Su Yinghong, Xia Wenzheng, Li Haizhou, Huang Xin, Sun Yingfei, Gao Yashan, Zan Tao
From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Plast Reconstr Surg Glob Open. 2025 Aug 4;13(8):e7009. doi: 10.1097/GOX.0000000000007009. eCollection 2025 Aug.
Severe burn injuries may limit head and neck mobility while distorting facial features; they also place significant psychological strain on patients. The anterior thoracic area, similar in color and texture to the adjacent face-neck regions, often uses preexpanded flaps for reconstruction. Preexpanded internal mammary artery perforator (IMAP) flaps can further minimize donor area damage, provide a relatively thin flap for repairing large skin defects, and do not require an additional graft flap to close the donor site. In this article, we presented a case involving prolonged tissue expansion leading to an atypical vascular supply pattern within the patient's flap. The compression of ipsilateral vessels promoted a reconfiguration of choke vessels in the trans-perforasome zones, transforming them into functional vessels that serve as primary perforators for the preexpanded IMAP flap. This case validates and extends applications of perforasome theory within clinical settings. The perforasome is a 3-dimensional anatomical unit that comprises a single perforator vessel interconnected with adjacent perforators via either a true or choke vessel. These remodeled vessels subsequently served as the dominant perforator supplying the preexpanded IMAP flap. It also suggests that in instances of excessive expansion, the flap experienced ischemia and hypoxia, exhibiting a vascular remodeling process similar to "delayed" flaps. Therefore, this can be actively leveraged to execute intricate surgical procedures.
严重烧伤会限制头颈部活动并扭曲面部特征，还会给患者带来巨大心理压力。胸前区颜色和质地与相邻的面颈部区域相似，常用于预扩张皮瓣重建。预扩张的胸廓内动脉穿支（IMAP）皮瓣可进一步减少供区损伤，为修复大面积皮肤缺损提供相对较薄的皮瓣，且无需额外移植皮瓣来闭合供区。在本文中，我们介绍了一例因组织扩张时间延长导致皮瓣内血管供应模式异常的病例。同侧血管受压促使穿支体区域的阻塞血管重新配置，使其转变为功能性血管，作为预扩张IMAP皮瓣的主要穿支。该病例验证并拓展了穿支体理论在临床中的应用。穿支体是一个三维解剖单元，由单一穿支血管通过真血管或阻塞血管与相邻穿支相连组成。这些重塑后的血管随后成为供应预扩张IMAP皮瓣的主要穿支。这也表明，在过度扩张的情况下，皮瓣会经历缺血缺氧，呈现出类似于“延迟”皮瓣的血管重塑过程。因此，这可被积极利用来实施复杂的外科手术。
