股前外侧皮瓣移植修复四肢及口腔颌面软组织缺损

Anterolateral thigh flap transplantation for repair of soft tissue defects in limbs as well as oral and maxillofacial regions

背景:高能量损伤所致四肢大面积软组织缺损及口腔颌面部肿瘤切除术后软组织缺损是临床常见的组织缺损,应用股前外侧皮瓣修复此类缺损不但能覆盖创面而且对供区影响小。目的:总结分析游离股前外侧皮瓣在四肢及口腔颌面软组织缺损修复中的临床效果及治疗经验。方法:收集41例四肢及口腔颌面创伤或肿瘤切除后软组织缺损应用游离股前外侧皮瓣修复的临床资料,软组织缺损面积为(12～25)cm×(5～11)cm,根据受区软组织缺损大小、形态切取股前外侧皮瓣,将皮瓣动静脉与受区动静脉吻合,覆盖创面。观察移植后股前外侧皮瓣成活、供区愈合情况,患者对手术的满意程度,受区的功能恢复情况。结果与结论:所有皮瓣均完全成活,其中2例出现血管危象,均为移植后24～36h出现皮瓣淤黑,予及时血管探查发现均为静脉栓塞,经手术取栓后皮瓣成活。病例随访4个月～3年,均得到覆盖创面的目的,2例患者移植后因皮瓣臃肿再次入院行削薄手术。游离股前外侧皮瓣血管恒定,血管口径大,可切取面积大,修复四肢及口腔颌面皮肤黏膜大面积软组织缺损安全可靠。

BACKGROUND：Massive soft tissue defects of limbs caused by high-energy injuries and oral and maxillofacial soft tissue defects caused by tumor resection are common tissue defects in clinic.Anterolateral thigh flap for repair of these defects can cover wound surface without bad effects on the flap donor site.OBJECTIVE：To summarize and analyze the clinical effects and treating experience of free anterolateral thigh flap in repairing soft tissue defects in limbs and the oral and maxillofacial regions.METHODS：Forty-one cases of soft tissue defects in limbs and oral and maxillofacial regions caused by injuries or tumor resection were collected.The size of soft tissue defects ranged from 12 cm to 25 cm in length and 5 cm to 11 cm in width.According to the size and shapes of soft tissue defects, the anterolateral thigh flaps were designed, followed by arteriovenousanstomosis between the flap and defects.The survival situation of anterolateral thigh flaps, healing condition, function restoration and patents＇ satisfaction were all observed.RESULTS AND CONCLUSION：All flaps survived.Among them, vascular crisis occurred in 2 flaps, as black silts appeared in flaps within 24 to 36 hours after operation.Vascular detection found that both flaps were presented with vein thrombosis, and eventually survived following timely thrombolysis.Forty-one cases were all found successfully covering the wound surface after a follow-up of 4 months to 3 years.Two patients with bloated flaps were satisfied after featheredge surgery.Free anterolateral thigh flap is safe and reliable for repairing limbs defects as well as oral and maxillofacial soft tissue defects, especially for some large-size skin mucocutaneous defects, since its vessels are invariable with heavycalibre and large dermatomic area.