同侧下肢双皮瓣提升术:腓骨骨皮瓣抬高的前方入路。

IF 1.4 4区 医学 Q3 SURGERY
Annals of Plastic Surgery Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI:10.1097/SAP.0000000000004046
Itaru Tsuge, Hiroki Yamanaka, Motoki Katsube, Michiharu Sakamoto, Naoki Morimoto
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引用次数: 0

摘要

摘要:游离腓骨皮瓣通过腓肠肌后缘的 "外侧入路 "提升已有 40 多年的历史。然而,在这种方法中,手术视野受到限制,因为下颌骨重建中的皮瓣提升是在仰卧位与肿瘤切除同时进行的,即使使用定位枕也是如此。我们在此提出 "前入路 "作为一种新的手术方法。我们回顾性地调查了七年来使用前路(包括三种前路)进行的游离腓骨瓣手术。首先,为避开腓浅神经的走向,在腓肠肌前缘后方 1-2 厘米处切开嵴筋膜。腓肠肌前缘与前肌间隔膜分离。在对腓骨远端和近端进行截骨后,从前方视角切开骨间膜。将腓骨拉至前肌间隔膜和腓肠肌之间的前方间隙,使手术视野变浅。55 例患者均未发现术后腓浅或腓深神经麻痹。55 例患者中有 31 例(56.4%)只使用了一次止血带,平均用时 95 分钟。24 名患者(43.6%)在间隔 38 分钟后需要第二次使用止血带。在过去 3 年中,30 例病例中有 25 例(83.3%)只使用过一次止血带。此外,21 例病例(38.2%)使用了双皮瓣,全部涉及同侧 ALT 皮瓣。有18例患者在耳鼻喉科医生完成肿瘤切除术前成功完成了双皮瓣的抬高和预制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Double-Flap Elevation From the Ipsilateral Lower Extremity: The Anterior Approach to Fibula Osteo-Cutaneous Flap Elevation.

Abstract: The free fibular flap has been elevated by a "lateral approach" from the posterior edge of the peroneal muscle for more than 40 years. However, in this approach, the surgical view is limited because flap elevation in mandibular reconstruction is performed simultaneously with tumor resection in the supine position, even when using positioning pillows. We herein propose an "anterior approach" as a new surgical method. We retrospectively investigated free fibular flap surgeries performed using the anterior approach, which consists of three anterior approaches, over a seven-year period. First, to avoid the course of the superficial peroneal nerve, the crural fascia was incised 1-2 cm posterior to the anterior edge of the peroneal muscle. The anterior edge of the peroneus muscle is detached from the anterior intermuscular septum. After performing osteotomies distal and proximal to the fibula, the interosseous membrane was incised from the anterior view. Pulling out the fibula to the anterior space between the anterior intermuscular septum and the peroneal muscle made the surgical field shallow. No postoperative superficial or deep peroneal nerve palsies were found in the 55 patients. Only one tourniquet was used in 31 of the 55 cases (56.4%), with an average of 95 min. Twenty-four patients (43.6%) required a second tourniquet 38 min after an interval. Only one tourniquet was used in 25 of the 30 (83.3%) cases in the last 3 years. Moreover, double flaps were used in 21 cases (38.2%), all of which involved ipsilateral ALT flaps. In 18 cases, double-flap elevation and prefabrication were successfully finished before the completion of tumor resection by otorhinolaryngologists.

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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
584
审稿时长
6 months
期刊介绍: The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.
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