The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: One surgeon's experience in 92 cases
The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: One surgeon's experience in 92 cases
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DOI：
10.1002/micr.20952
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发表时间：
2012-02-01
期刊：
影响因子：
2.1
通讯作者：
Sesenna, Enrico
中科院分区：
文献类型：
--
作者：
Bianchi, Bernardo;Ferri, Andrea;Sesenna, Enrico
背景：与筋膜皮瓣或穿支皮瓣的适应症相比，游离大腿前外侧（ALT）肌皮瓣的应用在很大程度上被低估了。在本文中，作者批判性地回顾了单个外科医生使用游离ALT肌皮瓣进行头颈部重建的经验，重点介绍了其在不同头部区域的应用以及该技术的优缺点。患者和方法：92 名患者接受游离 ALT 肌皮瓣治疗。重建区域包括舌头、口咽、下颌、上颌、下咽、脸颊和颅底。结果：皮瓣成活率为97.8%。供区发病率包括两例使用其闭合的皮肤移植物部分坏死的情况，最终供区并发症率为 2.2%。总体结果显示 89% 的患者恢复正常或软饮食。 88% 的患者言语良好或可理解，89% 的患者美容结果良好或可接受。结论：游离 ALT 肌皮瓣在头颈部重建中具有独特的优势，包括在需要时提供足够的体积、消除死腔、支持面部软组织、低供体部位发病率以及无需进行穿支解剖即可获取，从而实现最佳的患者预后。皮下组织体积过大、厚度过大，特别是在西方人群中，必须被视为该技术的主要缺点，最后，男性患者大腿区域多毛皮肤的高发生率以及与使用皮肤移植相关的供区疤痕必须被视为补充的小缺点。 (C) 2012 年 Wiley 期刊公司。显微外科 32：87-95，2012 年。
Background: Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction, focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique. Patients and methods: Ninety-two patients were treated using a free ALT musculocutaneous flap. Reconstructed areas included tongue, oropharynx, mandible, maxilla, hypopharynx, cheek, and skull base. Results: Flap survival rate was 97.8%. Donor site morbidity consisted in two cases of partial necrosis of the skin graft used its closure with a final donor site complication rate of 2.2%. Overall results showed an 89% of patients returned to a normal or a soft diet. Speech was good or intelligible in 88% and cosmesis resulted good or acceptable in 89% of cases. Conclusion: The free ALT musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the use of skin grafts have to be considered as supplementary minor drawbacks. (C) 2012 Wiley Periodicals, Inc. Microsurgery 32: 87-95, 2012.