穿支螺旋桨皮瓣简史、概念、手术设计和临床应用

Brief history,definition,flap design,and clinical applications of the perforator propeller flap

1991年,Hyakusoku首次报道螺旋桨皮瓣技术,历经30年发展,穿支螺旋桨皮瓣技术已经成为修复重建外科最基本的缺损修复方法之一。文章简要回顾了穿支螺旋桨皮瓣的发展历史,并对穿支螺旋桨皮瓣的概念、命名方法和分类的现状进行了回顾。通过临床病例,详细介绍了穿支螺旋桨皮瓣手术过程和技术细节。按照头颈部、躯干、四肢等不同解剖学部位,对穿支螺旋桨皮瓣的临床应用现状进行了回顾,分析了穿支螺旋桨皮瓣的优缺点、常见并发症及其预防措施。对临床工作中,应用穿支螺旋桨皮瓣经常遇到的一些问题和目前的研究现状进行了分析和总结。穿支螺旋桨皮瓣的应用日渐广泛,但仍然存在一些亟待解决的问题,比如穿支血管的准确定位、穿支体区的准确界定、皮瓣旋转角度、血管通畅性和血管蒂长度之间的关系等。作者认为虽然存在以上问题,但穿支螺旋桨皮瓣技术必将像组织扩张技术、游离皮瓣转移技术一样,最终成为修复重建领域一项常规的、重要的缺损修复和器官再造方法。

Since the first description by Hyakusoku in 1991,perforator propeller flaps have become one of the most commonly used method for defect reconstruction across the entire human body.We briefly reviewed the history,definition,nomenclature,and classification of perforator propeller flaps,and the corresponding surgical techniques were introduced in detail as well by reviewing our clinical cases.The clinical applications of the perforator propeller flaps were reviewed thoroughly by describing its use in different anatomic regions including the head and neck,trunk,extremities,buttock,and perineum respectively.Both the advantages and drawbacks of the flaps,common complications,and its prevention were also analyzed.Problems that we often encountered in the application of perforator propeller flaps and its current research status were analyzed and summarized.Although the perforator propeller flaps have been increasingly widely used,there still exist some important issues that deserve more concern and need to be solved,including precise perforator localization,accurate definition of perforators,correlations between the rotation angle of the flap,vascular patency and pedicle length.Though with the aforementioned problems,we believe that,like the tissue expansion and microsurgical flap transfer technique,the perforator propeller flap technique will ultimately become a conventional and important method for defect and organ reconstruction.