Serafin D, Georgiade N G
Ann Surg. 1978 Jun;187(6):620-8. doi: 10.1097/00000658-197806000-00006.
Since 1974, 69 patients with extensive defects have undergone reconstruction by microsurgical composite tissue transplantation. Using this method, donor composite tissue is isolated on its blood supply, removed to a distant recipient site, and the continuity of blood flow re-established by microvascular anastomoses. In this series, 56 patients (81%) were completely successful. There have been eight (12%) failures, primarily in the extremities. There have been five (7%) partial successes, (i.e., a microvascular flap in which a portion was lost requiring a secondary procedure such as a split thickness graft). In those patients with a severely injured lower extremity, the failure rate was the greatest. Most of these were arterial (six of seven). These failures occurred early in the series and were thought to be related to a severely damaged recipient vasculature. This problem has been circumvented by an autogenous interpositional vein graft, permitting more mobility of flap placement. In the upper extremity, all but one case were successful. Early motion was permitted, preventing joint capsular contractures and loss of function. Twenty-three cases in the head and neck region were successful (one partial success). This included two composite rib grafts to the mandible. Prolonged delays in reconstruction following extirpation of a malignancy were avoided. A rapid return to society following complete reconstruction was ensured. Nine patients presented for reconstruction of the breast and thorax following radical mastectomy. All were successfully reconstructed with this new technique except one patient. Its many advantages include immediate reconstruction without delayed procedures and no secondary deformity of the donor site. Healthy, well vascularized tissue can now be transferred to a previously irradiated area with no tissue loss. This new method offers many advantages to older methods of reconstruction. Length of hospital stay and immobilization are reduced. The total number of operative procedures required in achieving the desired result is also less, thus decreasing the cost of hospital care.
自1974年以来，69例有大面积缺损的患者接受了显微外科复合组织移植重建手术。采用这种方法，供体复合组织在其血供基础上被分离出来，转移到远处的受区，通过微血管吻合重建血流的连续性。在这组病例中，56例（81%）完全成功。有8例（12%）失败，主要发生在四肢。有5例（7%）部分成功（即微血管皮瓣部分坏死，需要进行二期手术，如断层皮片移植）。在那些下肢严重受伤的患者中，失败率最高。其中大多数是动脉性的（7例中有6例）。这些失败发生在该系列手术的早期，被认为与受区血管严重受损有关。通过自体静脉移植解决了这个问题，使皮瓣放置更具灵活性。在上肢，除1例之外均获成功。允许早期活动，防止关节囊挛缩和功能丧失。头颈部区域的23例手术成功（1例部分成功）。这包括两例下颌骨复合肋骨移植。避免了恶性肿瘤切除后重建的长时间延迟。确保了完全重建后能迅速回归社会。9例患者在根治性乳房切除术后接受乳房和胸部重建。除1例患者外，所有患者均通过这项新技术成功重建。其诸多优点包括无需延迟手术即可立即重建，供区无继发畸形。现在可以将健康、血运良好的组织转移到先前接受过放疗的区域，且无组织丢失。这种新方法比旧的重建方法有许多优势。缩短了住院时间和固定时间。为达到预期效果所需的手术总次数也减少了，从而降低了住院费用。
