应用周边穿支皮瓣作为股前外侧皮瓣皮穿支血管缺失时的替代方案研究

Nearby perforator flaps as alternative choices for anterolaterai thigh flap when lacking useful perforator

目的探讨当股前外侧皮瓣可用皮穿支血管（简称皮穿支）缺失时，应用周边穿支皮瓣作为替代方案完成修复过程。方法2010年8月至2012年8月，8例头颈鳞状细胞癌患者在股前外侧皮瓣制备中发现皮穿支缺失或不足，尝试采用同侧阔筋膜张肌皮瓣（5例），股前内侧皮瓣（3例）进行替代。结果全部8例替代皮瓣的制备均获得成功，无需再次选择新的供区。皮瓣制备时间50～85min。5例阔筋膜张肌皮瓣血管蒂长度6～10cm，血管蒂动脉外径2．5～3．0mm，静脉外径2．5～3．5mm。3例股前内侧皮瓣中，血管蒂长度10-15cm，1例采用股直肌支为蒂，动静脉外径均为1．0mm，另两例以旋股外侧动脉降支为蒂，动脉外径分别为3．5和3．0mm，静脉外径均为3．5mm。7例供区直接拉拢缝合，1例植皮。8例皮瓣全部成活，未发生供区并发症。结论阔筋膜张肌皮瓣和股前内侧皮瓣可作为股前外侧皮瓣可用皮穿支缺失时的良好替代方案。

Objective To explore the proposal using nearby perforator flaps as alternative reconstructive choices for anterolateral thigh （ALT） flap when lacking useful perforator. Methods From August 2010 to August 2012, 8 cases with head and neck cancer were found lacking reliable perforator during ALT flap elevation, a tensor fascia latae （TFL） flap or an anteromedial thigh （AMT） flap was used to complete the reconstruction. Results All 8 alternative flaps were successfully harvested, other donor sites were not needed. Flap harvest time was 50 - 85 min. Of 5 TFL flaps, pediele lengths were 6 - 10 cm, and the diameters of the arteries and veins were 2. 5 - 3.0 mm and 2.5 - 3.5 mm respectively. Of 3 AMT flaps, pediele lengths were 10 -15 cm, the rectus femoris branch was used as pedicle in 1 flap, with artery and vein more than 1.0 mm in diameter, and the descending branch of the lateral circumflex femoral artery was used as pedicle in other 2 flaps, the diameters of the arteries were 3.5 and 3.0 mm respectively, the diameters of the veins were 3.5 mm. The donor sites were directly closed in 7 cases and skin graft was performed in another case. All the flaps were alive and no complication was found in the donor sites. Conclusion TFL or AMT flap is an good alternative to ALT flap lacking useful perforator.