穿支皮瓣研究领域的新技术、新方法

New methods and technologies in the field of perforator flap studies

在30年穿支皮瓣发展历史中,众多学者和外科医生提出了大量极富创意的新技术和新方法.该文简要回顾了穿支皮瓣的发现和给予我们的启示,三维可视化数字解剖学技术、血管体区和穿支体区理论、术前穿支血管探测技术、皮瓣血运判断新技术、自由设计穿支皮瓣、嵌合皮瓣技术、血流桥接皮瓣技术、螺旋桨皮瓣和拱顶石皮瓣等带蒂皮瓣技术、超级显微外科、超薄皮瓣即真皮下血管网皮瓣技术、皮瓣显微修薄技术以及携带血管化淋巴结瓣的穿支皮瓣再造乳房的同时治疗上肢淋巴水肿.这些新技术和新方法极大地提高了人们对皮瓣外科学的认知程度,促进了修复重建外科的发展.现在,修复重建外科的治疗范围更加广泛,从单一皮瓣解剖学特点的研究、传统的创面修复、不同解剖学部位组织缺损和器官再造策略研究,发展到各种创伤、肿瘤切除造成的创面修复、神经损伤和缺损的修复、异体复合组织移植修复缺损和再造器官,尤其是乳腺癌术后上肢淋巴水肿的研究和治疗得到了学者们的高度重视.可以预期,修复重建外科的方向将是从单纯的治疗手段的改良和精进,逐步向以疾病治疗为中心的方向发展.穿支皮瓣的研究将按照循证医学的要求,朝着更加精准化、微创化和个性化的方向发展,这无疑也符合医学的本质.

A large number of innovative and new technologies and method in the field of perforator flap were proposed with the hard work of many experts and surgeons. This paper briefly reviewed the following items including the discovery of the perforator flap and its enlightenment to us, three-dimensional visualized anatomy, angiosome and perforasome theories, pre-operative perforator detection techniques, techniques for evaluation of the flap vascular perfusion, the concept of freestyle perforator flap, chimeric flap,flow-through flap technique, new designs of pedicle perforator flap, particularly the propeller and keystone flaps, supramicrosurgery, superthin flap, microdissected thin perforator flap, and microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. These new technologies and method have greatly improved our understanding of flap surgery and promote the development of the reconstructive surgery. The traditional research focused on investigating the anatomic features of a single flap and strategies for the reconstruction of different defects and organs. Nowadays, the treatment scope of reconstructive surgery is more extensive and has developed to repair various refractory wounds following trauma and oncological resection, nerve injuries, and to reconstruct defect and organ by using the vascularized composite allotransplantation. Researches on the upper limb lymphedema after breast cancer surgery have been highly valued recently. It can be expected that the direction of reconstructive surgery would be transformed from the improvement of theraputic modalities to concentrating on the treatment of diseases, and this undoubtedly conforms to the essence of medicine. The research of perforator flaps will be directed to more precise, minimally invasive, and individualized according to the requirements of evidence-based medicine.