股前外侧皮瓣修复前臂大面积软组织缺损

Anterolateral thigh flap transfer for coverage of oversized soft tissue defect of the forearm

目的 介绍应用股前外侧皮瓣移植修复前臂大面积皮肤软组织缺损。方法 切取自髂前上棘至髌骨外缘连线 1/2以上的超长股前外侧皮瓣 ,修复前臂大面积软组织缺损 2 4例 ,对其中 4例 ,采用双侧股前外侧皮瓣组合修复 ;皮瓣面积最大为 3 6cm× 12cm ,最小为 2 0cm× 8cm。结果 2 4例 2 8块组织瓣全部成活 ,术后无血管危象发生。术后 14例获得 6～ 3 6个月的随访 ,前臂外形满意 ,皮肤质地柔软 ,弹性好 ,皮瓣恢复保护性感觉 ,有排汗功能。皮瓣供区游离植皮区瘢痕较大 ,但无功能影响。结论 超长股前外侧皮瓣能一次修复前臂大面积软组织缺损 ,方法可靠 ,解剖容易 ,是一种简单、理想的手术方法。

ObjectiveTo introduce the application of extra long anterolateral thigh flap transfer for coverage of oversized soft tissue defect of the forearm.MethodsExtra long anterolateral thigh flap was defined when the long axis of the flap was longer than 1/2 length of the line joining the anterior iliac crest and the lateral border of the patella. Since 1996, 24 consecutive cases of oversized forearm skin defect were treated with this flap. Four of these cases had skin defect on both the volar and dorsal aspect of the forearm and were treated with combined bilateral anterolateral thigh flaps. The area of flaps ranged from 20cm×8cm to 36cm×12cm. The donor site was covered with skin graft. Secondary operations included nerve grafting in 2 patients after 2 months and tenolysis in 4 patients in 3 months. Survival and quality of the flaps were observed postoperatively.ResultsThere was no postoperative vascular crisis of the transfer. All 28 flaps of the 24 cases survived completely. Sufficient follow up was obtained in 14 patients, ranging from 6 months to 36 months. The reconstructed forearms were found to have good appearance. The flaps were of soft texture, good consistency, protective sensation and sweating capability. There was no functional impairment at the donor sites although scar hyperplasia was obvious in some cases.ConclusionExtra long anterolateral thigh flap transfer can be applied to achieve one stage repair of oversized soft tissue defect of the forearm. Due to its constant vascular anatomy and technical ease of harvesting, this flap is a reliable and optimal choice for the management of this type of injury.