A retrospective clinical study of 41 cases of distally based anterolateral thigh flaps based on a new classification
杜青晏 1臧梦青 1朱珊 1童德迪 2李杉珊 1陈子翔 1刘元波1
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作者信息
1. 中国医学科学院整形外科医院瘢痕与创面治疗科,北京 100144
2. 首都医科大学附属北京积水潭医院手外科,北京 100035
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摘要
目的 探讨远端蒂股前外侧(distally based anterolateral thigh,dALT)皮瓣的特点及手术注意事项以提高手术成功率.方法 回顾性分析在2010年11月至2023年2月期间收治的41例患者,以dALT皮瓣修复膝关节周围软组织缺损,将以降支为蒂者定义为Ⅰ型皮瓣,以斜支为蒂者为Ⅱ型皮瓣,以横支为蒂者为Ⅲ型皮瓣,对比不同类型皮瓣的血管蒂长度、修复的缺损位置以及皮瓣转归.结果 Ⅰ型皮瓣24块,Ⅱ型皮瓣13块,Ⅲ型皮瓣4块.Ⅰ型皮瓣血管蒂较短,修复的缺损主要位于大腿远端1/3和膝关节前/外侧(62.5％,15/24);Ⅱ型和Ⅲ型皮瓣血管蒂较长,修复的缺损主要位于膝关节后/内侧和小腿近端1/3(84.7％,11/13;100.0％,4/4).Ⅲ型皮瓣的并发症发生率(50.0％)和皮瓣坏死率(25.0％)较高.结论 dALT皮瓣术前应注意评估可切取的血管蒂长度,术中需注意血管解剖、小心操作,避免破坏逆行血供,影响皮瓣血运.
Abstract
Objective To investigate the characteristics and surgical attentions of the distally-based anterolateral thigh(dALT)flap in order to improve the success rate of operation.Methods A retrospective analysis of 41 patients treated from November 2010 to February 2023 to repair soft tissue defects around the knee joint with dALT flaps.The dALT flap was classified into type Ⅰ,type Ⅱ,or type Ⅲ based on the origin(the descending,oblique,or transverse branch)of the chosen perforator.The vascular pedicle length,repaired defect location,and flap outcome of different types were compared.Results The type Ⅰ flap had a shorter vascular pedicle that primarily reached closer regions(distal third of the thigh and anterior/lateral knee)(62.5％,15/24).Type Ⅱ and type Ⅲ flaps had longer pedicles that mostly reached more distal regions(medial/posterior knee and proximal third of the leg)(84.7％,11/13;100.0％,4/4).However,the type Ⅲ flaps had higher complication rate(50.0％)and flap necrosis rate(25.0％).Conclusions To achieve more desirable outcomes using the dALT flap,preoperative assessment of vascular pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary.
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