以旋股外侧动脉横支为蒂的股前外侧皮瓣修复四肢皮肤软组织缺损

Soft tissue defects reconstruction by anterolateral thigh flap based on the transverse branch of the lateral circumflex femoral artery

目的探讨以旋股外侧动脉横支为蒂的股前外侧皮瓣修复四肢皮肤软组织缺损的临床效果。方法回顾性分析2020年4月至2021年3月苏州大学附属瑞华医院采用旋股外侧动脉横支为蒂的股前外侧皮瓣修复四肢创面的患者临床资料。术前以彩色多普勒超声定位股前外侧区穿支, 术中按照传统方法制备股前外侧皮瓣时, 发现穿支偏细, 口径不能满足血管吻合需求, 继续向上延长切口, 于大腿中上段寻找合适穿支, 并调整皮瓣设计, 切取以旋股外侧动脉横支为蒂的股前外侧皮瓣修复术区创面。股前外侧供区直接拉拢缝合。术后定期随访, 记录供区愈合与受区皮瓣存活情况, 根据综合评价量表评分标准评估皮瓣修复效果, 分为优(90~100分)、良(75~89分)、可(60~74分)、差(<60分)。结果共纳入13例四肢创伤患者, 男9例, 女4例, 年龄20~65岁, 其中手及前臂创面4例, 足踝部创面9例, 皮肤软组织缺损面积为7 cm×4 cm ~ 31 cm×8 cm。13例皮瓣术中可见横支发出18条皮穿支, 其中肌间隙皮穿支10条, 直接皮穿支8条。切取皮瓣面积为8 cm×6 cm~32 cm×10 cm, 1例皮瓣发生动脉危象, 行血栓取出术、剪除损伤段血管重新吻合后危象解除, 皮瓣成活;其余皮瓣均完全成活。13例术后随访6~20个月, 皮瓣质地柔软, 外观较好, 供区恢复良好, 无严重并发症。综合评价量表评定结果:优4例, 良7例, 可2例。结论以旋股外侧动脉横支为蒂的游离股前外侧皮瓣修复四肢皮肤软组织缺损, 可获得较好的效果, 且术中穿支解剖简单, 供区相对隐蔽, 可作为传统股前外侧皮瓣的有益补充。

Objective To investigate the feasibility and clinical outcome of anterolateral thigh flaps(ALTF)based on the transverse branch of the lateral circumflex femoral artery(LCFA)as the source artery in the repair of soft tissue defects of the extremities.Methods A retrospective analysis was conducted to analyze the clinical data from patients who received the ALTF pedicled with the transverse branch of the LCFA to repair the wounds of the extremities from April 2020 to March 2021 at Ruihua Affiliated Hospital of Soochow University.Preoperative Doppler ultrasound was applied to locate the perforators in the anterolateral thigh area.The ALTF was prepared based on the traditional method,and the perforators were found to be too thin to meet the requirements of vascular anastomosis.The incision was extended superiorly,and the designated perforators were found in the upper segment;thus,the flap was harvested accordingly.The ALTF pedicled with the transverse branch of the LCFA was finally harvested for wound reconstruction.The donor site was directly drawn and sutured.The wound healing of the donor site and the survival rate of the flap were recorded.The comprehensive evaluation scale was used to evaluate the repair effect,which was classified as excellent(90-100 points),good(75-89 points),fair(60-74 points),and poor(<60 points).Results Thirteen patients with extremity trauma were enrolled in the study,which consisted of nine males and four females.The age range was between 20 and 65 years old.There were 4 cases of hand/forearm wounds and 9 cases of foot/ankle wounds among the patients.The area of soft tissue defects was approximately 7 cm×4 cm to 31 cm×8 cm.Eighteen perforators from the transverse branches of the LCFA,including ten septocutaneous perforators and eight direct cutaneous perforators,were observed in thirteen surgeries.The area of flaps ranged 8 cm×6 cm to 32 cm×10 cm.One flap exhibited arterial crisis,which was relieved after thrombectomy and re-anastomosis of the injured segment;the flap survived.Other flaps survived completely.Thirteen patients were followed up for 6-20 months,and both flaps were soft in texture and good in appearance.In addition,there were no serious complications at the donor site.Finally,the curative effects of the ALTF pedicled with the transverse branch of the LCFA were estimated according to the flap comprehensive evaluation scale.Four cases obtained excellent curative effects,seven cases had good prognoses,and the effects of the remaining two cases were acceptable.Conclusions The ALTF pedicled with the transverse branch of the LCFA can be used to repair soft tissue defects of the extremities,with a good prognosis obtained;meanwhile,the anatomy of the perforators is simple,and the donor area is relatively inconspicuous.The flap can be a useful supplement to the conventional ALTF.