大面积缺损的肿瘤手术后通常需要增强手术规划以优化重建效果。因此，对于医疗复杂的患者，使用腹部皮瓣时需要创新的解决方案，以避免远端组织缺血。血管增强技术，如超级供血或涡轮增压，可增加医疗复杂患者的灌注量，以确保皮瓣存活。在本报告中，我们强调了在一名患有未控制糖尿病的患者中使用双侧脐下动脉穿孔（DIEP）皮瓣的超级供血方法，用于治疗231平方厘米大腿缺损。一名57岁的男性患者，糖尿病控制不佳（手术前血糖为510毫克/分升），伴有缺铁性贫血，出现了右大腿19×9平方厘米大小的大型非转移性鳞癌瘤病史长达两年。正电子发射断层扫描/计算机断层扫描和右侧腹膜后及腹股沟淋巴结活检结果诊断为3期局部化鳞癌。我们在切除肿瘤后，立即使用超级供血的双侧脐下动脉穿孔（DIEP）皮瓣进行深度缺损的重建。该皮瓣以同侧DIEP为蒂，对侧穿支吻合于缺损下方的外侧股动脉下行支（DLCFA）。静脉吻合器用于静脉，动脉则以端对端的方式手缝。超级供血的双侧脐下动脉穿孔（DIEP）皮瓣用于为高危患者的蒂部瓣进行增强灌注。患者的临床过程并发了一次假单胞菌感染，需要进行手术洗刷和坏死脂肪的清创。然而，皮瓣幸存并完全覆盖了缺损。患者需要门诊抗生素治疗假单胞菌感染，感染完全消除，不需要进一步的手术干预。在6个月的随访中，重建部位稳定，临床检查未见肿瘤复发。我们的结果表明，在大腿大面积缺损的情况下，超级供血的脐下动脉穿孔（DIEP）皮瓣可能是一种可行的选择，并可用于医疗复杂的患者，这些患者的创面愈合能力较差。©2023 Wiley Periodicals LLC

Patients with large defects after oncologic surgery often require enhanced surgical planning to optimize reconstructive outcomes. As such, medically complex patients require innovative solutions when utilizing abdominal flaps due to concern for ischemia of the distal tissue. Vascular augmentations, such as supercharging or turbocharging, serve to increase perfusion in these medical complex patients to ensure flap survival. In this report, we highlight the use of a supercharged bilateral pedicled deep inferior epigastric perforator (DIEP) flap in a patient with a 231 cm2 thigh defect in the setting of uncontrolled diabetes. A 57-year-old male with poorly-controlled diabetes (blood sugar prior to surgery 510 mg/dL) and iron deficiency anemia presented with a two-year history of a large nonmetastatic squamous cell carcinoma (SCC) measuring 19 × 9 cm2 on the right thigh. Positron emission tomography/computed tomography and biopsies of the right retroperitoneal and inguinal lymph nodes diagnosed the mass as Stage 3 localized SCC. After excision, we performed immediate reconstruction of the resultant defect with a supercharged bilateral pedicled DIEP flap. The flap was pedicled on the ipsilateral DIEP and the contralateral perforator was anastomosed to the descending branch of the lateral circumflex femoral artery (DLCFA) at the inferior aspect of the defect. A venous coupler was used for the veins and the arteries were hand-sewn in end-to-end fashion. The supercharged bilateral pedicled DIEP flap was utilized for enhanced augmented perfusion to the distal edge of the pedicled flap in a high-risk patient. The patient's clinical course was complicated by a Pseudomonas infection of a small hematoma requiring operative washout and debridement of necrotic fat. However, the flap survived and covered the defect completely. The patient required outpatient antibiotics for the Pseudomonas infection which resolved completely without further need for operative intervention. At 6-month follow up, the reconstruction was stable with no tumor recurrence on clinical exam. Our results suggest that a supercharged pedicled DIEP flap may be a viable option for large defects of the thigh and can may be utilized in medically complex patients with poor capacity for wound healing.© 2023 Wiley Periodicals LLC.