Utility of Preoperative Positron Emission Tomography (PET) in Localizing Perforator Vessels of Anterolateral Thigh Free Flap

Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ALT flaps have been criticized due to variability in vasculature, which may result in inadequate or non-existent perforators. This retrospective study aims to investigate the utility and validity of positron emission tomography (PET) scan to identify the location and characteristics of perforators to the ALT flap. Methods: We performed a 10-year retrospective review of ALT flaps at our institution to identify patients with preoperative PET scans available for analysis. Three reviewers (attending physician, fellow, and resident) were asked to identify the number, location, and characteristics (myocutaneous versus septocutaneous) of ALT perforators on imaging, and reviewer agreement was assessed. Results were then compared to available operative data. Results: One hundred twenty-one patients were identified who underwent ALT free flap surgery. Thirty-eight preoperative PET scans were identified for review. At least one perforator was identified in 92.1% of scans. Agreement percentages regarding the number of perforators ranged from 53% - 61% whereas agreement regarding the location of a single perforator ranged from 79% - 90%. However, reviewers did not agree regarding the type of perforator, with agreement ranging from 34% - 53%. Poor agreement was observed when compared to intraoperative data, with the number of perforators ranging from 26% - 34% and the type of perforator 11% - 24%. These findings are likely due to insufficient data available in operative reports. Conclusion: Although initial studies suggest that PET scan shows promising evidence to support the capacity to preoperatively identify ALT perforators, future prospective studies are warranted to fully validate these findings.

Clinical observation of endoscopic skull base reconstruction with an anterolateral thigh free fascia flap

Objective:Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications,affecting patient survival and quality of life.To date,surgical resection is the main treatment for radiation osteonecrosis.The repair after the operation is very important.Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain,aggravating osteonecrosis.This study aimed to verify the feasibility and safety of the ante-rolateral thigh free fascia flap in repairing large skull base defects.Methods:From June 2021 to July 2022,a total of 12 patients with a history of radiotherapy for naso-pharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head&Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects.During the endoscopic operation,a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction.The preoperative and postoperative pain scores were retrospectively analyzed,and the dynamic changes in endoscopic surgery sites were observed.Results:The 12 patients had a median age of 58 y,with 8(66.7%)males and 4(33.3%)females.The median headache score for the patients was 5(4-7)before surgery.The patient's headache was significantly relieved postoperatively,with 11 patients having a score of 0 and one patient having a score of 1.The stench was completely resolved after the operation.There were no serious complications during the perioperative period or 12 months after the operation.Conclusion:The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.

Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns:A Retrospective Case Series

Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

The application of anterolateral thigh flap in post-operative repairing of vulva tumor

Objective： The aim of this study was to evaluate the value of the application of anterolateral thigh flap in postoperative repairing of vulva tumor. Methods： Anterolateral thigh flap with the descending branch of the lateral circumflex femoral artery and the pedicle of anterolaterat thigh cutaneous nerve was used in primary repairing of the defect from postoperative vulva tumor, the sizes of the flaps ranged from 10 cm ×14 cm-14 cm× 20 cm. Results： All flaps survived, during a follow-up of 2 to 12 months, the appearance of the flaps was satisfactory with sensitive function without local recurrences. Conclusion： Anterelateral thigh flap has fairly long vessel pedicle, wider vessel diameter, and is in the covert area. Anterolateral thigh flap with sensory nerve is the ideal choice for postoperative repairing of vulva tumor.

Repair of a severe palm injury with anterolateral thigh and ilioinguinal flaps: A case report

BACKGROUND In daily life and work,there are more and more patients with trauma to the hand,which often results in skin and soft tissue defects.Although there are many repair methods,the function and appearance of the fingers will be adversely affected if the repair is inadequate.CASE SUMMARY In the present report we describe an 18-year-old male patient whose right hand was mangled by a machine.X-ray imaging showed that a right hand bone(middle finger)was absent and the alignment was poor.After hospitalization,he was diagnosed with a severe right hand injury,skin and soft tissue defects,partial finger defects,and a skin degloving injury.He underwent reconstructive surgery with anterolateral thigh and ilioinguinal flaps.After two repair operations,satisfactory results were obtained,including good fracture healing,good skin flap shape,and good wrist joint function.CONCLUSION This case highlights the good effect of anterolateral thigh and ilioinguinal flaps repair technique on severe palm injury.

Two Cases of Distal Anterolateral Thigh Flap

We report our experience with two cases of anterolateral thigh flaps based on the musculocutaneous perforators arising from a more distal part of the descending branch than in the conventional anterolateral thigh flap. Case 1: A 53-year-old man with a skin ulcer over the anterior surface of the left tibia secondary to plate fixation for an open fracture. The perforator marked with preoperative Doppler was located 8 cm proximal to the superior border of the patella. Without thinning, the flap was 10 × 4 cm in size and 5 mm thick. Case 2: A 46-year-old man with necrosis of the right index finger after replantation. The flap was 5 × 3 cm in size and 3 mm in thickness. This “distal” anterolateral thigh flap can be raised as a quite thin flap with a long pedicle and, therefore, is considered useful in the reconstruction of various soft tissue defects.

A Case of Harvesting Anterolateral Thigh Flaps Twice from the Ipsilateral Thigh of a Single Patient in Separate Operations

Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.

Scalp and Dura Matter Complex Reconstruction Using Free Anterolateral Thigh Flap with Vascularized Fascia

The reconstruction of large scalp and dural defects is difficult. Anterolateral thigh (ALT) flap is now widely used because of its reliable blood supply to the skin paddle. Additionally, ALT can be harvested with a large skin paddle and large, well-vascularized fascia. We have successfully treated eight scalp and dural composite defect cases (five male and three female) using ALT with vascularized fascia. The patients’ mean age was 59.1 ± 20.4 years ranging from 31 to 83 years. The mean dural defect size was 73 ± 21 cm2, ranging from 50 to 120 cm2. There were no postoperative infections, bleeding, cerebrospinal fluid leakage, or meningitis. Further discussion about the usefulness of vascularized fascia may be required and we believe that plastic surgeons, head and neck surgeons, and neurosurgeons should report on the results of dural reconstruction.

Prefabricated Anterolateral Thigh Flaps for Phalloplasty in Female-to-Male Transsexuals

Background Phalloplasty is still a challenging operation because of the high urethral complication rate.Several options regarding different flaps can be chosen,but there is still no perfect solution for phalloplasty in female-to-male(FTM)transgender patients.Our group tried to use prefabricated anterolateral thigh(ALT)flaps for phalloplasty to overcome the urethral complications.Methods A total of 21 transgender patients were included from 2010 to 2019.A twostage operation was performed to reconstruct the phallus.The vaginal mucosa was prefabricated as neourethra at the first stage,and the shaft of the phallus was reconstructed at the second stage.Results All reconstructed phallus survived completely in our study,and the satisfaction rate was 76.2%.The total complication rate was 57.1%.The occurrence of fistula and strictures after the operation was 52.4%and 5.8%,respectively Conclusion Prefabricated ALT flaps with vaginal mucosa have a lower stricture rate.This technique provides a simple,effective surgical option in FTM transsexuals.

The Antero-Lateral Thigh Flap in Coverage of Extensive Post Traumatic Upper Limb Defects

Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.

Unusual case of a free anterolateral thigh flap partial necrosis in a COVID-19 positive young male following extremity reconstruction

Free flap procedure provides an overall success rate of 97%, which decreases to 85% in hypercoagulable states. COVID-19, as a pro-thrombotic disorder, therefore seems detrimental to free flap survival. We encountered a case of unique pattern of free flap partial failure in a young male who underwent extremity reconstruction. The patient was diagnosed as COVID-19 positive on the 3rd day post-reconstruction. The flap survived well for the first 7 days post-operatively, but gradually the skin got necrosed and the subcutaneous fat layer was preserved when debriding. To our knowledge, this is the only case in which the skin of the free flap of a COVID-19 positive patient was necrosed almost entirely subsequently, while the subcutaneous fat was relatively preserved.

股前外侧皮瓣修复足踝部复合组织缺损的临床疗效分析

目的研究分析股前外侧皮瓣修复足踝部复合组织缺损的临床疗效。方法回顾性分析2020年1月至2023年6月本院收治的足踝部复合组织缺损患者共92例,根据皮瓣修复手术方法不同将92例患者分为两组,其中观察组51例,行股前外侧皮瓣修复治疗,对照组41例,行小腿岛状穿支皮瓣修复治疗。结果观察组患者的手术治疗时间,皮瓣愈合时间均明显短于对照组患者,差异具有统计学意义(P<0.05);两组患者术后皮瓣均完全成活;术后3个月,观察组患者AOFAS评分明显高于对照组(P<0.05);术后3个月,观察组患者BMRC感觉功能恢复分级中,S3-S4级占比明显高于对照组患者(P<0.05);观察组患者术后并发症发生率(11.76%)与对照组患者术后并发症发生率(12.20%)无明显差异,比较无统计学意义(χ^(2)=0.8214,P>0.05)。结论采用股前外侧皮瓣修复足踝部复合软组织缺损,可以获得较好的临床疗效,患者术后足踝功能以及皮瓣感觉功能恢复更好,适合临床选择应用。

结合内增压技术的股前外侧跨区皮瓣修复肢体较大创面临床研究

目的:对比结合内增压技术的股前外侧跨区皮瓣与传统股前外侧皮瓣在修复肢体较大创面缺损中的临床疗效。方法:回顾性分析2018年5月—2022年5月浙江大学医学院附属邵逸夫医院收治的肢体较大创面缺损共38例患者(缺损面积达到11 cm×39 cm~16 cm×65 cm)的临床资料。按照修复方式的不同,将患者分为跨区皮瓣修复组(18例)和传统皮瓣修复组(20例)。跨区皮瓣修复组采用结合内增压技术的股前外侧穿支皮瓣联合旋髂浅动脉皮瓣(ALTP-SCIAP)治疗,传统皮瓣修复组采用单侧或双侧股前外侧皮瓣,必要时联合植皮。比较两组术后皮瓣存活情况、供区修复情况、并发症、患者满意度等。结果:跨区皮瓣修复组中,切取移植皮瓣18例次,瓣宽(9.9±2.0)cm,瓣长(44.2±3.5)cm,存活面积(343.2±79.9)cm^(2)。传统皮瓣修复组中,切取移植皮瓣29例次,瓣宽(11.0±2.8)cm,瓣长(21.7±3.2)cm,存活面积(186.4±49.2)cm^(2)。瓣长和存活面积跨区皮瓣修复组显著大于传统皮瓣修复组(t=22.365和8.345,均P<0.05)。跨区皮瓣修复组皮瓣供区采用直接缝合11例次,皮肤牵拉器辅助下缝合6例次,部分植皮修复1例次。传统皮瓣修复组皮瓣供区采用直接缝合12例次,皮肤牵拉器辅助下缝合11例次,部分植皮修复6例次。两组皮瓣供区修复的植皮率分别为5.6%(1/18)和20.7%(6/29),差异无统计学意义(χ^(2)=2.007,P>0.05)。跨区皮瓣修复组中出现并发症1例(5.6%),患者满意度达到94.4%;而传统皮瓣修复组中出现并发症7例35.0%,患者满意度为70.0%。相比传统皮瓣修复组,跨区皮瓣修复组并发症发生率降低(χ^(2)=4.942,P<0.05),患者满意度升高(χ^(2)=4.448,P<0.05)。结论:与传统股前外侧皮瓣比较,结合内增压技术的股前外侧跨区皮瓣切取面积更大,皮瓣供区大多可Ⅰ期直接缝合,不需要植皮修复,并发症更少,患者满意度更高。

超声引导下腹股沟上髂筋膜阻滞对游离股前外侧皮瓣修复术后早期恢复质量的影响

目的探讨术前超声引导下腹股沟上髂筋膜阻滞对四肢毁损伤患者游离股前外侧皮瓣修复术后早期疼痛及恢复质量的影响。方法选择因四肢毁损伤择期行游离股前外侧皮瓣修复术的患者79例,男47例,女32例,年龄18~60岁,BMI 16~28 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:超声引导下腹股沟上髂筋膜阻滞组(F组,n=39)和对照组(C组,n=40)。F组在麻醉诱导前行超声引导下腹股沟上髂筋膜阻滞,注射0.375%罗哌卡因和地塞米松5 mg混合液共30 ml;C组不行神经阻滞,所有患者全麻用药方案相同。记录术中丙泊酚、瑞芬太尼、舒芬太尼、血管活性药物用量、拔管时间、PACU停留时间;出PACU时、术后2、6、12、24、48 h静息时NRS疼痛评分;术后第1、2天镇痛泵有效按压次数及补救镇痛情况;术前、术后第1、2天15项恢复质量量表(QoR-15)评分;术后48 h内不良反应(头晕、恶心呕吐、皮肤瘙痒、呼吸抑制、低氧血症等)发生情况;出院时皮瓣供区伤口愈合、受区存活情况及住院时间。结果与C组比较,F组术中瑞芬太尼、舒芬太尼用量及使用血管活性药的例数明显降低,拔管时间、PACU停留时间明显缩短(P<0.05);术后2、6 h静息时NRS疼痛评分和术后第1天镇痛泵有效按压次数、补救镇痛率均明显降低(P<0.05);术后第1、2天的QoR-15评分均明显提高(P<0.05);术后48 h内头晕、恶心呕吐的发生率明显降低(P<0.05)。两组术中丙泊酚用量,出PACU时、术后12、24、48 h静息时NRS疼痛评分,术后第2天镇痛泵有效按压次数及补救镇痛率,术后皮肤瘙痒、呼吸抑制、低氧血症发生率,皮瓣供区愈合率、受区存活率及住院时间差异均无统计学意义。结论超声引导腹股沟上髂筋膜阻滞应用于游离股前外侧皮瓣修复四肢毁损伤可减少围术期镇痛药用量,缩短麻醉复苏时间,缓解术后早期疼痛,减少术后不良反应发生,提高术后早期恢复质量。

不同皮瓣修复术对口腔颌面部肿瘤术后缺损手术时间及口腔功能指标的影响

目的:分析口腔颌面部肿瘤术后缺损患者行不同皮瓣修复术治疗的效果。方法:选择口腔颌面部肿瘤术后缺损患者58例,随机分为对照组和观察组,各29例。两组均施以皮瓣修复手术治疗,对照组胸大肌位置选择皮瓣,观察组为股前外侧皮瓣,比较不同部位皮瓣的效果差异。结果:观察组并发症总发生率低于对照组;手术时间、拔除胃管时间、经口进食时间、皮瓣愈合时间短于对照组;皮瓣制作+显微吻合时间长于对照组;外形修复、正常进食、口腔开合功能、口腔容纳水测试、正常吞咽、咀嚼功能、语言表达能力、正常咬合功能分数,皮瓣成活率和修复满意度高于对照组(P<0.05)。结论:口腔颌面部肿瘤术后皮瓣修复患者行不同皮瓣修复术的效果存在差异,股前外侧皮瓣相对比胸大肌皮瓣更具备优势,可缩短手术时间,改善口腔功能,安全度、患者满意度较高。

激光多普勒在游离股前外侧皮瓣血运监测中的临床研究

目的应用激光多普勒监测游离股前外侧皮瓣血流灌注情况,探索游离股前外侧皮瓣术后血流灌注规律,并研究其在游离股前外侧皮瓣坏死预测中的可行性。方法分析2018年1月-2019年12月采用游离股前外侧皮瓣移植修复手部创面患者资料56例,术后均采用激光多普勒监测法监测皮瓣血流灌注情况。激光多普勒监测指标为术中供区皮瓣切取前、术后即刻、术后第1天、3天、5天、7天、9天的皮瓣血液灌注。结果术后第9天,56例皮瓣全部成活,其中2例在术后4 h发生动脉危象,探查后危象解除;8例发生静脉危象,处理后危象解除,皮瓣顺利成活。与皮瓣断蒂前相比,术后即刻及术后1~5 d血液灌注明显加快(P<0.01),血液灌注在术后第5天达到高峰,随后呈现下降趋势。结论激光多普勒能较早发现游离皮瓣血管危象,临床医生可更加了解皮瓣情况。游离皮瓣灌注总体呈现先上升后下降的趋势,为临床用药及护理工作提供参考依据。

改良带蒂股前外侧肌皮瓣修复手部难愈性创面

目的 探讨改良带蒂股前外侧肌皮瓣修复手部难愈性创面的临床疗效。方法 对2019年1月-2023年7月收治的手部难愈性创面8例,均合并创面感染,且因血管损伤等原因不具备游离皮瓣移植条件,采用改良带蒂股前外侧肌皮瓣移植修复。皮瓣供区直接缝合或者植皮修复,二期行皮瓣断蒂术。结果 术后所有皮瓣均顺利成活,质地柔软,未发生血管危象,肩关节活动无僵硬,患者均保肢成功。结论 改良带蒂股前外侧肌皮瓣血供可靠,抗感染效果良好,舒适性佳,是修复手部难愈性创面的有效临床疗法。

多种模式疼痛护理干预在游离股前外侧皮瓣修复上肢创面中的应用

目的探讨分析多种模式疼痛护理干预在游离股前外侧皮瓣修复上肢创面中的应用价值。方法选取2020年8月至2023年8月我院收治的100例游离股前外侧皮瓣修复上肢创面患者,以数字表法分组,随机分为对照组(常规护理干预)和观察组(多种模式疼痛护理干预)2组,各50例,对比分析两组干预效果。结果术后6 h、12 h、24 h及48 h观察组疼痛数字评分法(NRS)评分低于对照组(P<0.05);干预后观察组较对照组日常生活活动能力量表(ADL)、健康调查见表(SF-36)评分更高(P<0.05);观察组较对照组满意度高(P<0.05)。结论多种模式疼痛护理干预用于游离股前外侧皮瓣修复上肢创面患者护理中能有效减轻其疼痛程度,提高日常生活活动能力、生活质量,患者对护理也更为满意,值得推广。

带蒂股前外侧穿支皮瓣移植术修复儿童臀部硬纤维瘤切除后皮肤软组织缺损1例并文献分析

目的结合文献探讨带蒂股前外侧穿支皮瓣移植术修复臀部硬纤维瘤切除后皮肤软组织缺损的疗效。方法回顾性分析湖南省儿童医院骨科2020年11月收治的1例臀部硬纤维瘤患儿临床资料,收集肿块情况以及肿块切除后皮肤软组织缺损大小、带蒂股前外侧穿支皮瓣修复后皮瓣存活情况以及髋关节功能。以"pedicled anterolateral perforator thigh flap"、"soft tissue defect of hip"为检索词,检索PubMed数据库相关英文文献;以"带蒂股前外侧皮瓣"、"臀部皮肤软组织缺损"为检索词,检索中国知网、万方数据库中相关中文文献;检索时间自1970年1月至2022年12月,排除综述、信件、会议摘要后进行文献复习。结果本例患儿臀部硬纤维瘤大小15 cm×8 cm×6 cm,手术后臀部皮肤软组织缺损大小15 cm×6.5 cm,切取带蒂股前外侧穿支皮瓣大小15 cm×6.5 cm,采取供区直接缝合,受区无需植皮,术后皮瓣存活,未见血管危象;出院后随访24个月,臀部硬纤维瘤未见复发,供区愈合良好;无肌疝,受区皮瓣颜色、质地良好,患肢髋、膝关节活动未见受限。共检索到符合纳入标准的文献2篇,均为个案报道,共2例带蒂股前外侧穿支皮瓣移植修复臀部软组织缺损,均为男性,1例采用双侧带蒂股前外侧穿支皮瓣移植,皮瓣大小分别为35 cm×8 cm和22 cm×7 cm;另外1例切取大小29 cm×20 cm,受区部分植皮;2例术后随访皮瓣均存活,皮瓣质地良好,未见髋关节活动受限。结论带蒂股前外侧穿支皮瓣移植修复臀部皮肤软组织缺损是一种有效、可行的治疗方法。

以腓肠肌内侧头动脉供血的游离股前外侧皮瓣修复小腿复杂创面的临床研究

目的探讨以腓肠肌内侧头动脉为受区供血动脉的游离股前外侧皮瓣修复小腿复杂创面的手术方法及临床疗效。方法回顾性分析2020年10月—2022年9月苏州瑞华骨科医院收治的11例小腿复杂创面患者的临床资料。患者均存在小腿大面积皮肤及皮下软组织缺损,均接受游离对侧大腿股前外侧皮瓣修复,受区以腓肠肌内侧头动脉为供血动脉,供区皮肤直接缝合。结果11例患者11块游离皮瓣均成活,供区、受区创面均Ⅰ期愈合。出院后患者均获随访,随访时间12~35个月。术后12个月随访结果显示,所有患者创面愈合良好,皮瓣外观、弹性良好;所有患者恢复正常膝、踝关节功能,具有自主生活能力;供区伤口愈合良好,无明显瘢痕增生。末次随访时,皮瓣感觉功能评定为S 3级者2例、S 2级者9例;患肢功能评分达优者5例、良者6例,优良率高达100%。结论腓肠肌内侧头动脉血管口径适于吻合、位置恒定,以该动脉供血的游离股前外侧皮瓣修复小腿严重创面,可有效覆盖软组织缺损,并避免损伤小腿残留主干血管,疗效满意。