改良二纵五横新算法在儿童股前外侧皮瓣设计中的临床应用

Clinical application of modified two-longitudinal and five-transverse method in preoperative design of the anterolateral thigh perforator flap in children

目的探讨改良二纵五横新算法在儿童股前外侧皮瓣(anterolateral thigh perforator flap,ALTP)设计中的临床应用效果。方法自2019年12月至2022年12月,我们对12例儿童皮肤软组织缺损患儿实施游离股前外侧皮瓣修复创面,所有患者均根据改良二纵五横新算法实施股前外侧皮瓣穿支定位探查,术前在股前外侧区域形成Ⅰ、Ⅱ、Ⅲ、Ⅳ区,使用便携式多普勒超声分别在4区内探测穿支,根据穿支分布情况设计皮瓣,皮瓣切取范围为3.5 cm×5.0 cm~18.0 cm×5.5 cm。结果术前探查12例患侧股前外侧供区穿支共计32支,Ⅰ、Ⅱ、Ⅲ、Ⅳ区穿支分布分别为8、9、10、5支。术中证实共30支,假阳性率为6.67%。穿支分布类型主要为降支24支,斜支6支。术后所有皮瓣顺利存活,供区均Ⅰ期愈合。术后随访时间为2~32个月,平均(8.2±0.4)个月。皮瓣外观、质地可,供区残留少许瘢痕。结论改良二纵五横新算法在儿童ALTP穿支定位、皮瓣设计及切取中安全可行,提供了可靠的皮瓣设计基础,有较高的应用价值。

Objective To explore the clinical application effect of the modified two-longitudinal and five-transverse new algorithmin the design of the anterolateral thigh perforator flap(ALTP)in children.Methods From December 2019 to December 2022,12 children with skin and soft tissue defects were repaired by ALTP in our department.All patients underwent localization and exploration of the perforating branches of the ALTP based on the modified two-longitudinal and five-transverse new algorithm.Before operation,Ⅰ,Ⅱ,Ⅲ,Ⅳareas were formed in the anterolateral area of the thigh,and the perforators were detected in the above four areas using portable ultrasound Doppler,and the flaps were designed according to the distribution of the perforators.The size of the flap ranged from 3.5cm×5.0 cm to 18.0 cm×5.5 cm.Results A total of 32 perforating branches were detected in the 4 areas of the anterolateral femoral donor area in 12 patients before operation.The number of perforating branches inⅠ,Ⅱ,Ⅲ,Ⅳareas was 8,9,10 and 5,respectively.The false positive rate was 6.67%.The distribution types of perforating branches are mainly 24 descending branches and 6 oblique branches.After operation,all the flaps survived well and the donor site achieved primary healing.All patients were follow-up for 2 to 32 months,with an average of(8.2±0.4)months.The appearance and texture of the flap were good,and there was no obvious scar hyperplasia in the donor area.Conclusion The new algorithm of modified two-longitudinal and five-transverse method is safe and feasible in the localization of perforating branch,flap design and harvesting of ALTP perforations in children.It provides a reliable basis for flap design and has high application value.