Verhelle Nicolas, Vranckx Jan, Van den Hof Bert, Heymans Olivier
Department of Plastic and Reconstructive Surgery, CHU Sart Tilman, University of Liège, Liège, Belgium.
Plast Reconstr Surg. 2005 Jul;116(1):170-7; discussion 178-81. doi: 10.1097/01.prs.0000169698.89331.0b.
In lower leg defects with bone, hardware, or articular exposure, a free tissue transfer is often the only valuable option. However, in well-selected clinical cases, pedicled flaps are still indicated because they provide an alternative for the more demanding and risky microsurgical procedure. The medial adipose-fascial flap of the leg represents an ideal local regional fascial flap.
Twenty-two medial adipose-fascial flaps (performed in 21 patients) were reviewed retrospectively and compared with a series of 22 free gracilis flaps (22 patients) selected out of 150 muscular free flaps for lower leg reconstruction. All patients with defects larger than 40 cm, peripheral vascular disease, deep defects, and osteomyelitis were excluded in order to obtain the same surgical indications in which the local medial adipose-fascial flap could have been used.
The overall surgical results were comparable, but more medical complications, a longer operative time, and a longer hospital stay were seen in the free muscle group. Moreover, patients reconstructed with a medial adipose-fascial flap appeared to be more satisfied with the aesthetic result of their reconstruction.
Muscle coverage is not mandatory to cover bone in the lower leg. The medial adipose-fascial flap can provide a good alternative for free flap coverage. This flap seems to have fewer medical complications, requires a shorter operative time and hospital stay, and can provide better aesthetic results than a free muscle flap.
在伴有骨骼、内固定物或关节外露的小腿缺损病例中，游离组织移植往往是唯一有效的选择。然而，在精心挑选的临床病例中，带蒂皮瓣仍是可行的，因为它为更复杂且风险更高的显微外科手术提供了一种替代方案。小腿内侧脂肪筋膜瓣是一种理想的局部区域筋膜瓣。
对22例（21名患者）小腿内侧脂肪筋膜瓣手术进行回顾性分析，并与从150例用于小腿重建的游离肌皮瓣中挑选出的22例（22名患者）游离股薄肌皮瓣进行比较。为确保符合局部内侧脂肪筋膜瓣的相同手术指征，所有缺损大于40厘米、患有周围血管疾病、深部缺损及骨髓炎的患者均被排除。
总体手术效果相当，但游离肌皮瓣组出现更多内科并发症，手术时间更长，住院时间也更长。此外，接受内侧脂肪筋膜瓣重建的患者对重建后的美学效果似乎更满意。
小腿骨骼覆盖并非必须采用肌皮瓣。内侧脂肪筋膜瓣可为游离皮瓣覆盖提供良好的替代方案。与游离肌皮瓣相比，该皮瓣内科并发症更少，手术时间和住院时间更短，美学效果更佳。
