내측 비복 천공지 유리피판을 이용한 수부재건 = Hand Reconstruction with Medial Sural Perforator Free Flap

다국어 초록 (Multilingual Abstract)

Purpose: The main advantages of the perforator flap are minimal donor site morbidity, preservation of any main source artery and its thin characteristics. Most perforator flaps for hand reconstruction need primary and secondary procedures such as a flap debulkiness and liposuction etc. However, flap thickness of calf area is thinner than any other perforator flaps.Methods: We performed an anatomical study and clinical application of medial sural artery perforator flap. We found that there are two or more medial sural perforators located on a straight line drawn from the mid-point of popliteal crease to the mid-point of medial malleolus. Most pathway of medial sural artery comes along with this line. It is possible to observe the first perforators almost exactly 8cm from midpoint of popliteal crease in a distal half circle drawn with a radius of 2cm.Results: We report 12 cases in 11 patients of hand reconstruction with medial sural perforator free flap from Febrary 2003 to Febrary 2006. Complete healing was possible in 11 cases. Total flap loss for venous insufficiency was in 1 patient. During the follow-up, good contour and full range of motion was observed on hand reconstruction with medial sural perforator free flap.Conclusion: In the authors' experience, this anatomical study made it possible to prepare a diagram of the exact location of the medial sural perforators. This flap can be used to achieve acceptable functional and aesthetic results for hand reconstruction because of its thin characteristics.

참고문헌 (Reference)

1 Thione A, "The medial sural artery perforators:anatomic basis for a surgical plan" 53 : 2004

2 Cavadas PC, "The medial sural artery perforator free flap" 108 : 2001

3 Yang D, "Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery:anatomical basis and clinical applications" 112 : 2003

4 Medalie DA, "Perforator-based forearm and hand adipofascial flaps for the coverage of difficult dorsal hand wounds" 48 : 2002

5 Shim JS, "Novel method of the upper one third of lower leg and knee reconstruction" 32 : 2005

6 Kim HH, "New design & identification of the medial sural perforator flap:an anatomical study & its clinical applications" 117 : 2006

7 Koshima I, "New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities" 51 : 2003

8 Lee TH, "Lower extremity reconstruction of soft tissue defects with perforator island flap" 32 : 2005

9 Koshima I, "Inferior epigastric artery skin flaps without rectus abdominis muscle" 42 : 645-, 1989

10 Michel S, "Dorsalis pedis flap donor site: acceptable or not?" 102 : 1998

11 Kim KS, "Distally based dorsal forearm fasciosubcutaneous flap" 114 : 2004

12 Hallock GG, "Anatomic basis of the gastrocnemius perforator-based flap" 47 : 2001

13 Hallock GG, "A history of the development of muscle perforator flaps and their specific use in burn reconstruction" 25 : 2004