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股前外侧穿支皮瓣切取技巧分析
A technique analysis for dissection of anterolateral thigh perforator flap
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朱跃良,殷作明,王家祥,吕乾,赵泽雨,浦绍全,石健,徐永清
- , 2017, DOI: 10.7507/1002-1892.201607112
Abstract: 目的 改进股前外侧穿支皮瓣的切取技巧,减少手术时间。 方法 选取 2008 年 1 月—2015 年 6 月采用股前外侧穿支皮瓣修复的400例患者作为研究对象,分析其皮瓣成功愈合(370 例,92.5%)及术后二次探查(30 例,7.5%)的技术因素;同时结合文献已报道的皮瓣切取技术,提出一种改良的皮瓣切取技术,即以逆行追踪穿支蒂-顺行切取降支主干的方法切取皮瓣,并于 2015 年 6 月—2016 年 6 月应用于 100 例患者。其中男 76 例,女 24 例;年龄 11~71 岁,平均 35.6 岁。创面范围 8 cm×5 cm~23 cm×9 cm。受伤至手术时间 5~31 d,平均 14.3 d。 结果 手术时间为(30.1±19.3)min,较未改进的切取方法手术时间(85.0±30.2)min 明显缩短。术后 94 例皮瓣成活并顺利愈合,创面及切口均 Ⅰ 期愈合。6 例发生血管危象,术后探查发现 4 例为静脉危象,术后取出血栓,皮瓣完全成活;2 例为动静脉危象,探查失败,皮瓣全部坏死后行二期创面植皮+换药后愈合。94 例皮瓣成活患者获随访,随访时间 3~12 个月,平均 6.3 个月。皮瓣生长良好,其中 21 例行二期修薄手术。 结论 改进后的股前外侧穿支皮瓣切取方法可进一步减少手术时间,降低切取难度。
Objective To improve the harvesting techniques of anterolateral thigh perforator flap, and to reduce the operation time. Methods Between January 2008 and June 2015, 400 patients undergoing repair with anterolateral thigh perforator flap were included to analyze the technical factors, including 370 cases (92.5%) obtaining primary healing and 30 cases (7.5%) receiving re-exploration. Combined with the literature, a modified flap dissection was made: reverse tracing and sequential dissection of the descending branch of the lateral circumflex femoral artery. Between June 2015 and June 2016, the modified free anterolateral thigh perforator flap was used in 100 cases. Of 100 cases, 76 were male and 24 were female, aged from 11 to 71 years (mean, 35.6 years). The wound size ranged from 8 cm×5 cm to 23 cm×9 cm. The time between injury and surgery ranged from 5 to 31 days (mean, 14.3 days). Results The operation time of modified flap dissection was reduced to (30.1±19.3) minutes from (85.0±30.2) minutes (unmodified flap dissection). Postoperatively, 94 flaps survived uneventfully, and incision healed by first intention. Six flaps received re-exploration surgery because of vascular compromise; the flap survived after removal of thrombosis in 4 cases of vein thrombosis; the flap necrosed in 2 cases of vein and artery thrombosis, and skin grafting was performed. Ninety-four patients whose flaps survived were followed up 3-12 months (mean, 6.3 months); the flaps had good color and appearance, and second stage operation was performed to make the flap thinner in 21 cases. Conclusion Improved harvesting technique of free anterolageral thigh perforator flap could decrease surgery time and difficulty in dissection.
Colgajo libre de perforantes de tensor de fascia lata como procedimiento de rescate de un colgajo anterolateral de muslo Tensor fasciae latae perforator free flap as a backup procedure for an anterolateral thigh flap  [cached]
A. Rodríguez Lorenzo,C.H. Lin
Cirugía Plástica Ibero-Latinoamericana , 2009,
Abstract: El colgajo anterolateral de muslo es uno de los colgajos más utilizados para la reconstrucción de una amplia variedad de defectos. En aproximadamente un 2% de los casos este colgajo presenta una distribución vascular considerada como difícil, lo que hace necesario plantear opciones reconstructivas alternativas intraoperatoriamente. En el presente artículo presentamos un caso clínico en el que se resolvió con éxito esta situación reconvirtiendo un colgajo de perforantes anterolateral del muslo, basado en una perforante de peque o calibre y con una disección intramuscular muy larga, en un colgajo de perforantes de Tensor de Fascia Lata. Anterolateral thigh flap is one of the most popular flaps used for reconstruction of a wide variety of defects. A difficult vascular pattern can be found in 2% of the cases in this flap which makes neccessary to shift to an alternative reconstructive option through a decision that it is usually made intraoperatively. In the current study we report a case in which this situation was successfully resolved by shifting an anterolateral thigh flap, based on a small perforator with a long intramuscular course, to a Tensor Fasciae Latae perforator flap.
The Clinical Application of Anterolateral Thigh Flap  [PDF]
Yao-Chou Lee,Haw-Yen Chiu,Shyh-Jou Shieh
Plastic Surgery International , 2011, DOI: 10.1155/2011/127353
Abstract: The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe. 1. Introduction Since Song et al. [1] introduced the anterolateral thigh flap in 1984, it gains popularity because of several advantages [2, 3]. First, the flap can be harvested simultaneously as two-team work. The operation time could be shortened. Second, the pedicle length is long enough to anastomosis with recipient vessels. The vein graft could be avoided. Third, the large caliber of pedicle vessels makes microanastomosis easier. Fourth, the flap could serve as fasciocutaneous, adipofascial, or myocutaneous flap as needed. Fifth, the flap can have great volume variability. Pliability could be achieved by primary thinning. Bulkiness could be added by incorporation of the deepithelialized skin or a portion of muscle cuff. Sixth, the lateral femoral cutaneous nerve can be included to provide as a sensate flap. Seventh, the flap pedicle could bridge the vascular gap as flow-through flap, especially in mangled extremities. Eighth, the donor site morbidity is minimal. 2. Flap Anatomy 2.1. Perforator Both septocutaneous and musculocutaneous perforators were identified in the anterolateral thigh flaps. Initially, it was thought that septocutaneous route composes the dominance [1, 4]. Recently, the anatomic studies suggested that musculocutaneous route takes the majority [2, 5–7]. In Shieh et al.’s and Wei et al.’s reports, 83.2% and 87.1% of perforators were found to be musculocutaneous, respectively [2, 3]. The differences between each studies might relate to the bias of the selection of the perforators by different authors.
分叶股前外侧穿支皮瓣在血管蒂保护中的作用研究
Clinical application of anterolateral thigh polyfoliate perforator flap for vascular pedicle protection
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李海,邓呈亮,魏在荣,金文虎,聂开瑜,唐修俊,王达利,常树森,李书俊
- , 2017, DOI: 10.7507/1002-1892.201703048
Abstract: 目的 探讨增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损创面的临床疗效。 方法 2014 年 1 月—2017 年 1 月,采用增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损创面 24 例。其中男 15 例,女 9 例;年龄 5~64 岁,中位年龄 33.5 岁。上肢创面 8 例,合并桡骨茎突骨骨折 1 例,伸指肌腱外露 3 例,肱桡肌肌腱外露 1 例。下肢创面 16 例,合并跟骨或跖骨、趾骨骨折 4 例,跟腱离断 1 例,趾长伸趾肌腱、趾长屈趾肌腱外露 8 例。创面范围为 8 cm×5 cm~18 cm×12 cm。根据创面大小及缺损区域,常规超声多普勒探查旋股外侧动脉穿支(2~5 支)并标记;将不规则创面分解成多个部分(分 2~4 叶)分别计算面积,皮瓣切取范围 9 cm×6 cm~20 cm×14 cm,最大单叶瓣切取面积 24 cm×6 cm;分叶血管蒂长 7~12 cm;蒂部联合创面嵌入分叶瓣面积 5 cm×3 cm~7 cm×5 cm。 结果 术后皮瓣全部成活,无动、静脉危象发生。24 例均获随访,随访时间 2~28 个月,平均 9 个月。1 例合并跟骨骨折行内固定患者皮瓣修复后伴窦道形成,经常规换药后 3 个月愈合。所有皮瓣均菲薄,无需二次修薄;5 例合并骨折者软组织均Ⅰ期愈合。所有患者受区腕关节、踝关节跖屈、背屈功能正常。 结论 设计增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损安全可靠,是减少游离股前外侧穿支皮瓣动、静脉危象的方法之一。
Objective To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect. Methods Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case. Wounds located in lower extremity in 16 cases, complicated with calcaneal or metatarsal, phalangeal fractures in 4 cases, Achilles tendon departure in 1 case, toe long extensor tendon and flexor digitorum longus tendon exposed in 8 cases. The wound area ranged from 8 cm×5 cm to 18 cm×12 cm. According to wound size, anterolateral thigh perforators were detected by conventional ultrasound Doppler (2-5 perforators). The irregular wounds were decomposed into multiple parts and the leaf number (2-4 leaves) of polyfoliate flap depended on the part number of the wound. The flap area ranged from 9 cm×6 cm to 20 cm×14 cm, and the largest area of single leaf was 24 cm×6 cm. The vascular pedicle length ranged from 7 cm to 12 cm. The foliate flap area with protecting pedicle ranged from 5 cm×3 cm to 7 cm×5 cm. Results All the flaps survived, and no vascular crisis occurred. All the patients were followed up 2-28 months (mean, 9 months). Sinus occurred in 1 case of calcaneal fracture after flap repair, and the sinus was healed after 3 months by conventional dressing. All the flaps were thin and had a good texture. Healing of soft tissue was found in 5 patients with fracture. The wrist and ankle plantar flexion and dorsiflexion function of recipient site were normal in all patients. Conclusion
Flow-through 嵌合旋股外侧动脉降支穿支皮瓣的临床应用
Clinical application of Flow-through chimeric anterolateral thigh perforator flap
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唐举玉,杜威,卿黎明,吴攀峰,周征兵,俞芳,庞晓阳,曾磊,潘丁,肖勇兵,刘睿
- , 2018, DOI: 10.7507/1002-1892.201802039
Abstract: 目的 探讨 Flow-through 嵌合旋股外侧动脉降支穿支皮瓣移植修复四肢合并深部死腔的皮肤软组织缺损的可行性及疗效。 方法 2014 年 5 月—2017 年 6 月,收治 6 例合并深部死腔、骨缺损或骨关节与肌腱外露的四肢皮肤软组织缺损患者。患者均为男性;年龄 26~60 岁,平均 44 岁。致伤原因:交通事故伤 4 例,机器绞轧伤 1 例,重物砸伤 1 例。损伤部位:下肢 5 例,上肢 1 例。创面范围 7 cm×4 cm~26 cm×10 cm。合并骨缺损 3 例,骨关节及肌腱外露 3 例,慢性骨髓炎 2 例,主干动脉损伤 2 例。采用 Flow-through 嵌合旋股外侧动脉降支穿支皮瓣移植修复,股外侧肌瓣填塞深部死腔,穿支皮瓣覆盖浅表创面。肌瓣切取范围 5 cm×2 cm~20 cm×5 cm,穿支皮瓣切取范围 10 cm×5 cm~28 cm×11 cm。供区直接闭合。 结果 术后皮瓣均顺利成活,受区创面与供区切口均Ⅰ期愈合。患者均获随访,随访时间 3~24 个月,平均 10 个月。所有皮瓣颜色、质地良好,重建的主干动脉通畅,患肢末梢血运良好。皮瓣供区仅遗留线性瘢痕,股四头肌肌力正常,膝关节活动无影响。 结论 Flow-through 嵌合旋股外侧动脉降支穿支皮瓣移植不仅能实现创面的立体修复,而且不牺牲受区主干血管,是修复四肢合并深部死腔、伴(或不伴)受区主干动脉缺损的有效方法之一。
Objective To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities. Methods Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients’ mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly. Results All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction. Conclusion The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels
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
Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap
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宋达疆,李赞,周晓,谢松林
- , 2017, DOI: 10.7507/1002-1892.201703122
Abstract: 目的 探讨制备游离带感觉超薄股前外侧穿支皮瓣修复?甲瓣供区的可行性及临床疗效。 方法 2011 年 5 月—2013 年 12 月,以游离带感觉超薄股前外侧穿支皮瓣修复 9 例拇指缺损患者的?甲瓣供区。男 8 例,女 1 例;年龄 19~42 岁,平均 31.2 岁。伤后至入院时间为 3~12 h,平均 6.5 h。致伤原因:机器碾压伤 4 例,交通事故伤 3 例,绞伤 2 例。采用?甲瓣游离移植重建拇指后,遗留供区软组织缺损范围为 3 cm×2 cm~8 cm×5 cm。携带股外侧皮神经分支制备带感觉股前外侧穿支皮瓣,游离移植修复供区创面;皮瓣切取范围为 3.0 cm×2.0 cm~8.5 cm×5.0 cm。皮瓣修薄前厚度为 2.0~4.5 cm,平均 3.2 cm;皮瓣修薄后厚度为 0.4~0.6 cm,平均 0.5 cm。所有股前外侧皮瓣供区直接闭合。 结果 术后所有再造拇指和皮瓣均成活。随访时间 6~30 个月,平均 15.8 个月。皮瓣质地和色泽与周围皮肤接近,外形不臃肿,两点辨别觉为 8~15 mm,平均 10.5 mm。患者大腿功能未见明显影响。 结论 游离带感觉超薄股前外侧穿支皮瓣质地薄且易塑形,适用于修复?甲瓣供区缺损。
Objective To explore the feasibility of harvesting free thinned innervated anterolateral thigh (ALT) perforator flap for repairing the donor defect after wrap-around flap transfer. Methods Between May 2011 and December 2013, free thinned innervated ALT perforator flap was used to repair the donor defects after wrap-around flap transfer in 9 patients. There were 8 males and 1 female, with a mean age of 31.2 years (range, 19-42 years). The interval time between injury and admission was 3-12 hours (mean, 6.5 hours). Injury causes included machine crush injury (4 cases), traffic accident injury (3 cases), and twisting injury (2 cases). The wrap-around flaps were transferred to reconstruct thumb defects. And the size of donor site defect ranged from 3 cm×2 cm to 8 cm×5 cm. A branch of the lateral femoral cutaneous nerve was carried to make innervated ALT perforator flap for donor site repair. The size of innervated ALT perforator flap ranged from 3.0 cm×2.0 cm to 8.5 cm×5.0 cm. The thickness of innervated ALT perforator flap before defatting ranged from 2.0 to 4.5 cm (mean, 3.2 cm); the thickness after defatting ranged from 0.4 to 0.6 cm (mean, 0.5 cm). The defect at the anterolateral thigh was primarily closed in all cases. Results All reconstructed thumbs and ALT perforator flaps survived. All patients were followed up 6-30 months (mean, 15.8 months). The ALT perforator flaps had good appearance and color, with no further flap revision or defatting procedures. The static two-point discrimination was 8-15 mm (mean, 10.5 mm). All patients could walk and run normally without postoperative skin erosions or ulcerations. Conclusion The free thinned innervated ALT perforator flap is pliable and thin. It is suitable for repairing the donor site defects after wrap-around flap transfer for thumb reconstruction.
股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用
Clinical application of relaying anteromedial thigh perforator flap in resurfacing of donor defect after anterolateral thigh flap transfer
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宋达疆,李赞,周晓,彭小伟,周波,吕春柳,杨丽嫦,彭文
- , 2017, DOI: 10.7507/1002-1892.201609085
Abstract: 目的 探讨股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床疗效。 方法 2012 年 2 月—2015 年 12 月,收治 23 例口腔癌患者。其中男 21 例,女 2 例;年龄 29~74 岁,平均 52.6 岁。舌鳞状细胞癌 16 例,口颊癌 7 例。肿瘤TNM分期:T 4N 0M 03 例,T 4N 1M 0 5 例,T 3N 1M 0 7 例,T 3N 2M 0 5 例,T 3N 0M 0 3 例。病程 6~18 个月,平均 8.8 个月。行颈淋巴清扫和原发病灶根治性切除术后,采用游离股前外侧穿支皮瓣行口腔缺损修复,供区采用股前内侧接力穿支皮瓣移位修复。 结果 所有患者均确认有恒定的股前内侧穿支存在,未发现穿支缺如。术后所有皮瓣均顺利成活,供受区创面均Ⅰ期愈合。未发生血管危象、伤口裂开和明显肿胀等情况。23 例均获随访,随访时间 6~20 个月,平均 9.4 个月。皮瓣供区仅遗留线性瘢痕,大腿功能未见明显影响,颜色及外观轮廓自然。 结论 股前内侧接力穿支皮瓣是修复游离股前外侧穿支皮瓣供区的理想选择。
Objective To investigate the clinical application of relaying anteromedial thigh (AMT) perforator flap in resurfacing of the donor defect after anterolateral thigh (ALT) flap transfer. Methods Between February 2012 and December 2015, 23 cases of oral carcinoma underwent radical resection; after resection of lesions, the tongue or mouth floor defects were reconstructed by ALT perforator flaps, and the donor sites were repaired with relaying AMT perforator flap at the same stage. There were 21 males and 2 females,with a mean age of 52.6 years (range, 29-74 years). Sixteen patients had tongue squamous cell carcinoma and 7 patients had buccal cancer. According to TNM tumor stage, 3 cases were classified as T 4N 0M 0, 5 cases as T 4N 1M 0, 7 cases as T 3N 1M 0, 5 cases as T 3N 2M 0, and 3 cases as T 3N 0M 0. The disease duration ranged from 6 to 18 months (mean, 8.8 months). Results The AMT perforators existed consistently in all patients. All flaps survived, and primary healing of wounds was obtained at recipient sites and donor sites. No vascular crisis, wound dehiscence, or obvious swelling occurred. All patients were followed up 6-20 months (mean, 9.4 months). There was only linear scar at the donor sites, and the function of thighs was normal. The color and contour of the flaps were satisfactory. Conclusion The relaying AMT perforator flap is an ideal choice to reconstruct the donor site of ALT flap.
游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损
Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect after oral cancer ablation
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宋达疆,李赞,周晓,章一新,彭小伟,周波,吕春柳,彭翠娥,彭文,欧延
- , 2018, DOI: 10.7507/1002-1892.201708110
Abstract: 目的探讨应用游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损的临床效果。 方法2008 年 1 月—2016 年 12 月,收治 42 例口腔颌面部恶性肿瘤患者。男 31 例,女 11 例;年龄 31~68 岁,平均 44.5 岁。口颊黏膜鳞癌 28 例,颊部皮肤基底细胞癌 10 例,牙龈鳞癌 3 例,腮腺复发导管癌 1 例。病程 1~24 个月,平均 13.5 个月。肿瘤根治性切除后遗留缺损范围为 6.0 cm×4.5 cm~9.0 cm×7.0 cm ;均为颊部洞穿缺损。设计并切取游离分叶股前外侧穿支皮瓣修复口内黏膜及颊部皮肤软组织缺损,皮瓣切取范围为 7 cm×5 cm~10 cm×8 cm 。供区直接拉拢缝合。 结果手术时间 4.5~7.5 h ,平均 5.5 h 。所有皮瓣均顺利成活,供、受区切口均Ⅰ期愈合。术后患者均获随访,随访时间 9~60 个月,平均 22 个月。患者对颊面部外形满意,张口度为 3~5 cm ,语言功能恢复良好。供区仅遗留线性瘢痕。随访期间,3 例患者因肿瘤复发死亡,其余患者均无瘤生存。 结论游离分叶股前外侧穿支皮瓣设计切取灵活,修复口腔颌面部恶性肿瘤术后颊部洞穿缺损效果满意。
ObjectiveTo investigate the effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect following oral cancer ablation. MethodsBetween January 2008 and December 2016, 42 patients with oral cancer were treated. There were 31 males and 11 females with an average age of 44.5 years (range, 31-68 years). There were 28 cases of buccal mucosa carcinoma, 10 cases of basal cell carcinoma of buccal skin, 3 cases of gingiva carcinoma, and 1 case of recurrent parotidduct carcinoma. The disease duration ranged from 1 to 24 months (mean, 13.5 months). The size of through-and-through maxillofacial defect ranged from 6.0 cm×4.5 cm to 9.0 cm×7.0 cm. All defects were repaired with the bipaddled anterolateral thigh perforator flap. The paddles were adjusted to repair the buccal area. And the size of flap ranged from 7 cm×5 cm to 10 cm×8 cm. The donor sites were closed directly. ResultsThe operation time was 4.5-7.5 hours (mean, 5.5 hours). All flaps healed and the wounds of recipient and donor sites healed by first intention. All patients were followed up 9-60 months (mean, 22 months). All patients were satisfied with their facial appearance and the speech function. The range of mouth opening was 3-5 cm. Three patients died of recurrence during the follow-up period and the other patients were alive. ConclusionThe bipaddled anterolateral thigh perforator flap is flexible and reliable for the through-and-through maxillofacial defect reconstruction following oral cancer ablation.
改良股前外侧游离穿支皮瓣桥式交叉移植修复小腿中下段软组织缺损
Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg
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杨林,刘宏君,张文忠,宋国勋,夏狮聪,张乃臣,顾加祥,袁超群
- , 2017, DOI: 10.7507/1002-1892.201705022
Abstract: 目的 探讨应用改良股前外侧游离穿支皮瓣桥式交叉移植修复小腿中下段软组织缺损的临床疗效。 方法 2011 年 3 月—2015 年 6 月,收治 15 例小腿中下段皮肤软组织缺损患者。男 9 例,女 6 例;年龄 22~48 岁,平均 32.6 岁。致伤原因:交通事故伤 8 例,机器绞伤 5 例,重物压砸伤 2 例。受伤至入院时间为 2 h~1 周,平均 86.2 h。创面缺损范围为 13 cm×9 cm~23 cm×16 cm。入院后一期清创、负压引流治疗,二期行改良股前外侧游离穿支皮瓣桥式交叉修复创面,皮瓣切取范围 15 cm×10 cm~25 cm×15 cm。供区直接缝合或游离植皮修复。修复术后 4 周断蒂。 结果 术后 1 例皮瓣出现血管危象,2 例皮瓣部分皮缘发生坏死,经对症处理后成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮均顺利成活。术后患者均获随访,随访时间 6~24 个月,平均 13 个月。皮瓣外观满意,质地与健侧相似,皮瓣恢复保护性感觉;术后 6 个月两点辨别觉为 15~28 mm,平均 19.5 mm。供区无瘢痕挛缩,双下肢功能均正常。 结论 改良股前外侧游离穿支皮瓣采用健侧胫前/后血管桥式交叉供血,血供可靠,供区损伤小,是修复小腿中下段大面积软组织缺损伴主干血管严重损伤的可供选择的修复方式之一。
Objective To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg. Methods Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation. Results After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site. Conclusion Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable
Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications
Tommaso Agostini,Giulia Lo Russo,Yi Xin Zhang,Giuseppe Spinelli
Archives of Plastic Surgery , 2013, DOI: http://dx.doi.org/10.5999/aps.2013.40.2.91
Abstract: Background A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimalskin resurfacing. Several techniques have been described to thin an ALT flap including anadipocutaneous flap, an adipofascial flap and delayed debulking.Methods By systematically reviewing all of the available literature in English and French, thepresent manuscript attempts to identify the common surgical indications, complications anddonor site morbidity of the adipofascial variant of the ALT flap. The studies were identifiedby performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database ofSystematic Reviews, Current Contents, PubMed, Google, and Google Scholar.Results The study selection process was adapted from the Preferred Reporting Items forSystematic Reviews and Meta-Analyses statement, and 15 articles were identified usingthe study inclusion criteria. These articles were then reviewed for author name(s), year ofpublication, flap dimensions and thickness following defatting, perforator type, type of transfer,complications, thinning technique, number of cases with a particular area of application anddonor site morbidity.Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects andimprove pliability. Its strong and safe blood supply permits adequate immediate or delayeddebulking without vascular complications. The presence of the deep fascia makes it possibleto prevent sagging by suspending and fixing the flap for functional reconstructive purposes(e.g., the intraoral cavity). Donor site morbidity is minimal, and thigh deformities can bereduced through immediate direct closure or liposuction and direct closure. A safe bloodsupply was confirmed by the rate of secondary flap debulking.
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