Combined Anterolateral Thigh and Anteromedial Thigh Flap for Extensive Extremity Reconstruction: Vascular Anatomy and Clinical Application
Combined Anterolateral Thigh and Anteromedial Thigh Flap for Extensive Extremity Reconstruction: Vascular Anatomy and Clinical Application
复制标题
大腿前外侧和大腿前内侧皮瓣联合进行广泛的肢体重建：血管解剖学和临床应用
DOI：
10.1055/s-0035-1558985
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发表时间：
2015-11-01
影响因子：
2.1
通讯作者：
Chai, Yi-Min
中科院分区：
文献类型：
--
作者：
Jia, Ya-Chao;Chen, Hong-Hao;Chai, Yi-Min
背景 先前曾报道过大腿前外侧（ALT）和大腿前内侧（AMT）组合皮瓣用于复杂的头颈重建。然而，由于血管变异，它尚未得到普及。在此，我们探讨这种组合皮瓣的血管基础，并报告其在四肢重建中的应用。方法本研究分为血管解剖和临床应用两部分。在解剖研究中，解剖了成人大腿的 52 侧，以识别供应 ALT 和 AMT 皮瓣的血管穿支，重点关注旋股外侧动脉降支产生的相当大的穿支（大于 0.5 mm）。临床上，2006 年 1 月至 2010 年 12 月，采用 ALT 和 AMT 皮瓣联合皮瓣治疗 5 名男性患者，进行广泛的肢体重建。 32 岁（范围：23-45 岁）。组合皮瓣用于覆盖前臂（n=≥3）和小腿（n=≥2）的大面积软组织缺损。记录每位患者的美观和功能结果。结果解剖学研究显示，50 条大腿（96.2%）存在供应 ALT 皮瓣的大量穿支，32 条大腿（61.5%）存在供应 AMT 皮瓣的穿支。 30 条大腿（57.7%）有 ALT 和 AMT 皮瓣可供使用。所有 5 个皮瓣均完全成活。覆盖供体部位的皮肤移植物顺利愈合。平均随访时间为 9.6 个月（范围：6-12 个月）。随访期间未出现并发症。结论 ALT 和 AMT 联合皮瓣因其良好的可操作性和可接受的供区发病率而可用于选定患者的广泛肢体重建。
BackgroundThe combined anterolateral thigh (ALT) and anteromedial thigh (AMT) flap has been previously reported for use in complicated head and neck reconstruction. However, it has not gained popularity due to the vascular variation. Here, we explore the vascular basis of this combined flap, and report its application in extremity reconstruction.MethodsThis study was divided into two parts: vascular anatomy and clinical application. In the anatomical study, 52 sides of adult thighs were dissected to identity vascular perforators supplying the combined ALT and AMT flap, with focus on sizeable perforators (larger than 0.5 mm) arising from the descending branch of the lateral circumflex femoral artery.Clinically, five male patients were treated by combined ALT and AMT flaps for extensive extremity reconstruction from January 2006 to December 2010. The mean age was 32 years (range, 23–45 years). The combined flap was used for covering large soft-tissue defects in forearm (n= 3) and calf (n= 2). For each patient, esthetic and functional results were recorded.ResultsThe anatomical study showed that sizeable perforators supplying the ALT flap were present in 50 thighs (96.2%), and the perforators supplying the AMT flap were present in 32 thighs (61.5%). The combined ALT and AMT flaps were available in 30 thighs (57.7%).All five combined flaps survived completely. Skin grafts covering the donor sites healed uneventful. The mean follow-up was 9.6 months (range, 6–12 months). No complications were recorded during the follow-up.ConclusionThe combined ALT and AMT flap may be used for extensive extremity reconstruction in selected patients for its great maneuverability and acceptable donor-site morbidity.