PRS:浅筋膜提高术!一种更安全的超薄股前外侧穿支皮瓣切取技术

2021-03-15 MedSci原创 MedSci原创

研究者忠于超薄的概念,试图使皮瓣解剖变得更简单、更安全,研究者描述了一种改良后的超薄股前外侧穿支皮瓣切取技术。

穿支解剖学的最新知识和显微外科技术的发展使外科医生能够安全地切取薄皮瓣。近年来,股前外侧穿支皮瓣作为目前软组织重建的主力军,开始在分隔深浅脂肪的浅筋膜上设计和切取。这使得根据缺陷量身定做的超薄皮瓣区域逐渐提高。

研究者忠于超薄的概念,试图使皮瓣解剖变得更简单、更安全,研究者描述了一种改良后的超薄股前外侧穿支皮瓣切取技术。

本研究介绍了16例创伤或肿瘤消融后复杂软组织缺损患者的手术方法。所有患者均采用超薄的股前外侧穿支游离皮瓣,通过浅筋膜提高术进行一期重建。评估并发症和功能结果。

自2018年6月至2019年9月,采用上述方法对16例股前外侧穿支超薄皮瓣进行浅筋膜提高术。

当包含深筋膜时,大腿前外侧穿支游离皮瓣的切取作为标准开始。内侧入路允许在肌束膜和深筋膜之间的安全平面上容易而直接地显示穿支。因此,很容易根据术中发现选择有利的穿支,选择最可靠的穿支。

一旦确定了最好的穿支,就对血管进行肌内解剖,直到旋股外侧动脉的降支被解剖到所需的长度为止。到目前为止,皮瓣切取技术与常规的全厚股前外侧穿支游离皮瓣并无不同。

在手术的这一步,一块大约2厘米宽的圆形深筋膜瓣就在穿支刺穿筋膜的位置居中,首先进行设计,然后切开。在双穿支的情况下,深筋膜瓣的设计是椭圆形的,因此更宽。在深筋膜和浅筋膜之间的整个脂肪组织,实际上是一个圆柱体,被解剖到浅筋膜。

在确定了浅层疏松的乳晕脂肪和深部致密、分隔的纤维脂肪小叶之间的浅筋膜样结构后,可以在浅筋膜平面上快速抬起超薄的大腿前外侧穿支瓣,直到到达先前解剖的筋膜瓣和周围的脂肪组织块。

然后在其前外侧切开大腿前外侧穿支皮瓣。在皮瓣收获后,深筋膜可以很容易地修复,供区发病率最低。

结果显示,该研究队列的大腿前外侧穿支超薄皮瓣总体存活率为100%。在16支股前外侧穿支中,12支(75%)无并发症,4支(25%)有轻微并发症

没有重大并发症的报道,如全部皮瓣丢失,需要额外的抢救手术。在任何情况下都没有进行二次清理。

用上述入路切取的超薄股前外侧穿支皮瓣成功地用于显微外科重建,为缺损提供了良好的外皮覆盖。所描述的方法设法将技术要求高且可能容易出错的术式转变为更安全、更谨慎的方法。解剖过程安全、快速、简单,无重大并发症。由于供体和受体部位的发病率最低,它提供了很好的美容效果,避免了二次手术

原始文献:

Innocenti Marco,Calabrese Sara,Tanini Sara et al. A Safer Way to Harvest a Superthin Perforator Flap.[J] .Plast Reconstr Surg, 2021, 147: 466-469.

DOI: 10.1097/PRS.0000000000007676

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    2021-10-19 骨科

    不错,有用

    0

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    2021-03-24 kzlchina
  4. [GetPortalCommentsPageByObjectIdResponse(id=1061777, encodeId=4f201061e7718, content=不错,有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61ab2524529, createdName=骨科, createdTime=Tue Oct 19 11:29:59 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943325, encodeId=bce01943325a9, content=<a href='/topic/show?id=cec1e5449e7' target=_blank style='color:#2F92EE;'>#穿支皮瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75449, encryptionId=cec1e5449e7, topicName=穿支皮瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a7b6284, createdName=FukaiBao, createdTime=Mon Apr 26 20:47:09 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1669046, encodeId=41e91669046cb, content=<a href='/topic/show?id=bc2114e79b8' target=_blank style='color:#2F92EE;'>#PRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14779, encryptionId=bc2114e79b8, topicName=PRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=209526497271, createdName=kzlchina, createdTime=Wed Mar 24 22:47:09 CST 2021, time=2021-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969433, encodeId=4b999694335f, content=受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210529/4a471716789f4558bdce5a182154abc3/a73917ecb5c3406daa6d489ae21b5bb0.jpg, createdBy=47015509485, createdName=ms7000000436836187, createdTime=Sat May 29 14:00:34 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1425642, encodeId=e6251425642bc, content=<a href='/topic/show?id=e0cae1973bb' target=_blank style='color:#2F92EE;'>#皮瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71973, encryptionId=e0cae1973bb, topicName=皮瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9df03986056, createdName=sunylz, createdTime=Tue Mar 16 16:47:09 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948319, encodeId=976e9483194b, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210818/fc28215f52d5420bbf7edf4303dd3a05/a27dc401923347c494bf44b40c018416.jpg, createdBy=8cf55468929, createdName=kukuya, createdTime=Mon Mar 15 11:42:10 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948243, encodeId=c91a9482433b, content=好技术,广而告之, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Mon Mar 15 07:42:36 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948239, encodeId=bae3948239dd, content=不错的方法,值得学习推广, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82c55469104, createdName=ms8000001230458310, createdTime=Mon Mar 15 07:10:09 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948237, encodeId=69e494823ecd, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Mar 15 07:05:26 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-05-29 ms7000000436836187

    受益匪浅

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1061777, encodeId=4f201061e7718, content=不错,有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61ab2524529, createdName=骨科, createdTime=Tue Oct 19 11:29:59 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943325, encodeId=bce01943325a9, content=<a href='/topic/show?id=cec1e5449e7' target=_blank style='color:#2F92EE;'>#穿支皮瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75449, encryptionId=cec1e5449e7, topicName=穿支皮瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a7b6284, createdName=FukaiBao, createdTime=Mon Apr 26 20:47:09 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1669046, encodeId=41e91669046cb, content=<a href='/topic/show?id=bc2114e79b8' target=_blank style='color:#2F92EE;'>#PRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14779, encryptionId=bc2114e79b8, topicName=PRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=209526497271, createdName=kzlchina, createdTime=Wed Mar 24 22:47:09 CST 2021, time=2021-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969433, encodeId=4b999694335f, content=受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210529/4a471716789f4558bdce5a182154abc3/a73917ecb5c3406daa6d489ae21b5bb0.jpg, createdBy=47015509485, createdName=ms7000000436836187, createdTime=Sat May 29 14:00:34 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1425642, encodeId=e6251425642bc, content=<a href='/topic/show?id=e0cae1973bb' target=_blank style='color:#2F92EE;'>#皮瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71973, encryptionId=e0cae1973bb, topicName=皮瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9df03986056, createdName=sunylz, createdTime=Tue Mar 16 16:47:09 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948319, encodeId=976e9483194b, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210818/fc28215f52d5420bbf7edf4303dd3a05/a27dc401923347c494bf44b40c018416.jpg, createdBy=8cf55468929, createdName=kukuya, createdTime=Mon Mar 15 11:42:10 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948243, encodeId=c91a9482433b, content=好技术,广而告之, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Mon Mar 15 07:42:36 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948239, encodeId=bae3948239dd, content=不错的方法,值得学习推广, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82c55469104, createdName=ms8000001230458310, createdTime=Mon Mar 15 07:10:09 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948237, encodeId=69e494823ecd, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Mar 15 07:05:26 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-03-16 sunylz
  6. [GetPortalCommentsPageByObjectIdResponse(id=1061777, encodeId=4f201061e7718, content=不错,有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61ab2524529, createdName=骨科, createdTime=Tue Oct 19 11:29:59 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943325, encodeId=bce01943325a9, content=<a href='/topic/show?id=cec1e5449e7' target=_blank style='color:#2F92EE;'>#穿支皮瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75449, encryptionId=cec1e5449e7, topicName=穿支皮瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a7b6284, createdName=FukaiBao, createdTime=Mon Apr 26 20:47:09 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1669046, encodeId=41e91669046cb, content=<a href='/topic/show?id=bc2114e79b8' target=_blank style='color:#2F92EE;'>#PRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14779, encryptionId=bc2114e79b8, topicName=PRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=209526497271, createdName=kzlchina, createdTime=Wed Mar 24 22:47:09 CST 2021, time=2021-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969433, encodeId=4b999694335f, content=受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210529/4a471716789f4558bdce5a182154abc3/a73917ecb5c3406daa6d489ae21b5bb0.jpg, createdBy=47015509485, createdName=ms7000000436836187, createdTime=Sat May 29 14:00:34 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1425642, encodeId=e6251425642bc, content=<a href='/topic/show?id=e0cae1973bb' target=_blank style='color:#2F92EE;'>#皮瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71973, encryptionId=e0cae1973bb, topicName=皮瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9df03986056, createdName=sunylz, createdTime=Tue Mar 16 16:47:09 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948319, encodeId=976e9483194b, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210818/fc28215f52d5420bbf7edf4303dd3a05/a27dc401923347c494bf44b40c018416.jpg, createdBy=8cf55468929, createdName=kukuya, createdTime=Mon Mar 15 11:42:10 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948243, encodeId=c91a9482433b, content=好技术,广而告之, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Mon Mar 15 07:42:36 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948239, encodeId=bae3948239dd, content=不错的方法,值得学习推广, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82c55469104, createdName=ms8000001230458310, createdTime=Mon Mar 15 07:10:09 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948237, encodeId=69e494823ecd, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Mar 15 07:05:26 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-03-15 kukuya

    谢谢分享

    0

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    2021-03-15 学医无涯

    好技术,广而告之

    0

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    2021-03-15 ms8000001230458310

    不错的方法,值得学习推广

    0

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    2021-03-15 yangchou

    好文章,谢谢分享。

    0

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