整形经典文献解读（1）阅读者皮瓣

The “Reading Man” Procedure: A New Technique for the Closure of Circular Skin Defects.

对于类圆形皮肤缺损，作者提出了新的局部皮瓣修复方法。

1. Illustration showing surgical technique. A, Circular

defect. B, Determining the direction of the central limb

of the Z-plasty (dotted lines). To obtain a fine scar, this line

should be perpendicular to the relaxed skin tension lines

(RSTL). C, The central limb of the Z-plasty is drawn as an

imaginary tangential line passing through the margin of the

circular defect. D, E, Other limbs of Z-plasty are planned

with angles of 45 degrees and 60 degrees according to unequal

Z-plasty concept. E, Flap nearby the defect (f1) is used

for the defect closure whereas other flap (f2) is transposed

for closure of donor site of first flap with Z-plasty maneuver.

F, The final view after defect closure.

作者分析认为Reading man technique方法实用易于掌握，可应用于各种解剖部位的圆形皮肤缺损，较传统的菱形皮瓣或Z瓣，具有皮瓣旋转张力小，皮瓣周围组织损伤少的特点。

如图示为阅读者皮瓣的设计步骤，其中最为重要的一点是确定缺损部位的最小张力线RSTL，依据此线确定皮瓣设计方向。与最小张力线垂直方向做创面切线，长度为创面直径的1.5倍，反折形成60度夹角皮瓣，以此皮瓣旋转修复创面，于创面切线的另一端做夹角45度的切口形成三角皮瓣修复供区。

Reading man technique依据RSTL就可以设计我们所需要的皮瓣，简单有效，三角瓣的设计对供区的修复，可以使创面闭合的张力更小，有利皮瓣成活，术区更加平整，外观更美观。

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