Archives of Plastic Surgery

  • 제45권4호
  • /
  • Pages.298-303
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  • 2018
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Anatomic basis for flap thinning

  • Park, Seong Oh (Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine) ;
  • Chang, Hak (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Imanishi, Nobuaki (Department of Anatomy, Keio University College of Medicine)
  • 투고 : 2017.09.14
  • 심사 : 2018.01.07
  • 발행 : 2018.07.15
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초록

Flap thinning is a procedure for making a thick flap thinner. This procedure does more than simply fill in the defected area, and it is better for reconstructing the area both functionally and aesthetically. However, because flap thinning is a rather blind procedure, it may have harmful effects on flap vascularity. Therefore, the vasculature of a flap must be understood before performing flap thinning. This paper analyzes the basic anatomy underlying flap thinning based on the previous anatomic study that categorized flaps into 6 types by their vascular structures. This paper also reviews specific studies of frequently practiced flap procedures (deep inferior epigastric artery perforator flap, thoracodorsal artery perforator flap, and anterolateral thigh flap) and presents important precautions for flap thinning procedures. Finally, this paper briefly examines the axiality of the subdermal plexus, which needs to be taken into account when performing flap thinning.

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참고문헌

  1. Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg 2003;112:1875-85. https://doi.org/10.1097/01.PRS.0000091248.41007.2D
  2. Kimura N, Satoh K, Hasumi T, et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 2001;108:1197-208. https://doi.org/10.1097/00006534-200110000-00015
  3. Ross GL, Dunn R, Kirkpatrick J, et al. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 2003;56:409-13. https://doi.org/10.1016/S0007-1226(03)00126-7
  4. Schaverien M, Saint-Cyr M, Arbique G, et al. Three- and four-dimensional arterial and venous anatomies of the tho- racodorsal artery perforator flap. Plast Reconstr Surg 2008; 121:1578-87. https://doi.org/10.1097/PRS.0b013e31816b1479
  5. Schaverien M, Saint-Cyr M, Arbique G, et al. Three-and four-dimensional computed tomographic angiography and venography of the anterolateral thigh perforator flap. Plast Reconstr Surg 2008;121:1685-96. https://doi.org/10.1097/PRS.0b013e31816b4587
  6. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications. Ann Plast Surg 2014;72:246-52. https://doi.org/10.1097/SAP.0b013e31825b3d3a
  7. Rozen WM, Murray AC, Ashton MW, et al. The cutaneous course of deep inferior epigastric perforators: implications for flap thinning. J Plast Reconstr Aesthet Surg 2009;62: 986-90. https://doi.org/10.1016/j.bjps.2008.01.007
  8. Sharabi SE, Hatef DA, Koshy JC, et al. Is primary thinning of the anterolateral thigh flap recommended? Ann Plast Surg 2010;65:555-9. https://doi.org/10.1097/SAP.0b013e3181cbfebc
  9. Nakajima H, Minabe T, Imanishi N. Three-dimensional analysis and classification of arteries in the skin and subcutaneous adipofascial tissue by computer graphics imaging. Plast Reconstr Surg 1998;102:748-60. https://doi.org/10.1097/00006534-199809010-00020
  10. Imanishi N, Nakajima H, Fukuzumi S, et al. Venous drainage of the distally based lesser saphenous-sural veno-neuroadipofascial pedicled fasciocutaneous flap: a radiographic perfusion study. Plast Reconstr Surg 1999;103:494-8. https://doi.org/10.1097/00006534-199902000-00020
  11. Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadi- pofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast Reconstr Surg 1998;102:779-91. https://doi.org/10.1097/00006534-199809010-00024
  12. Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg 1999;103:104-20. https://doi.org/10.1097/00006534-199901000-00018
  13. Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996;97:985-92. https://doi.org/10.1097/00006534-199604001-00016
  14. Chang H. Arterial anatomy of subdermal plexus of the face. Keio J Med 2001;50:31-4.

피인용 문헌

  1. Microsurgical reconstruction of posttraumatic large soft tissue defects on face vol.61, pp.12, 2018, https://doi.org/10.5124/jkma.2018.61.12.724
  2. Reply: ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid‐sized defects of the chest wall based on a systematic review of thoracoabdominal flaps vol.119, pp.8, 2018, https://doi.org/10.1002/jso.25436
  3. Thin and superthin perforator flap elevation based on preoperative planning with ultrahigh-frequency ultrasound vol.47, pp.4, 2018, https://doi.org/10.5999/aps.2019.01179
  4. Pedicled sural flaps versus free anterolateral thigh flaps in reconstruction of dorsal foot and ankle defects in children: a systematic review vol.48, pp.4, 2018, https://doi.org/10.5999/aps.2020.00983
  5. Evaluating effects of primary defatting for flap thinning on the development of perfusion‐related complications in free perforator flap reconstruction vol.41, pp.8, 2018, https://doi.org/10.1002/micr.30819
  6. Ultrathin free flaps for foot reconstruction: impact on ambulation, functional recovery, and patient satisfaction vol.55, pp.6, 2018, https://doi.org/10.1080/2000656x.2021.1898974