分离式大腿前外侧皮瓣:解剖变异的新分类和手术规划算法。

IF 2.2 3区 医学 Q2 SURGERY
Journal of reconstructive microsurgery Pub Date : 2024-07-01 Epub Date: 2024-01-11 DOI:10.1055/a-2242-7194
Hsiang-Shun Shih, Ting-Han Chiu, Seng-Feng Jeng, Jill Chen
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引用次数: 0

摘要

背景:分割大腿前外侧皮瓣是一种多功能的重建选择,但长期以来一直被低估,因为没有实用的穿孔分类和最佳策略。采集 "毛细血管非大小穿孔器 "有可能将皮瓣分离范围扩大到那些没有多个大小穿孔器的患者。在设计合适的皮瓣时,对缺损特征、受瓣血管、皮瓣蒂长度和分割时机的考虑应同等重要。因此,需要进行精细化设计,以实现精确的重建:方法:纳入2014年至2021年期间由一名外科医生进行大腿前外侧皮瓣采集的所有患者。方法:纳入2014年至2021年期间由单个外科医生进行大腿前外侧皮瓣采集的所有患者,记录穿孔器的大小梗、走向、起源和进一步成功的皮瓣分割方法。对皮瓣存活率的手术结果进行了分析:结果:在总共 277 个大腿前外侧皮瓣中发现了 134 个(48.4%)双穿孔器、123 个(44.4%)单穿孔器和 20 个(7.2%)无大小穿孔器的解剖变异。皮瓣总存活率为 97.5%。通过使用一系列直接皮瓣分割、毛细血管无大小穿孔器采集和流式吻合技术,对82个皮瓣进行了皮瓣分割,其中包括29个以前被认为 "不可分割 "的单穿孔器皮瓣和5个无大小穿孔器皮瓣。结果发现,分割皮瓣和非分割皮瓣的存活率相当,由可扩张穿孔器和毛细血管不可扩张穿孔器供应的分割区段的存活率也相当。98.9%的大腿供体部位实现了原发性闭合:结论:对常见的大腿前外侧皮瓣解剖变异提出了新的分类方法,并结合创新的 "制作 "概念,制定了一套全面的分割皮瓣策略算法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm.

Background:  Split anterolateral thigh flap is a versatile reconstruction option, yet long underestimated as no practical perforator classification and no optimal strategy were present. Harvesting "capillary nonsizable perforators" could potentially expand flap splits to those with no existing multiple sizable perforators. Concerns over defect characteristics, recipient vessels, pedicle length, and split timing should all be weighted equally in designing the suitable flap. Refinement is thus required to enable precise reconstructions.

Methods:  All patients undergoing anterolateral thigh flap harvests between 2014 and 2021 performed by a single surgeon were included. The perforator patterns of sizable pedicle, course, origin, and further successful flap-split methods were documented. Surgical outcome of flap survival was analyzed.

Results:  Anatomical variants of 134 (48.4%) dual, 123 (44.4%) single, and 20 (7.2%) no sizable perforators were found in a total of 277 anterolateral thigh flaps. The overall flap survival rate was 97.5%. Flap split was performed in 82 flaps, including 29 single and 5 no sizable perforator cases previously considered "unsplittable," by utilizing a series of direct skin paddle split, capillary nonsizable perforators harvesting, and flow-through anastomosis technique. Comparable flap survivals were found between split and nonsplit flaps as well as between split segments supplied by sizable and capillary nonsizable perforators. Primary closure was achieved in 98.9% of the thigh donor sites.

Conclusion:  A new classification of the common anterolateral thigh flap anatomical variants was proposed and a comprehensive algorithm of split flap strategy was developed along with the innovative "fabricate" concept.

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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
期刊介绍: The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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