Shieh S J, Chiu H Y, Yu J C, Pan S C, Tsai S T, Shen C L
Department of Surgery, National Cheng-Kung University Hospital and Medical College, Tainan, Taiwan.
Plast Reconstr Surg. 2000 Jun;105(7):2349-57; discussion 2358-60. doi: 10.1097/00006534-200006000-00006.
Thirty-seven consecutive free anterolateral thigh flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer ablation between January of 1997 and June of 1998. The success rate was 97 percent (36 of 37), with one flap lost due to a twisted perforator. The anatomic variations and length of the vascular pedicle were investigated to obtain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators were always found and presented as musculocutaneous or septocutaneous perforators in this series of 37 anterolateral thigh flaps. They were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle. In type I, vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In type IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascular pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitable for anastomosis with the neck vessels. Reconstruction of one-layer defect, external skin or intraoral lining, was carried out in 18 cases, through-and-through defect in 17 cases, and composite mandibular defect in two cases. With increasing knowledge of anatomy and refinements of surgical technique, the anterolateral thigh flap can be harvested safely to reconstruct complicated defects of head and neck following cancer ablation with only minimal donor-site morbidity.
1997年1月至1998年6月期间，36例患者接受了37例连续的游离股前外侧皮瓣移植，用于癌症切除术后头颈部缺损的重建。成功率为97%（37例中的36例），1例皮瓣因穿支扭转而坏死。研究了血管蒂的解剖变异和长度，以更好地了解其解剖结构，并避免在用于头颈部重建时出现一些手术失误。在这37例股前外侧皮瓣中，总能发现皮穿支，并表现为肌皮穿支或隔皮穿支。根据穿支的来源及其穿过股外侧肌的方向，将其分为四种类型。I型：由旋股外侧动脉降支发出的垂直肌皮穿支，占56.8%（37例中的21例），长度为4.83±2.04 cm。II型：由旋股外侧动脉横支发出的水平肌皮穿支，占27.0%（37例中的10例），长度为6.77±3.48 cm。III型：由旋股外侧动脉降支发出的垂直隔皮穿支，占10.8%（37例中的4例），长度为3.60±1.47 cm。IV型：由旋股外侧动脉横支发出的水平隔皮穿支，占5.4%（37例中的2例），长度为7.75±1.06 cm。血管蒂的平均长度为12.01±1.50 cm，动脉直径约为2.0至2.5 mm；两条伴行静脉直径为1.8至3.0 mm，适合与颈部血管吻合。18例患者进行了单层缺损（外部皮肤或口内黏膜）的重建，17例患者进行了贯通性缺损的重建，2例患者进行了下颌骨复合缺损的重建。随着对解剖结构认识的增加和手术技术的改进，股前外侧皮瓣可以安全切取，用于重建癌症切除术后复杂的头颈部缺损，供区并发症极少。
