Rodriguez Eduardo D, Rosson Gedge D, Bluebond-Langner Rachel, Bochicchio Grant, Grant Michael P, Singh Navin K, Silverman Ronald P, Scalea Thomas M
Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, MD 21201, USA.
J Trauma. 2007 Apr;62(4):892-7. doi: 10.1097/TA.0b013e318039bb02.
Identification of a single donor site capable of providing all the components of the soft tissue envelope and the ability to selectively harvest a subset of these components is a central requirement for the microvascular reconstruction of the trauma patient. The anterolateral thigh (ALT) flap's long pedicle and adaptability in supporting a variety of tissues (muscle, fascia, soft tissue) make it a valuable tool for microsurgical reconstruction in these challenging patients. We investigated the utility of the ALT as a donor for microvascular tissue reconstruction in a Level I trauma center.
We conducted a retrospective chart review on all trauma patients treated by the plastic surgery service at the R Adams Cowley Shock Trauma Center who required microsurgical free flap coverage from July 2002 to March 2005. Fifty-eight patients underwent reconstruction of traumatic deformities with 62 microvascular free flaps from the ALT region.
Of the 58 patients, 42 were male and 16 were female with an average age of 39 years. Recipient site locations for the 62 flaps were lower extremity, upper extremity, trunk, and head and neck. Analysis of flap anatomy revealed that 43 were fasciocutaneous, 14 were myocutaneous, 2 were adipofascial, and 3 were myofascial (vastus lateralis muscle). Six flaps were based on septocutaneous perforators, whereas the remainder contained myocutaneous perforators. Nine thigh donor sites required a split thickness skin graft, and 53 were closed primarily. The size of the flaps ranged from 36 cm2 to 600 cm2.
The ALT is a predictable donor site that facilitates a 2-team approach. ALT displays minimal donor site morbidity and in most cases provided sufficient tissue to cover the entire traumatic defect. Our results suggest the ALT is a reliable tissue source and an ideal donor site for the management of complex traumatic wounds in the United States.
确定一个能够提供软组织包膜所有成分的单一供区，并能够选择性地获取这些成分的一个子集，是创伤患者微血管重建的核心要求。股前外侧（ALT）皮瓣的长蒂以及在支持多种组织（肌肉、筋膜、软组织）方面的适应性，使其成为这些具有挑战性患者显微外科重建的宝贵工具。我们在一级创伤中心研究了ALT作为微血管组织重建供区的效用。
我们对2002年7月至2005年3月期间在R·亚当斯·考利休克创伤中心接受整形外科治疗且需要显微外科游离皮瓣覆盖的所有创伤患者进行了回顾性病历审查。58例患者接受了来自ALT区域的62个微血管游离皮瓣进行创伤畸形重建。
58例患者中，男性42例，女性16例，平均年龄39岁。62个皮瓣的受区部位包括下肢、上肢、躯干以及头颈部。皮瓣解剖分析显示，43个为筋膜皮瓣，14个为肌皮瓣，2个为脂肪筋膜瓣，3个为肌筋膜瓣（股外侧肌）。6个皮瓣以隔穿支为蒂，其余皮瓣包含肌皮穿支。9个大腿供区需要断层皮片移植，53个供区一期缝合。皮瓣面积从36平方厘米到600平方厘米不等。
ALT是一个可预测的供区，便于采用双组手术方式。ALT供区并发症极少，在大多数情况下能提供足够的组织覆盖整个创伤缺损。我们的结果表明，ALT是美国治疗复杂创伤伤口的可靠组织来源和理想供区。
