A brief discussion on the harvest of thinned perforator flap, detection of perforator vessels, and evaluation of flap blood supply
-
摘要: 修复重建不仅仅是对不同部位组织器官缺损的简单修复和再造，更需要与缺损匹配、以假乱真的完美修复，穿支皮瓣的薄型化策略就是其主要内容之一。近年来，单纯皮肤穿支皮瓣理念及其临床应用颠覆了以往皮瓣必须携带真皮下血管网的传统观念，拓展了人们对皮瓣外科的认知程度，有望提高修复重建水平。该文针对穿支皮瓣的薄型化切取，特别是最新的厚度类似于全厚皮的单纯皮肤穿支皮瓣的切取，以及穿支血管的术前探测、穿支皮瓣的血运评估及其临床研究进行探讨，提出与受区缺损完美匹配的“金缮”修复，还对单纯皮肤穿支皮瓣的穿支体区和三维可视化数字解剖等研究进行了展望。Abstract: Repair and reconstruction surgery is not just a simple repair and reconstruction of tissue and organ defects in different parts, but also requires perfect repair that matches the defect and confuses the real. The thinning strategy of perforator flap is one of its main contents. In recent years, the concept of pure skin perforator flap and its clinical application have overturned the traditional concept that flaps must carry subdermal vascular plexus and improved our understanding of flap surgery, and it is expected to enhance the level of repair and reconstruction. This article explores the harvest of thinned perforator flaps, especially the harvest of innovative pure skin perforator flap with the thickness similar to full thickness skin, as well as the preoperative detection of perforator vessels, blood supply evaluation of perforator flaps, and their clinical applications. It proposes a "Jinshan" repair that perfectly matches the recipient area defect, and also prospects research on the perforasome and three-dimensional visualized digital anatomy of pure skin perforator flaps.
-
[1] FanS, ZhangHQ, LiQX, et al. The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: a pilot study[J]. Plast Reconstr Surg, 2018, 141(6):902e-910e. DOI: 10.1097/PRS.0000000000004411. [2] 张世民,唐茂林,穆广态,等.穿支皮瓣及相关术语的专家共识[J].中国临床解剖学杂志,2010,28(5):475-477.DOI: 10.13418/j.issn.1001-165x.2010.05.001. [3] TaylorGI,PalmerJH.The vascular territories (angiosomes) of the body: experimental study and clinical applications[J].Br J Plast Surg,1987,40(2):113-141.DOI: 10.1016/0007-1226(87)90185-8. [4] KoshimaI,SoedaS.Inferior epigastric artery skin flaps without rectus abdominis muscle[J].Br J Plast Surg,1989,42(6):645-648.DOI: 10.1016/0007-1226(89)90075-1. [5] AllenRJ,TreeceP.Deep inferior epigastric perforator flap for breast reconstruction[J].Ann Plast Surg,1994,32(1):32-38.DOI: 10.1097/00000637-199401000-00007. [6] Saint-CyrM,WongC,SchaverienM,et al.The perforasome theory: vascular anatomy and clinical implications[J].Plast Reconstr Surg,2009,124(5):1529-1544.DOI: 10.1097/PRS.0b013e3181b98a6c. [7] PignattiM,OgawaR,HallockGG,et al.The "Tokyo" consensus on propeller flaps[J].Plast Reconstr Surg,2011,127(2):716-722.DOI: 10.1097/PRS.0b013e3181fed6b2. [8] 计鹏, 曹涛, 张智, 等. 股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果[J]. 中华烧伤与创面修复杂志, 2023, 39(10): 926-932. DOI: 10.3760/cma.j.cn501225-20230627-00232. [9] ThomasCV.Thin flaps[J].Plast Reconstr Surg,1980,65(6):747-752.DOI: 10.1097/00006534-198006000-00006. [10] HyakusokuH,GaoJH.The "super-thin" flap[J].Br J Plast Surg,1994,47(7):457-464.DOI: 10.1016/0007-1226(94)90027-2. [11] KimuraN.A microdissected thin tensor fasciae latae perforator flap[J].Plast Reconstr Surg,2002,109(1):69-77; discussion 78-80.DOI: 10.1097/00006534-200201000-00012. [12] NarushimaM,YamasobaT,IidaT,et al.Pure skin perforator flap for microtia and congenital aural atresia using supermicrosurgical techniques[J].J Plast Reconstr Aesthet Surg,2011,64(12):1580-1584.DOI: 10.1016/j.bjps.2011.07.005. [13] NarushimaM,YamasobaT,IidaT,et al.Supermicrosurgical reconstruction for congenital aural atresia using a pure skin perforator flap: concept and long-term results[J].Plast Reconstr Surg,2013,131(6):1359-1366.DOI: 10.1097/PRS.0b013e31828bd466. [14] 武雷, 丁英状, 郝敏如, 等. 两种下腹部组织瓣修复四肢大面积皮肤软组织缺损后患者的腹部功能与外形[J]. 中华烧伤与创面修复杂志, 2023, 39(10): 959-967. DOI: 10.3760/cma.j.cn501225-20230428-00145. [15] KwonJG, BrownE, SuhHP, et al. Planes for perforator/skin flap elevation-definition, classification, and techniques[J]. J Reconstr Microsurg, 2023, 39(3):179-186. DOI: 10.1055/s-0042-1750127. [16] DrimourasG, KostopoulosE, AgiannidisC, et al. Redefining vascular anatomy of posterior tibial artery perforators: a cadaveric study and review of the literature[J]. Ann Plast Surg, 2016,76(6):705-712. DOI: 10.1097/SAP.0000000000000258. [17] 王辉,杨晓溪,霍永鑫,等.尺动脉穿支血管链皮瓣修复吻合血管的前臂远端或腕部创面的临床效果[J].中华烧伤杂志,2021,37(7):635-639.DOI: 10.3760/cma.j.cn501120-20200422-00234. [18] 刘洋,宋达疆,谢松林,等.游离修薄腹壁下动脉穿支皮瓣修复四肢大面积软组织缺损的临床效果[J].中华烧伤杂志,2020,36(7):590-593.DOI: 10.3760/cma.j.cn501120-20190415-00185. [19] 韩春梅,彭剑飞,贾献磊,等.修薄的股前外侧穿支皮瓣修复多个手指软组织缺损[J].中华显微外科杂志,2019,42(4):391-393.DOI: 10.3760/cma.j.issn.1001-2036.2019.04.020. [20] GohTLH, ParkSW, ChoJY,et al.The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap--a review of 210 cases[J].Plast Reconstr Surg,2015,135(2):592-601.DOI: 10.1097/PRS.0000000000000951. [21] KehrerA, SachanadaniNS, da SilvaNPB,et al.Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - basic and advanced applications and device settings[J].J Plast Reconstr Aesthet Surg,2020,73(6):1081-1090.DOI: 10.1016/j.bjps.2019.11.035. [22] InnocentiM,CalabreseS,TaniniS,et al.A safer way to harvest a superthin perforator flap[J].Plast Reconstr Surg,2021,147(3):466-469.DOI: 10.1097/PRS.0000000000007676. [23] ChetbounA,MasqueletAC.Experimental animal model proving the benefit of primary defatting of full-thickness random-pattern skin flaps by suppressing "perfusion steal"[J].Plast Reconstr Surg,2007,120(6):1496-1502.DOI: 10.1097/01.prs.0000282039.99450.9d. [24] NarushimaM, YamasobaT, IidaT, et al. Pure skin perforator flaps: the anatomical vascularity of the superthin flap[J]. Plast Reconstr Surg, 2018, 142(3):351e-360e. DOI: 10.1097/PRS.0000000000004698. [25] YamamotoT, YamamotoN, FuseY, et al. Subdermal dissection for elevation of pure skin perforator flaps and superthin flaps: the dermis as a landmark for the most superficial dissection plane[J]. Plast Reconstr Surg, 2021, 147(3):470-478. DOI: 10.1097/PRS.0000000000007689. [26] SuWJ,LuLG,LazzeriD,et al.Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning[J].Plast Reconstr Surg,2013,131(1):80-93.DOI: 10.1097/PRS.0b013e3182729e9e. [27] GaoYS, YuanYW, LiHZ, et al. Preoperative imaging for thoracic branch of supraclavicular artery flap: a comparative study of contrast-enhanced ultrasound with three-dimensional reconstruction and color duplex ultrasound[J]. Ann Plast Surg, 2016, 77(2):201-205. DOI: 10.1097/SAP.0000000000000601. [28] YoshimatsuH, HayashiA, YamamotoT, et al. Visualization of the "intradermal plexus" using ultrasonography in the dermis flap: a step beyond perforator flaps[J]. Plast Reconstr Surg Glob Open, 2019, 7(11):e2411. DOI: 10.1097/GOX.0000000000002411. [29] IzzettiR,OrangesT,JanowskaA,et al.The application of ultra-high-frequency ultrasound in dermatology and wound management[J].Int J Low Extrem Wounds,2020,19(4):334-340.DOI: 10.1177/1534734620972815. [30] OnoS, HayashiH, OhiH, et al. Imaging studies for preoperative planning of perforator flaps: an overview[J]. Clin Plast Surg, 2017, 44(1):21-30. DOI: 10.1016/j.cps.2016.09.004. [31] 张月恒,崔文举,宋坤修,等.改良CT血管造影术辅助基于浅筋膜穿支的股前外侧皮瓣穿支评估与偏心设计的前瞻性研究[J].中华烧伤与创面修复杂志,2023,39(2):141-149.DOI: 10.3760/cma.j.cn501225-20220902-00376. [32] 贺继强,唐举玉,卿黎明,等.动脉插管造影CTA与普通CTA显影股前外侧穿支的比较研究[J].中国临床解剖学杂志,2017,35(5):508-512.DOI: 10.13418/j.issn.1001-165x.2017.05.007. [33] KhoongYM,HuangX,GuSC,et al.Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL].Burns Trauma,2021,9:tkab042[2023-08-12]. https://pubmed.ncbi.nlm.nih.gov/34926708/.DOI: 10.1093/burnst/tkab042. [34] HuangX, LiH, GuS, et al. Intraoperative indocyanine green angiography facilitates flap fenestration and facial organ fabrication in total facial restoration[J/OL]. Plast Reconstr Surg, 2023(2023-06-28) [2023-08-12]. https://pubmed.ncbi.nlm.nih.gov/37382913/. DOI: 10.1097/PRS.0000000000010891. [published online ahead of print]. [35] HitierM,CracowskiJL,HamouC,et al.Indocyanine green fluorescence angiography for free flap monitoring: a pilot study[J].J Craniomaxillofac Surg,2016,44(11):1833-1841.DOI: 10.1016/j.jcms.2016.09.001. [36] ChubbDP,TaylorGI,AshtonMW.True and 'choke' anastomoses between perforator angiosomes: part Ⅱ. dynamic thermographic identification[J].Plast Reconstr Surg,2013,132(6):1457-1464.DOI: 10.1097/01.prs.0000434407.73390.82. [37] KohlerLH,KöhlerH,KohlerS,et al.Hyperspectral imaging (HSI) as a new diagnostic tool in free flap monitoring for soft tissue reconstruction: a proof of concept study[J].BMC Surg,2021,21(1):222.DOI: 10.1186/s12893-021-01232-0. [38] RauhA, HennD, NagelSS, et al. Continuous video-rate laser speckle imaging for intra- and post- operative cutaneous perfusion imaging of free flaps[J]. J Reconstr Microsurg, 2019, 35(7):489-498. DOI: 10.1055/s-0039-1681076. [39] TsugeI,SaitoS,YamamotoG,et al.Preoperative vascular mapping for anterolateral thigh flap surgeries: a clinical trial of photoacoustic tomography imaging[J].Microsurgery,2020,40(3):324-330.DOI: 10.1002/micr.30531. [40] 尹婕.浅谈“金缮”修复工艺之当代创作美学[J].美与时代(上),2018(1):27-29. [41] 张丕红,黄晓元,黄跃生.深度电烧伤创面早期修复专家共识(2020版)[J].中华创伤杂志,2020,36(10):865-871.DOI: 10.3760/cma.j.cn501098-20200706-00488. [42] 中国老年医学学会烧创伤分会,中国生物材料学会烧创伤创面修复材料分会,中国医师协会创面修复专业委员会.热压伤创面临床诊疗全国专家共识(2023版)[J].中华烧伤与创面修复杂志,2023,39(3):201-208.DOI: 10.3760/cma.j.cn501225-20220608-00227. [43] ViscontiG,BianchiA,HayashiA,et al.Thin and superthin perforator flap elevation based on preoperative planning with ultrahigh-frequency ultrasound[J].Arch Plast Surg,2020,47(4):365-370.DOI: 10.5999/aps.2019.01179. [44] 张元智,陆声,温树正,等.数字化技术在隐动脉皮瓣血供的可视化及其临床初步应用[J].中华创伤骨科杂志,2013,15(1):32-35.DOI: 10.3760/cma.j.issn.1671-7600.2013.01.010. [45] KimuraN,SaitohM,OkamuraT,et al.Concept and anatomical basis of microdissected tailoring method for free flap transfer[J].Plast Reconstr Surg,2009,123(1):152-162.DOI: 10.1097/PRS.0b013e3181934756. -
下载:
点击查看大图
图(1)
计量
- 文章访问数: 136
- HTML全文浏览量: 26
- PDF下载量: 27
- 被引次数: 0
