Bass L S, Karp N S, Benacquista T, Kasabian A K
Institute of Reconstructive Plastic Surgery, New York University Medical Center, NY., USA.
Ann Plast Surg. 1995 Mar;34(3):274-9; discussion 279-80. doi: 10.1097/00000637-199503000-00009.
Free-flap donor sites are a frequent source of morbidity, including scar deformity and reduced mobility, as well as a significant contributor to recovery time after surgery. We present our technique for endoscopic harvest of the rectus abdominis muscle. A groin crease incision is made, which allows identification of the vascular pedicle and access to the inferior portion of the muscle. A balloon dissection device is inserted along the posterior rectus sheath and inflated. The inferior incision is closed over an endoscopic port after medial and lateral ports are inserted under direct vision at the level of the umbilicus. The cavity is insufflated with carbon dioxide, allowing visualization using a 10-mm, 30-degree endoscope. The remaining dissection is performed sharply, and the muscle is harvested via the groin incision. This technique has proved feasible during study in fresh human cadavers. Insufflation greatly reduces work load with retractors. The balloon device speeds dissection with a minimum of trauma. Because all dissection is performed from within the rectus sheath, the peritoneal cavity is not violated. Endoscopic rectus abdominis harvest using the fascial plane is safe and efficient and carries the potential to reduce donor-site morbidity.
游离皮瓣供区是常见的发病原因，包括瘢痕畸形和活动度降低，也是术后恢复时间延长的重要因素。我们介绍了内镜下获取腹直肌的技术。做一个腹股沟皱襞切口，这样可以识别血管蒂并进入肌肉下部。将球囊剥离装置沿腹直肌后鞘插入并充气。在内镜直视下于脐水平插入内侧和外侧端口后，在内镜端口上方关闭下部切口。向腔内注入二氧化碳，使用10毫米、30度的内窥镜进行观察。其余的剥离操作采用锐性分离，通过腹股沟切口获取肌肉。在新鲜人体尸体研究中，该技术已证明是可行的。注入气体大大减少了牵开器的工作量。球囊装置以最小的创伤加快了剥离速度。由于所有剥离操作均在腹直肌鞘内进行，未侵犯腹膜腔。使用筋膜平面进行内镜下腹直肌获取是安全有效的，有可能降低供区发病率。
