Mastering the technique of chimeric perforator flap to further improve the reconstructive level of compound tissue defects
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摘要: 复合组织缺损的精准修复是显微重建领域面临的一大难题,穿支皮瓣和嵌合皮瓣技术的融合产生了嵌合穿支皮瓣技术。嵌合穿支皮瓣中穿支皮瓣与骨瓣、肌瓣、筋膜瓣仅以血管蒂相连,各组织成分具有足够的自由度,骨瓣可精准重建骨缺损；肌瓣可精准重建动力肌缺损和填塞深部无效腔；筋膜瓣可重建关节囊或肌腱缺损；穿支皮瓣能自由覆盖浅表创面,实现复合组织缺损的立体修复。与传统的骨皮瓣、肌皮瓣相比,嵌合穿支皮瓣大大提升了皮瓣受区修复效果,明显减少了皮瓣供区损害,建议熟练掌握嵌合穿支皮瓣技术,进一步提升复合组织缺损的修复重建水平。Abstract: The precise repair of compound tissue defects remains a significant challenge in the field of microsurgical reconstruction. In recent years, the integrated advent of perforator flap and chimeric flap techniques has led to the development of the chimeric perforator flap technique. In chimeric perforator flaps, the perforator flap is connected to bone, muscle, or fascial flaps solely through the vascular pedicle, allowing each tissue component considerable freedom of movement. Bone flaps can effectively reconstruct bone defects, muscle flaps can accurately restore functional muscle deficits and fill deep dead spaces, fascial flaps can reconstruct joint capsule or tendon defects, while perforator flaps can freely cover superficial wounds, thus achieving three-dimensional repair of compound tissue defects. Compared with traditional bone flaps and musculocutaneous flaps, chimeric perforator flaps significantly improve the repair outcomes of the recipient area while markedly reducing damage to the donor area. It is recommended to master the technique of chimeric perforator flaps proficiently in order to further enhance the level of reconstruction and repair for compound tissue defects.
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Key words:
- Perforator flap /
- Chimeric transplantation /
- Compound tissue defects /
- Reconstruction /
- Wound repair
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参考文献
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图 1 嵌合穿支皮瓣分型示意图。1A.Ⅰ型,即骨瓣-穿支皮瓣嵌合；1B.Ⅱ型,即肌瓣-穿支皮瓣嵌合；1C.Ⅲ型,即筋膜瓣-穿支皮瓣嵌合；1D.Ⅳ型,即骨瓣-肌瓣-穿支皮瓣嵌合；1E.Ⅴ型,即肌瓣-筋膜瓣-穿支皮瓣嵌合；1F.Ⅵ型,即骨瓣-筋膜瓣-穿支皮瓣嵌合；1G.Ⅶ型,即骨瓣-肌瓣-筋膜瓣-穿支皮瓣嵌合
图 2 嵌合旋股外侧动脉降支穿支皮瓣移植治疗例1患者胫骨创伤后骨髓炎。2A.清创后创面情况；2B.术中皮瓣设计；2C.术中皮瓣断蒂后；2D.皮瓣血液循环重建示意图；2E.术后1年随访时皮瓣受区的恢复情况；2F.术后1年随访时皮瓣供区的恢复情况
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