb pose significant challenges for surgeons, especially when extensive coverage is needed. Free flaps are preferred for their reliable soft tissue, with the deep inferior epigastric perforator (DIEP) flap being particularly advantageous in middle-aged women due to its ample tissue and the ability to perform abdominoplasty at the donor site. However, its bulkiness can be an issue for lower limb reconstruction. We present two cases where the DIEP flap was used for lower limb reconstruction with immediate flap thinning. By employing a unique thinning method based on the vascular connection between perforators, we successfully extended the flap's use without needing to anastomose the pedicles. All flaps were well-vascularized with no complications, demonstrating that maintaining the anterior fascia between perforators optimizes the DIEP flap for reconstructive purposes.
下肢复杂的软组织缺损给外科医生带来了巨大挑战，尤其是在需要大面积覆盖时。游离皮瓣因其可靠的软组织而成为首选，腹壁下深动脉穿支（DIEP）皮瓣在中年女性中特别具有优势，因为其组织丰富，且能够在供区进行腹壁成形术。然而，其体积较大可能会成为下肢重建的一个问题。我们介绍两例使用DIEP皮瓣进行下肢重建并立即进行皮瓣减薄的病例。通过采用基于穿支血管连接的独特减薄方法，我们成功地扩展了皮瓣的应用范围，而无需吻合蒂部。所有皮瓣血运良好，无并发症，表明保留穿支之间的前筋膜可优化DIEP皮瓣用于重建目的。
