TCNCYH PhiJ trwang 77(6) - 2011
VAT MACH XUYEN LFNG DUNG TRONG
P H A UTHUAT TAO HJNH
T r l n T h i l t S e n , N g u y i n Bac Hiing Truing D^i hQc Y Ha Noi V^t m^ch xuydn Id ch^ng cudi cung trong tiin trinh phdt triin cua cdc vat td chuc vdi sw khdi diu tCr vat ngau nhien. Ky nguyen cua vat mach xuydn bit diu fu- ndm 1989 vd din nay dd trd thdnh mdt chit lidu thdng dung tmng phiu thuat tao hinh nhd cd nhQ'ng wu diim vwqrt trdi: bdo tdn nai cho vat, vat cd thi dw(?c thiit ki theo bit ky loai tdn khuyit ndo, cd thi Idm mdng vat, cudng mach ddi vd hwdng cua cudng mach ludn thay ddi tuy theo ydu cau tdn khuyit Chi djnh cua loai vat ndy phu thudc vdo nhiiu yiu td: di$n tich vd khdi IWQng nai cin tao hinh, ydu ciu thim my, sw Iwa chgn cua b$nh nhdn vd kinh nghidm cCJa phiu thudt vidn.
TIP khda: danh phap, vat mach xuyen, p h l u thugt tgo hinh
Ljch sip phat t r i l n cua vat mgch xuyen Vgt mgch xuyen (perforator flap) cd t h i eoi Id chgng cudi ciing trong t i l n trinh hinh thdnh vd phdt trien cua vgt da. Dau I n d i u tien cua vipe sii- dgng vgt da trong ljch su- Phiu thugt Tgo hinh eua lodi ngudi Id vide tdi tgo Igi mui bj d t d nhung nd lp An Dp bang vide su- dgng vgt da trdn cd tii- han 3000 ndm trudc ddy. Ky thuat tai tao mui bang vat ma cua ngudi An Op sau dd edn dup-c dp dgng d chdu Au tin t h i ky thiF IX d i n the ky XII. Tagliacozzi (1597) da su- dgng vgt da tir canh tay cho tai tao khuylt mui hoan todn. Trong mdt thai gian ddi, eae vgt da dup-c de xuat vd su- dung tren lam sang deu d dgng vgt n g i u nhien do su- hgn che v l kiln thLPC hp thdng mach mdu trong da. Cdc cdng trinh nghien CLFU v l he thdng dpng mgch tren ca t h i cua Manchot (1889) va Salmon (1935) da cung chf dirng lai nhu nhCrng kiln thu-c giai phiu vd khdng dup-c cdc nha tao hinh chu y tdi khi thilt ke cae vat da. Trong mdt nghien cii-u cua minh, Milton (1960) lan dau tien k i t ndi cae kiln thu-e giai phau vdi ky thugt tgo vgt da vd t h i y rang mdt vat da dup-c tang su-c sdng neu cd mdt ddng mach di tdi d p mau. Nhd dd McGregor va Morgan dua ra khai nipm vgt trge mgch vd vgt n g i u nhien tir nam 1972. Vgt ngiu nhien la vat da khdng bao gdm mdt true mgch mdu, dieu nay khac vdi vgt da trge mgch dg-a tren mdt cudng mgch dudi da chgy theo mpt hudng. McCraw va cdng sg- (1977) nhdn thay vat da n i m tren mdt ca se dugc d p mau tir nhu-ng mgch xudt phat tip trong ca dd di len.
Sau dd khai niem vgt ca vd vgt da ca vdi mdt true maeh 6\soc xac nhdn. Ger vd Ortieochea
md ta cdc vgt da ca tir ndm 1981 vd sau dd cac vgt da ca vgt ca trd nen phd bien vd dugc dp dgng trong h l u h i t mpi tinh hudng tgo hinh.
Tuy nhien cdc vgt ndy bpc lp nhieu nhugc dilm, eae bien dgng ca nai cho vd nai nhdn vgt da ca lam giam chit lugng tgo hinh. Ydu c l u tim cac giai phdp nham giam nhugc d i l m cua vat da ca da trd thdnh d p bach trong phiu thudt tgo hinh. Ponten (1981) gidi thieu mdt logi sieu vgt
"superflap" d chi dudi, ddy la nhCi-ng vgt da kem can sau va ed SLPC sdng tdt han cdc vgt ngau nhien ciing kich thudc. Beak (1983) vd Song (1984) ddng phdt hien ra vat diii ngoai dugc d p mau tir nhO-ng mach xuyen cd ngudn gdc khac nhau. Cdc tdc gia nhdn thay mpt vgt da diii ngoai cd t h i sdng nhd chf tir mdt mgch xuyen.
Ddy la u-ng dung dau tien eua vat mgch xuyen tren lam sang. Cormack va Lanberty dua ra khai niem vgt da can va khang djnh loai vgt nay dugc d p mau bdi ddng mgch chgy tir trong ca hay vdch gian ca rdi ra da (1984). Nam 1987, Taylor vd Palmer dg-a tren cae nghien cu-u giai phau eua Manchot vd Salmon trudc dd, da dua ra khai niem phdn dogn mgch (angiosome) d l chl ra rang moi viing da cua ca the deu do mpt cudng mgch ehi phdi. Nam 1986, Nakajima vd cpng sg- gia djnh mdi mpt viing da eua vgt da d n dugc d p mau bdi mpt logi mgch can khac nhau, cd 6 logi mgch can khac nhau dugc phdn biet nhd vdo dge d i l m di qua ea cua chung trudc khi di vdo can sdu. Khai nipm mgch xuyen dugc Koshima vd Soeda de xuat vd nghien CLPU mdt each ed hp thdng nham logi bd nhu-ng nhugc d i l m cua vgt da ea (1989). Koshima vd Soeda da md ta vide su- dung cua cae vat da
TCNCYH Ph^j trwang 77(6) 2011
dg-a tren cdc nhanh xuyen quanh rdn dan thuin cua dpng mgch thugng vj sdu dudi, vgt da thu dugc du mdng va ca thing bgng dugc bao tdn.
Allenc va Treece d l xuat vide su dgng vgt mgch xuyen ddng mgch thugng vj sdu dudi (DIEP) de tgo hinh ngg-c (1994). Tilp theo mdt logt cdc mgch xuydn tren ca the dugc nghidn CLPU ddng nghTa vdi vipc ra ddi nhilu vgt mgch xuydn lidn quan. Sg* biing nd cdc logi vgt mgch xuydn ciing vdi sg- khdng thdng nhat tdn gpi cdc vgt ndy Id bu-c tranh chung v l vgt da mgch xuydn trong Phiu thugt tgo hinh. Mpt phin do cd qua nhieu vgt mgch xuyen dugc nhieu tdc gia nghidn CLPU va cdng bd ddng thdi trong y vdn the gidi, mdt khde tinh da dgng v l giai phau dugc phdt hidn trong tirng nghidn etpu dd Idm phu-c tgp han trong vide ddt ten cdc vgt xuydn. Vf dg nhu vgt thugng vj sdu dudi (DIEP) eOng ed nhilu tdn tiiy theo tirng tdc gia, nhu vgt paraumbilical perforator flap, paraumbilical perforator - based flap, deep inferior epigastric perforator flap, deep inferior epigastric artery perforator flap, inferior epigastric artery skin flap without rectus abominis muscle, deep inferior epigastric artery skin flap. Tranh ludn ve thudt ngii- eua vgt mach xuyen cang phu-c tap khi mpt sd tac gia de nghj chf edng nhan cac mach xuyen thg-c sg- la cac mgch xuyen qua ca. Cho dii khdng cd sg- thdng nhat ve thuat ngu- va phdn log] giu-a nhieu tac 5ia, nhung ed mpt dilm chung diu dugc thira nhdn la cd 3 logi vat mgch xuydn dg-a tren ban chit cua cdc mgch d p mdu: vgt ra da trg-c tiep, vgt vach ca vd vat da ca. Sg- phat triln mpt logt ky thugt mdi cho vgt mgch xuydn da md ra mpt tuang lai dly trien vpng eua logi vgt nay dp dgng trong tgo hinh: sidu vi phiu (supramicrosurgery) d l xuat do Koshima va cdng sg- (ndm 2002), vi phiu tich (microdissecton) do Kimura va cpng sg- (2002), vgt ngiu hu-ng tg- do (free-style free flap) do Wei vd cpng sg- (2004). Ddy cQng Id hudng phat triln trong tuang lai eua vgt mgch xuyen nham su- dgng cd hipu qua han nhung chit lipu tgo hinh da dugc nghien cQ-u tir 3 thgp ky qua.
Khai niem chung ve vgt mach xuyen Vat mgch xuydn la mdt vgt da hay da can dugc d p mau bdi mdt mach xuyen chgy qua
mOt ca lidn quan. Cdc mgch xuydn cd ngudn gdc tip cdc mgch trge cua ca t h i , cdc mgch ndy di qua mdt sd clu trCic cua ea t h i nhu ca, td chu-c lidn kit ke hay md trudc khi chui vdo trong da. Mdc dii vj tri va kfch cd cua cdc mgch xuydn rit thay ddi nhung chf cd mdt sd hO-u hgn cic mgch xuydn tilm tdng trong ca thi, tdn gpi cua tipng vgt mgch xuydn chu ylu dg'a trdn ten gpi cua cdc mgch d p mdu. Trudc ddy mdt vgt da cdn chf dugc coi Id vgt mgch xuydn khi cd mgch nudi di qua cd trudc khi di vdo da, nhung kh^i nidn ndy it diyqtc quan tdm vi khdng cd y nghTa thg-c tien, cdc phiu thudt vidn chf d n phdn bidt logi mgch xuydn trg-c tilp nudi da va mgch xuydn vdch ea vdi mgch xuydn ca, logi mgch phiu tich khd khdn han trdn Idm sang.
Cdn CLP vdo sd lugng mgch xuydn md quylt djnh 6\jfqtc kfch thudc vd hinh ddng cua vat. Vgt mgch xuydn dugc d l xult trdn ca sd cua vgt da ea tuang ung, tuy nhidn sg- khde bidt duy nhit vgt mgch xuydn va vgt da ca Id toan bp khoi ca khdng dugc lly ciing vgt mgch xuyen. Dilu nay cd the giam thilu nhO-ng tdn thuang cua ca cQng nhu nhu-ng biln dgng tgi nai cho vgt. Chi djnh cho vgt mgch xuydn phg thupc vdo nhilu ylu td, bao gdm ca dipn tich vd thdnh phin ciia vat d n thilt ke, ydu clu tham my ciia nai nhgn, sg- Ig-a chpn bpnh nhdn, kinh nghipm vd trang bj cua cdc bdc sT phiu thugt. Chdng chi djnh Chung eho nhung bdnh nhdn tgi nai d n tgo vgt khdng cd mgch xuyen, hodc mgch xuydn qua nhd, nai cho cd spo hodc tdn thuang cu. Noi cho vgt mgch xuydn phai dam bao 4 ddc dilm sau: Cd mdt ngudn d p mau (mgch xuyen) co t h i dg- doan dugc va hdng djnh; It nhat mpt mgch xuydn Idn (cd dudng kinh > 0,5 mm);
Cudng mgch xuydn du ddi cho tirng mge dich phiu thudt tgo hinh; Nai cho vgt ddng trg-c tiep khdng bj cdng.
Ky thudt phiu tfch vgt mgch xuyen khdng khde miy so vdi k^ thugt tgo vgt da ca kinh diln, chl cd dilm khde bipt Id vipe phiu tich mgch xuyen trong ca dugc tien hdnh ti my vd co lien quan khdng phai lly ciing vgt da. Vgt mgch xuyen chf 6\rQtc su- dung khi xac dinh dugc mgch xuydn cd dO kfch ed. Cac ky thugt 6e phat hipn mgch xuyen trudc khi phau thugt bao gdm hinh anh cpng hudng tip va sieu am mau cd thi
TCNCYH Phij trwang 77(6) 2011 danh gia dugc ddng chay, dudng kinh mgch,
dudng di eua mgch xuyen. Dp tin egy cua cac cdng nghd hipn nay la tdt, nhung hgn che kit qua tip chi phi, ndng Ig-c eua eac ky thudt vien.
Tuy nhien doppler d m tay ed gia trj cao han trong viec xac djnh mach xuyen trudc vd trong khi phiu thugt Vdi mpt sd vgt mach xuyen, nhu vgt diii trudc ngoai, vj tri cua cac dilm ra da cua mgch xuyen dugc qui ude trong mpt gidi hgn tuang ddi hang djnh. Kich thudc va hinh dang tdn thuang dugc t h i hipn bang mpt miu, dg-a vao miu dd thiet ke vgt ciing vdi vj tri mgch xuyen nam tren vat. Phiu tich mgch xuyen bao gid cung dugc thg-c hipn tip mpt bd cua vgt da.
Trdnh rach da xung quanh vgt cho den khi xac dinh dugc mgch xuyen dap u-ng du yeu d u ve kich thudc vd chilu ddi cua mgch. Phiu tich d mat dudi cdn sdu la dudng nhanh nhit vd an todn nhit de xdc djnh cdc mgch xuydn. Tim dugc hai mgch xuyen tren mdt vgt la d n thilt de phdng trudng hgp ed mdt mach xuyen bi tdn thuang trong khi phau tich. Cdn bao ve tdi da ede tTnh mgch tuy hdnh cung vdi cudng mach sau dd tiln hdnh phdu tich mach xuyen chay trong ca. Cae bd ca dugc taeh ra khdi dudng di cua mach xuyen, eae mgch mdu vdo nudi ca d\:fac khdu hay ddt mdt each d n than. Phau tich ca nguge ddng cho din mgch chinh cua mgch xuydn. Tiep tgc phiu tich cudng mgch chfnh cho din nai dg- doan mgch cd chilu dai va dudng kinh thfch hgp cho mge dich tgo hinh.
Cin bao tdn thin kinh chgy ciing mgch mau.
Ca lien quan cd the dugc d l Igi hoan todn, cung cd t h i mdt dai nhd ca cung dugc phau tfch kem cudng mgch trong trudng hgp mach xuyen qua nhd.' Tuy nhien, vipc phiu tich vgt mgch xuyen quan trpng nhat la phai phiu tich ti mi cua mach xuyen qua ca, vide nay ddi hdi ky nang vd thdi gian. Sau khi nhac vat ciing mgch xuyen, khdu phgc hdi ca va Idp can sdu. Khdu nai cho vgt khdng dugc cang 6e tranh hdi chung khoang sau md. Trong trudng hgp nai cho vgt qua cang, ghep da cd the dugc tiln hdnh tgi nai cho vgt.
Vat mgch xuyen dugc su- dgng d nhieu dgng khac nhau, vgt cudng lien vd vgt tg- do. Vdi eac tdn khuyet phin mdm nam cgnh mdt viing cd mgch xuyen, vgt mgch xuyen cudng lien dugc thiet ke sao cho cudng mgch du dai d l ed thi
chuyin vgt tdi khuyet tdn ma khdng bj cang cudng mgch. Cdc dgng vgt cudng ngogi vi hay trung tdm dugc su- dgng tuy theo clu true giai phiu ciia mgch chfnh. Odi vdi vgt cudng lien, dieu d n chii y nhit la bao tdn hp thdng tTnh mgch cua mgch xuyen d l tranh hipn tugng u- trp hdi luu tTnh mgch, mdt hipn tugng kha phd bien trong khi su- dgng vgt cudng liln. U'u dilm ciia vgt cudng lien la khdng d n din ky thugt vi phiu mgch mdu. Odi vdi vgt tg- do, chilu dai cudng mgch xuydn, dipn tich vd thdnh phin vgt da la cac yeu td quyet djnh cho mge dfch tgo hinh. Phgm vi sip dgng ciia cdc vgt mgch xuyen tg- do rat rpng rai, cd t h i ndi vgt xuyen tg- do cd thi dp dgng cho bit cu viing nao ciia ea thi.
odi vdi vgt tg- do, mpi thdnh phin ciia nai cho cd lien quan tdi mgch xuydn cd t h i dugc su- dgng trong mdt vgt. Cd t h i dd la cac vgt da dan thuin, hay vgt da md, vgt da cdn vd vgt da md lly ciing mpt phin ca cho tipng loai mge dieh tao hinh. Cac vat mach xuyen cd the dugc thilt ke dudi dgng vgt kep (chimeric flap) tuy thudc sd lugng mgch xuyen ed ciing nguyen uy tip mdt mach chinh. Dg-a tren ca sd eua tung mgch xuydn rieng le, cd t h i tgo ra nhieu vgt ddc lap theo sd lugng eua mach xuyen. Cac dgng vgt kep dugc su- dgng trong nhung trudng hgp tgo hinh ba chilu cua cdc khuylt phirc tgp. Ngodi viec tgo hinh ehe phu, cdc vgt mgch xuyen cdn dugc sip dgng nhu nhung chit lieu ddn, tgo ca quan ndi nhd nhu-ng thdnh phin phong phu ndm trong phgm vi d p mdu cua vgt xuyen.
Lfu dilm Idn nhit cua vgt mgch xuydn la bao tdn dugc chu-c nang ca lien quan vd giam thilu nhu-ng biln dgng tai nai cho vgt. Nhd dd ca khdng bj hi sinh, ngay ca khi ca bj se mdt phin. Sg- gidng nhau v l each phiu thugt ciia cae vgt da ca vd cdc vgt mgch xuyen tuang u-ng la mpt uu thi, ehi khac nhau v l vipe phiu tich dudng di ciia mgch xuydn trong ca. Nai eho vgt dugc bao tdn tdi da va giam dau ddn sau phiu thuat. Vgt mgch xuyen cd t h i dugc thilt k l tg- do theo khudn mau khuylt tdn va khdng bj hgn che ve chieu cua cudng mgch. Vgt da cd dipn tich dii Idn nhu vgt da ca tuang u-ng, tham ehi cdn ldn han nlu ed nhilu mgch xuyen, cd thi lay ea da cua nhu-ng viing k l can, vi vgy dipn tich vat thilt ke cd the rpng han viing d p mdu thg-c cua mgch. Cae viing da k l can cd
TCNCYH PhiJ trwang 77(6) 2011
t h i diing cung luc nhu vgt sinh ddi khi cd nhilu mach xuyen tip mpt ddng mgch chfnh. Cudng mgch cua vgt thudng ddi nhd lly mgch xuydn trong ca ciing vdi ddng mgch chlnh. Mdt khde cd t h i ngipng bit CLP nai ddu nlu khiu kfnh cua mgch cho phdp ndi dugc. Nhugc dilm Idn nhit cua vgt mgch xuydn Id v l k9 thudt phiu tich cudng mgch xuyen. Nhu-ng tdc ddng nhu xoin vdn cudng mgch, gilng gidt vgt cDng d l lam tdn thuang mgch xuydn. Cdc bit thudng ve giai phiu t h i hidn sg- khdng ddng nhit v l vj tri, sd lugng, kich thudc cua mgch xuydn ldm khd khdn han trong vide thilt k l vgt. Phiu thu$t vien phai chuln bj d l thay ddi thilt k l vgt hay thay ddi nai lly vgt nlu phat hidn sg- khdng thda mdn ve mgch xuyen ciia nai cho vgt. Phii n l tTnh mgch hay gdp do hd thdng tTnh mgch sdu tiiy hanh khdng du din luu cho vgt. Chilu ddy vgt khd Idn do ldp md dly d mdt sd ngudi Id mpt trd nggi cho tgo hinh.
Danh phap cho vgt mgch xuyen
Ciing vdi cupc tranh lugn v l khdi nipm mgch xuydn thgc su, vln d l dgt ten cua vgt mgch xuyen bj chia re bdi cdc xu hudng khde nhau.
Cdc tdc gia chdu Au vd bdc My de nghj cdch gpi theo ngudn dpng mgch d p mau cho vgt. Vi dg vgt nam trdn ea lung rpng dugc gpi la vgt dpng mgqh nguc lung. Nhdm tdc gia Han Qudc gpi theo ten ca lien quan eua vgt, tuang tg- vgt lung rdng dugc gpi la vgt mgch xuyen ea lung rpng.
Tuy nhien ngay ca vgt mgch xuyen lung rpng, dpng mgch ngg-c lung khdng phai la ngudn duy nhat clp mau, cdn phai k l den cdc mgch xuydn lien sudn vd that lung. Trong mpt nd Ig-c tim kiem nhung danh phap hgp ly nhit eho vgt mgch xuyen, hipn nay cd xu hudng thoa hidp Id
Bang 1. Ten gpi mpt sd vgt mgch xuyen
kit hgp c l hai cdch gpi tdn ddng mgch va tdn ca lidn quan. Cdc tdc g i i thdng nhit vide djnh danh vgt theo mdt nguydn t i c nhu sau:
Vgt da dugc tdch thdnh hai logi Id vgt da (cutaneous flaps) vd vgt xuydn da ca (musculocutaneous perforator flaps).
- Vgt da bao gdm t i t c l cdc vgt da trge mgch (axial), vgt mgch gian vdch (septocutaneous) v l vgt da cdn (fasciocutaneous), thudc typ A va B theo cdch phdn logi cua Mathes vd Nahai. Hdu td -s dugc thdm vdo tip vilt t i t cua mgch mdu chfnh d l chf ddy la vgt da cdn hay vgt da vdch.
- Vgt mgch xuydn Id cdc vgt mgch xuydn da eg thudc typ C theo cdch phdn logi eua Mathes vd Nahai, trong dd cd mgch nudi da di qua ca.
Vgt duge ddt tdn theo ngudn mgch. Hdu td AP d l chf ddy Id vgt mgch xuyen thg-c sg-.
Nlu vgt dg-a trdn mgch vach tn/c tilp hay da cdn, hdu td -s dugc them vao tip viet t i t ciia mgch vgt. VI dg vgt diii trudc ngoai (anterolateral thigh flap) la vgt da cdn cd ky hipu Id LCFAP-s
Khi nhilu vgt dg-a tren nhilu mgch xuydn da ca eua mpt ddng mgch, ca lien quan din mgch xuydn se dugc vilt tdt va in nghidng 6e chf ra ngudn gdc giai phiu cua vgt, (vi dg, LCFAP- vl cho ca thing ngoai (vastus lateralis).
- Trong trudng hgp vgt dga trdn cdc dpng mgch ngudn cd sd phdn dogn ngudn gdc, chang hgn nhu ddng mgch thit lung hoge lidn sudn sau, vgt cung dugc ddnh sd theo dpng mgch. Sd cua mgch tuang Cpng duge thdm vao sau chu vilt t i t cua vgt, (vf dg, PIAP-8 flap de chf nhanh xuydn lidn sudn sau sd 8 - posterior intercostal perforator).
thdng dgng trong Phlu thugt Tgo hinh Ten thdng dung
DIEP Vgt thugng vj sdu dudi TAP Vgt nguc lung
ALT Vgt dill trudc ngodi SGAP Vgt mdng tren l-GAP Vgt mdng dudi
Danh phap md'i DIEAP
TAP LCFAP-vl
S-GAP IGAP
Ngudn d^ng mgch Thugng vj sdu dudi
Ngg-c lung Nhdnh xudng mu diii
Mdng trdn Mdng dudi
Ce nguyen uy Thing bgng
Lung rpng Rpng ngodi
Mdng Idn Mdng Idn
TCNCYH Phu trwang 77(6) 2011 Triln vong cua vgt mgch xuyen trong
tu'eng lai
Sieu vi phau thuat (Supramicrosurgery) dugc Koshima va cdng sg- djnh nghTa nhu la ky thudt vi phiu ndi eac mgch mau cd dudng kinh khoang 0,5mm. Mdt uu diem eua logi ky thugt nay la cae mach xuyen chf d n phiu tich tren can, cdn dogn chay trong ea thi khdng phiu tich, nhd dd thdi gian va tdn thit cua ea la it nhat. nhung it phiu thudt vien cd ky nang ndi duge cac mgch mau nhd la mpt hgn ehe cua vat nay.
Vi phau tich lam mong vat (Microdissection for flap thinning) dugc Kimura vd cpng sg de xuat, ddy la ky thudt phiu tich cd su- dgng kinh hiln vi cdc nhdnh mgch xuyen chgy trong ldp md ndng, ddng thdi logi bd eae thuy md xung quanh cdc mgch mdu nay. Nhd vipe phiu tich tdch ldp md ra khdi Idp da tren ndng, vgt thu dugc ed chieu day khd mdng (2-3mm). Ky thudt nay cho phep kilm soat dugc chieu day ciia vat cho muc dich tgo hinh che phu hay tgo hinh ca quan ndi.
Vat ngau himg tiJ> do (Free-style free flap) la mdt dang vgt dua tren mdt cudng mach xuyen tai bit ky nai ndo eua ca t h i . Vat dugc thiet ke dua tren dae tinh ddng chay vd vj tri cua mgch
xuyen, hoan todn dpc lgp vdi cdc d u true xung quanh hay cac mgch mau chinh. Vgt ngiu hu-ng tg do md rdng ngudn cho vl cd t h i phiu tich d bit ky viing ndo cua ca thi. Cd t h i diing vgt tgi chd hay vgt tg do. Phiu tich trong ca la khdng d n thiet.
TAI
LIEU THAM
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Surg. 20 (2): 53 - 55.
3. Kim JT (2005). New nomenclature concept of perforator flap. Br. J. Plast Surg; 58:431 - 440.
4. Mathes SJ, Nahai F (1981). Classification of the vascular anatomy of muscles:
Experimental and clinical correlation. Plast Reconstr Surg; 67: 177 - 187
5. Taylor, G. I., and Palmer, J. H (1987). The vascular territories (angiosomes) of the body:
Experimental study and clinical applications. Br.
J. Plast. Surg. 40: 113.
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Summary
APPLICATIONS OF PERFORATOR FLAP IN PLASTIC SURGERY
Perforator flaps represent the latest descendant in a line of evolution that began with the random pattern flap. The perforator flap era began in 1989 and they become more popular in plastic surgery because of many advantages: reducing of donor-site morbidity; they can be tailored to accurately reconstruct the defect, including flap thinning for resurfacing shallow defects; freedom of orientation of the pedicle and a longer pedicle; large territories flap. Indications for specific perforator flaps are dependent on many factors including the surface area and volume requirements, aesthetic appeal, patient choice, and the experience and repertoire of the surgeon.
Keywords: nomenclature, perforator flap, plastic surgery
