Cho B C, Lee J H, Ramasastry S S, Baik B S
Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Taegu, Korea.
Ann Plast Surg. 1997 Jun;38(6):586-93. doi: 10.1097/00000637-199706000-00004.
Endoscopic techniques in plastic surgery have involved aesthetic procedures such as facelift, breast augmentation, abdominoplasty, and placement of tissue expanders. Recently, endoscopic harvest of the donor tissue for free flap transfer has included the omentum, jejunum, latissimus dorsi muscle, and rectus abdominis muscle. Ten patients with a soft-tissue defect in the lower extremity were successfully reconstructed from December 1994 to October 1995 with a free muscle transfer after endoscopic harvest of the latissimus dorsi muscle. Nine patients were male and 1 patient was female. A 5- to 6-cm incision was initially made along the posterior axillary line, allowing direct identification of the thoracodorsal vascular pedicle. The latissimus dorsi muscle was dissected posteriorly until the limits of open dissection were reached, and then the dissection was continued under endoscopic visualization. The largest harvested muscle was 15 x 25 cm in size. Follow-up ranged from 6 to 15 months. We believe that plastic surgeons can take advantage of endoscopic techniques to obtain reliable and safe results, with smaller scars and reduced postoperative donor site morbidity such as pain and wound-healing problems. This technique may prove particularly applicable to women, children, and patients who are prone to hypertrophic scars.
整形手术中的内镜技术已应用于诸如面部提升、隆胸、腹部整形以及组织扩张器置入等美容手术。近来，用于游离皮瓣移植的供体组织的内镜获取已包括大网膜、空肠、背阔肌和腹直肌。1994年12月至1995年10月期间，10例下肢软组织缺损患者在内镜获取背阔肌后成功进行了游离肌肉移植重建。9例为男性，1例为女性。最初沿腋后线做一个5至6厘米的切口，以便直接识别胸背血管蒂。将背阔肌向后方解剖，直至达到开放解剖的极限，然后在内镜直视下继续解剖。获取的最大肌肉尺寸为15×25厘米。随访时间为6至15个月。我们认为，整形外科医生可以利用内镜技术获得可靠且安全的结果，瘢痕更小，术后供区发病率降低，如疼痛和伤口愈合问题。该技术可能被证明特别适用于女性、儿童以及容易形成增生性瘢痕的患者。
