股前外侧皮瓣修复头面颈部畸形缺损:兼论皮瓣分型

Anterolateral Thigh Flap in the Reconstruction of Cranio-facio-cervical Defects: Re-appraisal of Flap Classification

目的总结应用股前外侧皮瓣修复头面颈部畸形缺损的经验,并深入探讨股前外侧皮瓣的血管分型。方法采用股前外侧皮瓣游离移植修复头面颈部烧伤及创伤性缺损、慢性溃疡、半面萎缩、肿瘤切除术后洞穿性缺损、增生性瘢痕及挛缩畸形等。结果58例股前外侧皮瓣的蒂血管中,45例来源于旋股外侧动脉降支,7例来源于旋股外侧动脉横支,其它血供来源包括旋股外侧动脉主干4例,股深动脉1例,股动脉1例。58例皮瓣全部成活,仅1例远端10%坏死,随访2～19年,外形和功能恢复满意。结论①股前外侧皮瓣可根据蒂血管来源和皮肤血供类型来表示其分型,即“血供来源─血供形式”分型法。②股前外侧皮瓣因其具有恒定而较长的血管蒂、易于解剖分离、能提供充足的组织量以及供区隐蔽等优点,对头面颈部畸形和缺损的修复有独特效果。

To describe our clinical experience of anterolateral thigh flap in the reconstruction of cranio-facio-cervical defects,and to re-appraisal the flap classification.Methods Fifty-eight free anterolateral thigh flaps were used to repair chronic ulcer,electrical burns,semi facial hypotrophy, full-thickness defect in the cranio-facio-cervical region.Results Of the 58 flaps,45 were supplied by the descending branch of the lateralcircumflex femoral artery (LCFA),7 supplied by the transverse branch of LCFA,4 supplied by the trunk of LCFA,one by the profound femoral artery and one by the femoral artery directly. There was no flap loss except for partial necrosis of a 10% area in the distal potion in one flap.Follow-up averaged 12.5 years(range:2～19 years),good to excellent aesthetic and functional recovery were achieved in the majority of patients.Conclusions ①A new classification concept for anterolateral thigh flap was presented,that is the 'blood pedicle-supply pattern' classification.②The advantages of the anterolateral thigh flap,such as long vascular pedicle,easy elevation,good pliability,make it sometime a preferable choice for head-face-neck reconstruction.