背景:用于自体乳房重建的横向上gracilis(TUG)皮瓣的局限性包括:短蒂,体积适中,肌肉牺牲和有问题的供体部位。Profunda动脉穿支(PAP)皮瓣利用了股薄肌后方的大穿支。我们描述了我们使用它的初步经验,并将其与我们的大型系列TUG襟翼进行了比较。
方法:我们的技术已经从青蛙腿发展到截石位,从前后到颅尾抬高。如果术中不适合PAP穿孔器,则可以使用臀下动脉穿孔器(IGAP)的降支或TUG皮瓣作为替代方案。使用前瞻性数据库比较了2010-2013年进行的TUG和PAP襟翼。
结果:进行了54个TUG和22个PAP皮瓣。术中4个PAP皮瓣转换为IGAP皮瓣,1个TUG。97%的皮瓣成功。平均皮瓣重量为295克(TUG)和242克(PAP)。两个系列的供体部位并发症包括血清肿(4TUG,1PAP)感觉障碍(2TUG,1个PAP)和疤痕翻修(3个TUG,1PAP)。
结论:与TUG皮瓣相比,我们对PAP皮瓣的初步经验并不普遍。这是一个更具挑战性的襟翼,带有学习曲线,特别是如果在仰卧位抬起;我们提出了我们的学习要点,以确保更安全的皮瓣收获,允许将TUG作为纾困选项。PAP的好处包括更长的椎弓根,不需要牺牲肌肉;穿孔器应该有一个更明确和更大的灌注区。疤痕最好隐藏起来,但我们尚未证明与TUG皮瓣相比,供体部位有显著改善。
方法:III.
BACKGROUND: Limitations of the transverse upper gracilis (TUG) flap for autologous breast reconstruction include: short pedicle, modest volume, muscle sacrifice and a problematic donor site. The Profunda Artery Perforator (PAP) flap utilises large perforators posterior to the gracilis muscle. We describe our preliminary experience of its use and compare it to our large series of TUG flaps.
METHODS: Our technique has evolved from frog-leg to lithotomy position, and from an anterio-posterior to cranio-caudal raise. This allows either the descending branch of the inferior gluteal artery perforators (IGAP) or the TUG flap as alternatives should PAP perforators be unsuitable intra-operatively. A prospective database was utilised to compare TUG and PAP flaps undertaken 2010-2013.
RESULTS: 54 TUG and 22 PAP flaps were performed. 4 PAP flaps were converted to IGAP flaps and 1 to TUG intra-operatively. 97% of all flaps were successful. Mean flap weight was 295 g (TUG) and 242 g (PAP). Donor site complications for both series included seroma (4 TUG, 1 PAP) sensory disturbance (2 TUG, 1 PAP) and scar revision (3 TUG, 1 PAP).
CONCLUSIONS: Our preliminary experience of the PAP flap has not been universally favourable compared to the TUG flap. It is a more challenging flap to raise, which carries with it a learning curve, especially if raised in the supine position; we present our learning points for safer flap harvest, allowing the TUG as a bail out option. The benefits of the PAP include a longer pedicle, without the need to sacrifice muscle; the perforators should have a more defined and larger perfusion zone. The scar is better hidden, but we have not yet proven significant improvements to the donor site compared to the TUG flap.
METHODS: III.