游离股前外侧复合组织瓣在颅面缺损修复中的应用

Free composite anterolateral thigh flap for reconstruction of craniofacial defects

目的探讨游离股前外侧复合组织瓣在颅内恶性肿瘤切除术后及颅面创伤后缺损修复中的应用。方法回顾性分析2007年9月至2016年9月应用游离股前外侧复合组织瓣行颅内恶性肿瘤切除术后或颅面创伤后缺损修复的病例。总结皮瓣成活率、并发症发生率（脑脊液漏、感染等）、患者满意度，评价手术安全性及有效性。结果应用游离股前外侧复合组织瓣修复颅面缺损10例（脂肪筋膜皮瓣3例、脂肪筋膜瓣2例、肌皮瓣4例、嵌合皮瓣1例）。随访3～17个月，平均12个月，皮瓣成活良好；无脑脊液漏、颅内感染；供区无并发症发生；患者对手术效果均较为满意。结论游离股前外侧复合组织瓣供区充足，供受区血管匹配，肌肉组织可有效填充颅内较深的不规则死腔；皮瓣血供丰富，可同期利用阔筋膜修补硬脑膜缺损，降低术后脑脊液漏及感染的发生率；远期随访效果稳定；是颅内恶性肿瘤切除术后及颅面创伤后缺损修复的较好选择。

Objective To evaluate the clinical outcomes of a series of patients who have undergone reconstruction of craniofacial defects after resection of intracranial tumors or craniofacial trauma with free composite anterolateral thigh flaps. Methods Retrospective analyses the clinical cases from September 2007 to September 2016. Data included flap survival rate, complication, satisfaction survey was reviewed to evaluate the efficacy and safety of this surgical strategy. Results Totally 10 free anterolateral thigh flaps including 3 cases of fasciocutaneous flaps, 2 case of adipofascial flaps, 4 cases of myocutaneous flaps, 1 case of chimeric flap, were adopted to reconstruct craniofacial defects. Follow-up ranged from 3 to 17 months （average, 12 months）. All flaps were transferred successfully. There were no cranial spinal fluid （CSF） leaks, intracranial infections or donor site complications. All patients were satisfied. Conclusions Because of its abundance of tissue, matched vessels to recipient site, versatility of muscular flaps to fill irregularly intracranial defects, reliable blood supply, feasibility of simultaneous fascia lata harvesting, free composite anterolateral thigh flap is the reconstructive method of choice for craniofacial defects reconstruction after resection of intracranial tumors or craniofacial trauma. The use of ALT flap was reliable in the decrease of CSF leak and infection rate and dependable according to long time follow-up.