以旋股外侧动脉斜支为蒂的逆行股前外侧皮瓣临床应用研究

Clinical applications of distally based anterolateral thigh flaps based on perforating vessels from lateral circumflex femoral artery oblique branch

目的探讨以来自旋股外侧动脉降支的斜支为蒂的逆行股前外侧皮瓣(distally based anterolateral thigh flap,dALT)修复下肢皮肤软组织缺损的可行性及技术要点。方法 2010年7月—2016年7月实施的18例dALT皮瓣手术中,应用以来自旋股外侧动脉降支的斜支为蒂的dALT皮瓣修复下肢皮肤软组织缺损7例。男4例,女3例;年龄3~58岁,平均26.7岁。膝关节附近血管纤维脂肪瘤、恶性纤维组织细胞瘤、软组织肉瘤各1例,病程分别为13年、1年、8个月;烧伤后膝关节周围瘢痕挛缩4例,病程6个月~35年。术中切除病变组织后遗留缺损范围为8 cm×6 cm^24 cm×8 cm,皮瓣切取范围为9 cm×7 cm^24 cm×8 cm;血管蒂长度为12~22 cm,平均16.6 cm;皮瓣旋转点至髌骨外上缘距离为9.5~14.0 cm,平均11.8 cm。供区直接拉拢缝合6例,植皮修复1例。结果术后皮瓣及植皮均顺利成活,受区创面及供区切口均Ⅰ期愈合。患者均获随访,随访时间5~54个月,平均30.7个月。皮瓣颜色、质地与受区周围皮肤相似。随访期间肿瘤患者无肿瘤复发,关节周围瘢痕挛缩患者伸屈功能及外观明显改善。结论如斜支来自旋股外侧动脉降支,具有足够长度共干血管,同时斜支发出皮肤穿支血管至股前外侧区,则可以选择以斜支为蒂的dALT皮瓣修复下肢皮肤软组织缺损。

Objective To explore the feasibility and technical points of soft tissue defect reconstruction of the lower extremity using the distally based anterolateral thigh （dALT） flap based on perforating vessels from the lateral circumflex femoral artery （LCFA） oblique branch. Methods Between July 2010 and July 2016, 7 patients underwent defect reconstruction of the lower extremities using the dALT flap based on perforating vessels from the LCFA oblique branch. There were 4 males and 3 females with an average age of 26.7 years （range, 3-58 years）. The etiologies included angiofibrolipoma in 1 case, malignant fibrous sarcoma in 1 case, soft tissue sarcoma in 1 case, and post-burn scar contracture in 4 cases. The disease duration was 13 years, 1 year, and 8 months in 3 patients with tumors respectively, and was from 6 months to 35 years in 4 patients with post-burn scar contracture. After resection of lesion tissues, the defect size ranged from 8 cm×6 cm to 24 cm×8 cm. The flap size ranged from 9 cm×7 cm to 24 cm×8 cm. The length of the pedicle ranged from 12 to 22 cm （mean, 16.6 cm）. The distance from the flap pivot point to the superolateral border of the patella ranged from 9.5 to 14.0 cm （mean, 11.8 cm）. The donor sites were directly closed in 6 cases and covered with the split-thickness skin graft in 1 case. Results All flaps survived after surgery without any major complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 54 months （mean, 30.7 months）. The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the knee joint were greatly improved in the patients with post-burn scar contracture. Conclusion For patients who have the oblique branch from the LCFA descending branch which sends out perforating vessels to the skin of the anterolateral thigh region, a dALT flap could be used to reconstruct soft tissue defects of the lower extremities.