Research progress in thin flap and flap thinning technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Conghang , YANG Yuanming , ZENG Fanglin ,  WANG Xiancheng , FANG Bairong

Department of Burn and Plastic Surgery, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China;

Corresponding author：

WANG Xiancheng, Email: wangxiancheng64@hotmail.com

Keywords：

Thin flap; flap thinning technique; research progress

DOI：

10.7507/1002-1892.201901090

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the historical origin and development of thin flap and flap thinning technique. Methods A wide range of domestic and foreign literatures on thin flaps and flap thinning technique were reviewed. The background, definition, methods, problems, challenges, and future development of thin flap and flap thinning technique were summarized and analysed. Results Thin flap and flap thinning technique play an important role in the development of flap surgery, leading flap surgery towards a more rational and refined direction. Conclusion Thin flap and flap thinning technique are still hot topics in the future. With the development of thin flap and flap thinning technique, clinicians will have more " free” choices.

Citation： JIANG Conghang, YANG Yuanming, ZENG Fanglin, WANG Xiancheng, FANG Bairong. Research progress in thin flap and flap thinning technique. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 912-916. doi: 10.7507/1002-1892.201901090 Copy

1.	徐永清, 何晓清. 皮瓣外科的新进展. 中国修复重建外科杂志, 2018, 32(7): 781-785.
2.	Hyakusoku H, Gao JH. The " super-thin” flap. Br J Plast Surg, 1994, 47(7): 457-464.
3.	Taylor GI, Corlett RJ, Boyd JB. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg, 1984, 37(3): 330-350.
4.	Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
5.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
6.	Thomas CV. Thin flaps. Plast Recontr Surg, 1980, 65(6): 747-752.
7.	胡安军, 刘新民, 王培柱, 等. 保留真皮下血管网超薄皮瓣的应用. 人民军医, 1989, (4): 69-70.
8.	Narushima M, Iida T, Kaji N, et al. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(6): 827-834.
9.	Narushima M, Yamasoba T, Iida T, et al. Pure skin perforator flaps: the anatomical vascularity of the superthin flap. Plast Reconstr Surg, 2018, 142(3): 351e-360e.
10.	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(5): 985-992.
11.	司徒朴, 陈杰, 陈金火, 等. 暴露真皮下血管网的带蒂皮瓣. 第一军医大学学报, 1986, 6(1): 60-61.
12.	肖添有, 司徒朴, 陈伯华, 等. 轴型血管蒂股前外侧真皮下血管网皮瓣的应用解剖. 中国临床解剖学杂志, 1997, 15(1): 7-10.
13.	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(5): 1197-1210.
14.	Lin CT, Huang JS, Hsu KC, et al. Different types of suprafascial courses in thoracodorsal artery skin perforators. Plast Reconstr Surg, 2008, 121(3): 840-848.
15.	吴迎, 王先成, 熊祥, 等. 带感觉神经的薄型股前外侧穿支皮瓣修复足背创面. 中华整形外科杂志, 2018, 34(10): 848-852.
16.	Kimura N. A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg, 2002, 109(1): 69-80.
17.	Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg, 2003, 112(7): 1875-1885.
18.	Yang WG, Chiang YC, Wei FC, et al. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
19.	Kimura N, Saitoh M, Hasumi T, et al. Clinical application and refinement of the microdissected thin groin flap transfer operation. J Plast Reconstr Aesthet Surg, 2009, 62(11): 1510-1516.
20.	Narushima M, Yamasoba T, Iida T, et al. Pure skin perforator flap for microtia and congenital aural atresia using supermicrosurgical techniques. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1580-1584.
21.	Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg, 2014, 30(7): 491-496.
22.	聂开瑜, 常树森, 魏在荣, 等. 旋股外侧动脉降支穿支皮瓣显微削薄的临床应用. 中国临床解剖学杂志, 2017, 35(1): 90-93.
23.	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(8): 986-990.
24.	方柏荣, 孙杨, 熊祥, 等. 腹壁下动脉穿支血管构造在腹壁下动脉穿支皮瓣修薄中的应用. 中华整形外科杂志, 2017, 33(1): 16-20.
25.	方柏荣, 王先成, 王乃利, 等. 浅层腹壁静脉系统的血管构造研究及其意义. 中国临床解剖学杂志, 2011, 29(5): 508-512.
26.	Hyakusoku H, Ogawa R//Blondeel N HG, et al. The subdermal vascular network flap-the concept of the " super-thin flap”, " perforator flaps”. St.Louis, Missouri: Quality Medical Publishing Inc, 2006: 1002-1027.
27.	Eo S, Kim D, Jones NF. Microdissection thinning of a pedicled deep inferior epigastric perforator flap for burn scar contracture of the groin: case report. J Reconstr Microsurg, 2005, 21(7): 447-452.
28.	Fang BR, Ameet H, Li XF, et al. Pedicled thinned deep inferior epigastric artery perforator flap for perineal reconstruction: a preliminary report. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1627-1634.
29.	Vinh VQ, Van Anh T, Gia TiênN, et al. Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged " super-thin flaps”: A retrospective analysis of 82 cases in Vietnam. Burns, 2018, 44(2): 462-467.
30.	Sharabi SE, Hatef DA, Koshy JC, et al. Is primary thinning of the anterolateral thigh flap recommended? Ann Plast Surg, 2010, 65(6): 555-559.
31.	宋达疆, 李赞, 周晓, 等. 游离带感觉超薄股前外侧穿支皮瓣修复鰒甲瓣供区创面的疗效观察. 中国修复重建外科杂志, 2017, 31(8): 987-991.
32.	齐伟亚, 郑大伟, 张旭阳, 等. 血运重建后皮瓣修薄法在股前外侧皮瓣游离移植中的应用. 中国修复重建外科杂志, 2016, 30(4): 525-527.
33.	宋建星, 邢新, 陈江萍, 等. 超声去脂真皮下血管网皮瓣在手指皮肤撕脱伤中的应用. 中国修复重建外科杂志, 2001, 15(4): 196-198.
34.	杨丽, 方柏荣, 贺吉庸, 等. 基于 CT 血管造影的腹壁下动脉穿支皮瓣三维模型的构建及应用. 中华烧伤杂志, 2018, 34(5): 297-302.
35.	薛兵建, 刘元波, 臧梦青, 等. 吲哚菁绿 SPY 成像技术在皮瓣外科中的应用. 中华整形外科杂志, 2017, 33(5): 339-344.
36.	Fan S, Zhang HQ, Li QX, et al. The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: a pilot study. Plast Reconstr Surg, 2018, 141(6): 902e-910e.
37.	Du Z, Zan T, Huang X, et al. DFO enhances the targeting of CD34-positive cells and improves neovascularization. Cell Transplant, 2015, 24(11): 2353-2366.
38.	Troidl C, Troidl K, Schierling W, et al. Trpv4 induces collateral vessel growth during regeneration of the arterial circulation. J Cell Mol Med, 2009, 13(8B): 2613-2621.
39.	Park TH, Lee SH, Park YJ, et al. Presurgical botulinum toxin A treatment increases angiogenesis by hypoxia-inducible factor-1α/vascular endothelial growth factor and subsequent superiorly based transverse rectus abdominis myocutaneous flap survival in a rat model. Ann Plast Surg, 2016, 76(6): 723-728.
40.	Murphy RC, Lawrence WT, Robson MC, et al. Surgical delay and arachidonic acid metabolites: evidence for an inflammatory mechanism: an experimental study in rats. Br J Plast Surg, 1985, 38(2): 272-277.
41.	Alkureishi LW, Shaw-Dunn J, Ross GL. Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br J Plast Surg, 2003, 56(4): 401-408.
42.	Chetboun A, Masquelet AC. Experimental animal model proving the benefit of primary defatting of full-thickness random-pattern skin flaps by suppressing " perfusion steal”. Plast Reconstr Surg, 2007, 120(6): 1496-1502.
43.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
44.	杨曦, 徐永清, 何晓清, 等. 数字化技术制备大鼠跨区穿支皮瓣微小血管模型的实验研究. 中国修复重建外科杂志, 2017, 31(12): 1485-1489.
45.	Gao ZM, Lin DM, Wang Y, et al. Role of the NO/cGMP pathway in postoperative vasodilation in perforator flaps. J Reconstr Microsurg, 2015, 31(2): 107-112.
46.	Williams BA, Currie RW, Morris SF. Impact of arteriogenesis in plastic surgery: choke vessel growth proceeds via arteriogenic mechanisms in the rat dorsal island skin flap. Microcirculation, 2009, 16(3): 235-250.
47.	Jin Z, Chen S, Wu H, et al. Inhibition of autophagy after perforator flap surgery increases flap survival and angiogenesis. J Surg Res, 2018, 231: 83-93.
48.	魏在荣. 皮瓣命名方式探讨. 中华损伤与修复杂志 (电子版), 2011, 06(3): 337-341.
49.	徐祥, 李涛, 陈振兵, 等. 应用超薄皮瓣技术改进胸背动脉穿支皮瓣的修复效果. 中华显微外科杂志, 2017, 40(5): 438-440.
50.	李倩, 肖海涛, 岑瑛. 选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损. 中国修复重建外科杂志, 2018, 32(3): 350-353.
51.	杨柳, 褚庭纲, 吴蓓茸. 薄型股前外侧穿支皮瓣个体化修复四肢创面. 中国修复重建外科杂志, 2018, 32(11): 1491-1493.
52.	Ravnic DJ, Leberfinger AN, Koduru SV, et al. Transplantation of bioprinted tissues and organs: technical and clinical challenges and future perspectives. Ann Surg, 2017, 266(1): 48-58.
53.	Hong N, Yang GH, Lee J, et al. 3D bioprinting and its in vivo applications. J Biomed Mater Res B Appl Biomater, 2018, 106(1): 444-459.

1. 徐永清, 何晓清. 皮瓣外科的新进展. 中国修复重建外科杂志, 2018, 32(7): 781-785.
2. Hyakusoku H, Gao JH. The " super-thin” flap. Br J Plast Surg, 1994, 47(7): 457-464.
3. Taylor GI, Corlett RJ, Boyd JB. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg, 1984, 37(3): 330-350.
4. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
5. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
6. Thomas CV. Thin flaps. Plast Recontr Surg, 1980, 65(6): 747-752.
7. 胡安军, 刘新民, 王培柱, 等. 保留真皮下血管网超薄皮瓣的应用. 人民军医, 1989, (4): 69-70.
8. Narushima M, Iida T, Kaji N, et al. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(6): 827-834.
9. Narushima M, Yamasoba T, Iida T, et al. Pure skin perforator flaps: the anatomical vascularity of the superthin flap. Plast Reconstr Surg, 2018, 142(3): 351e-360e.
10. 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(5): 985-992.
11. 司徒朴, 陈杰, 陈金火, 等. 暴露真皮下血管网的带蒂皮瓣. 第一军医大学学报, 1986, 6(1): 60-61.
12. 肖添有, 司徒朴, 陈伯华, 等. 轴型血管蒂股前外侧真皮下血管网皮瓣的应用解剖. 中国临床解剖学杂志, 1997, 15(1): 7-10.
13. 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(5): 1197-1210.
14. Lin CT, Huang JS, Hsu KC, et al. Different types of suprafascial courses in thoracodorsal artery skin perforators. Plast Reconstr Surg, 2008, 121(3): 840-848.
15. 吴迎, 王先成, 熊祥, 等. 带感觉神经的薄型股前外侧穿支皮瓣修复足背创面. 中华整形外科杂志, 2018, 34(10): 848-852.
16. Kimura N. A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg, 2002, 109(1): 69-80.
17. Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg, 2003, 112(7): 1875-1885.
18. Yang WG, Chiang YC, Wei FC, et al. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
19. Kimura N, Saitoh M, Hasumi T, et al. Clinical application and refinement of the microdissected thin groin flap transfer operation. J Plast Reconstr Aesthet Surg, 2009, 62(11): 1510-1516.
20. Narushima M, Yamasoba T, Iida T, et al. Pure skin perforator flap for microtia and congenital aural atresia using supermicrosurgical techniques. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1580-1584.
21. Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg, 2014, 30(7): 491-496.
22. 聂开瑜, 常树森, 魏在荣, 等. 旋股外侧动脉降支穿支皮瓣显微削薄的临床应用. 中国临床解剖学杂志, 2017, 35(1): 90-93.
23. 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(8): 986-990.
24. 方柏荣, 孙杨, 熊祥, 等. 腹壁下动脉穿支血管构造在腹壁下动脉穿支皮瓣修薄中的应用. 中华整形外科杂志, 2017, 33(1): 16-20.
25. 方柏荣, 王先成, 王乃利, 等. 浅层腹壁静脉系统的血管构造研究及其意义. 中国临床解剖学杂志, 2011, 29(5): 508-512.
26. Hyakusoku H, Ogawa R//Blondeel N HG, et al. The subdermal vascular network flap-the concept of the " super-thin flap”, " perforator flaps”. St.Louis, Missouri: Quality Medical Publishing Inc, 2006: 1002-1027.
27. Eo S, Kim D, Jones NF. Microdissection thinning of a pedicled deep inferior epigastric perforator flap for burn scar contracture of the groin: case report. J Reconstr Microsurg, 2005, 21(7): 447-452.
28. Fang BR, Ameet H, Li XF, et al. Pedicled thinned deep inferior epigastric artery perforator flap for perineal reconstruction: a preliminary report. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1627-1634.
29. Vinh VQ, Van Anh T, Gia TiênN, et al. Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged " super-thin flaps”: A retrospective analysis of 82 cases in Vietnam. Burns, 2018, 44(2): 462-467.
30. Sharabi SE, Hatef DA, Koshy JC, et al. Is primary thinning of the anterolateral thigh flap recommended? Ann Plast Surg, 2010, 65(6): 555-559.
31. 宋达疆, 李赞, 周晓, 等. 游离带感觉超薄股前外侧穿支皮瓣修复鰒甲瓣供区创面的疗效观察. 中国修复重建外科杂志, 2017, 31(8): 987-991.
32. 齐伟亚, 郑大伟, 张旭阳, 等. 血运重建后皮瓣修薄法在股前外侧皮瓣游离移植中的应用. 中国修复重建外科杂志, 2016, 30(4): 525-527.
33. 宋建星, 邢新, 陈江萍, 等. 超声去脂真皮下血管网皮瓣在手指皮肤撕脱伤中的应用. 中国修复重建外科杂志, 2001, 15(4): 196-198.
34. 杨丽, 方柏荣, 贺吉庸, 等. 基于 CT 血管造影的腹壁下动脉穿支皮瓣三维模型的构建及应用. 中华烧伤杂志, 2018, 34(5): 297-302.
35. 薛兵建, 刘元波, 臧梦青, 等. 吲哚菁绿 SPY 成像技术在皮瓣外科中的应用. 中华整形外科杂志, 2017, 33(5): 339-344.
36. Fan S, Zhang HQ, Li QX, et al. The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: a pilot study. Plast Reconstr Surg, 2018, 141(6): 902e-910e.
37. Du Z, Zan T, Huang X, et al. DFO enhances the targeting of CD34-positive cells and improves neovascularization. Cell Transplant, 2015, 24(11): 2353-2366.
38. Troidl C, Troidl K, Schierling W, et al. Trpv4 induces collateral vessel growth during regeneration of the arterial circulation. J Cell Mol Med, 2009, 13(8B): 2613-2621.
39. Park TH, Lee SH, Park YJ, et al. Presurgical botulinum toxin A treatment increases angiogenesis by hypoxia-inducible factor-1α/vascular endothelial growth factor and subsequent superiorly based transverse rectus abdominis myocutaneous flap survival in a rat model. Ann Plast Surg, 2016, 76(6): 723-728.
40. Murphy RC, Lawrence WT, Robson MC, et al. Surgical delay and arachidonic acid metabolites: evidence for an inflammatory mechanism: an experimental study in rats. Br J Plast Surg, 1985, 38(2): 272-277.
41. Alkureishi LW, Shaw-Dunn J, Ross GL. Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br J Plast Surg, 2003, 56(4): 401-408.
42. Chetboun A, Masquelet AC. Experimental animal model proving the benefit of primary defatting of full-thickness random-pattern skin flaps by suppressing " perfusion steal”. Plast Reconstr Surg, 2007, 120(6): 1496-1502.
43. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
44. 杨曦, 徐永清, 何晓清, 等. 数字化技术制备大鼠跨区穿支皮瓣微小血管模型的实验研究. 中国修复重建外科杂志, 2017, 31(12): 1485-1489.
45. Gao ZM, Lin DM, Wang Y, et al. Role of the NO/cGMP pathway in postoperative vasodilation in perforator flaps. J Reconstr Microsurg, 2015, 31(2): 107-112.
46. Williams BA, Currie RW, Morris SF. Impact of arteriogenesis in plastic surgery: choke vessel growth proceeds via arteriogenic mechanisms in the rat dorsal island skin flap. Microcirculation, 2009, 16(3): 235-250.
47. Jin Z, Chen S, Wu H, et al. Inhibition of autophagy after perforator flap surgery increases flap survival and angiogenesis. J Surg Res, 2018, 231: 83-93.
48. 魏在荣. 皮瓣命名方式探讨. 中华损伤与修复杂志 (电子版), 2011, 06(3): 337-341.
49. 徐祥, 李涛, 陈振兵, 等. 应用超薄皮瓣技术改进胸背动脉穿支皮瓣的修复效果. 中华显微外科杂志, 2017, 40(5): 438-440.
50. 李倩, 肖海涛, 岑瑛. 选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损. 中国修复重建外科杂志, 2018, 32(3): 350-353.
51. 杨柳, 褚庭纲, 吴蓓茸. 薄型股前外侧穿支皮瓣个体化修复四肢创面. 中国修复重建外科杂志, 2018, 32(11): 1491-1493.
52. Ravnic DJ, Leberfinger AN, Koduru SV, et al. Transplantation of bioprinted tissues and organs: technical and clinical challenges and future perspectives. Ann Surg, 2017, 266(1): 48-58.
53. Hong N, Yang GH, Lee J, et al. 3D bioprinting and its in vivo applications. J Biomed Mater Res B Appl Biomater, 2018, 106(1): 444-459.

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