游离股前外侧皮瓣修复头颈肿瘤术后缺损

Free anterolateral thigh flap for reconstruction of head and neck defects

目的探索供区功能和外观损伤更小的游离股前外侧（anterolateral thigh,ALT）皮瓣修复技术,运用于头颈肿瘤术后缺损.方法2003年12月-2005年5月中国医科院肿瘤医院头颈外科用于头颈部手术缺损修复的游离股前外侧皮瓣8例.头颈部肿瘤手术缺损按受区部位分为口咽侧壁3例,舌活动部2例,颊黏膜、舌根和颅底各1例.结果8例游离ALT皮瓣手术均获成功.供区伤口一期愈合,未发现切口裂开,下肢运动和感觉功能障碍等手术并发症.8例皮瓣的穿支血管类型均为肌皮穿支,皮瓣应用面积为（4～8）cm×（5～10）cm.手术时间5～10 h,平均7 h.皮瓣切取制作时间65～115 min,平均80 min.结论游离股前外侧皮瓣具有修复技术可靠、供区部位隐蔽和并发症少等优点,是头颈部缺损修复的理想皮瓣之一.

Objective To explore the anterolateral thigh （ALT） free flap in which the donor site is less noticeable and the morbidity is minimal for the reconstruction of head and neck defect. Methods A retrospective review was performed of 8 ALT flaps reconstructions for head and neck tumor ablation defects between Dec. 2003 and May 2005. Recipient sites were subdivided into pharyngeal wall （ n = 3 ）, oral tongue （ n = 2 ）, buccal mucosa （ n = 1 ）, base of tongue （ n = 1 ） and skull base （ n = 1 ）. The operative technique of ALT flap was described. Results All 8 free flaps survived. No complication was observed in the donor site, like wound dehiscence, weakness of the legs. The anatomy of the perforators were recognized as musculocutaneous pattern in all 8 cases. The size of the flap ranged from （4 -8） cm× （5 - 10） cm. The average time of operation was 7 hours with a range of 5 to 10 hours. The average time cost for ATL flap harvest was 80 minutes with a range of 65 to 115 minutes. Conclusions Free ALT flap is a reliable reconstruction technique for head and neck surgical defects. Because of the minimum donor site morbidity and the concealed site, this flap is the ideal choice for reconstruction of head and neck surgical defects.