New York, N.Y. From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2008 Aug;122(2):492-496. doi: 10.1097/PRS.0b013e31817dc4c0.
Although the anterolateral thigh flap has been used extensively in reconstruction, the use of large or extended skin paddles (i.e., >240 cm) is thought to be associated with an increased risk of partial flap necrosis. This assumption may be attributable to cadaver perfusion studies of isolated anterolateral thigh flaps. The authors' clinical experience has shown, however, that significantly larger flaps can be reliably harvested based on the standard skin perforators. The purpose of this report was therefore to evaluate the authors' clinical experience with the extended anterolateral thigh flap for reconstruction of oncologic defects.
All consecutive patients who had undergone reconstruction of oncologic defects using an extended anterolateral thigh flap (defined as >or=240 cm) were identified. Patient characteristics and outcome data were analyzed.
Fifteen patients met the inclusion criteria (flap size >240 cm) during the study period. The average size of the flaps was 341 cm (range, 240 to 480 cm). All flaps were perforator flaps and most had one perforator. In two patients, anterolateral thigh- and tensor fasciae latae-based perforators were used. There was one total flap loss on postoperative day 7 caused by recipient vessel spasm. One patient had partial necrosis of the distal portion of the flap with delayed healing.
The anterolateral thigh flap is an excellent choice for massive defects requiring skin and soft-tissue coverage. The flap can be extended safely beyond the limit of 240 cm as suggested by cadaver perfusion studies. Inclusion of tensor fasciae latae perforators may increase the blood supply of the flap proximally; however, in general, a single perforator is capable of supplying a large area of the lateral thigh.
尽管股前外侧皮瓣已广泛应用于重建，但使用大或扩展的皮瓣（即>240cm）被认为与部分皮瓣坏死的风险增加有关。这种假设可能归因于孤立股前外侧皮瓣的尸体灌注研究。然而，作者的临床经验表明，可以基于标准皮穿支可靠地采集明显更大的皮瓣。因此，本报告的目的是评估作者使用扩展股前外侧皮瓣重建肿瘤缺损的临床经验。
确定了在研究期间接受过使用扩展股前外侧皮瓣（定义为>或=240cm）重建肿瘤缺损的所有连续患者。分析了患者特征和结果数据。
在研究期间，15 名患者符合纳入标准（皮瓣大小>240cm）。皮瓣的平均大小为 341cm（范围为 240-480cm）。所有皮瓣均为穿支皮瓣，大多数皮瓣有一个穿支。在 2 名患者中，使用了股前外侧皮瓣和阔筋膜张肌皮瓣的穿支。术后第 7 天因受区血管痉挛导致 1 例全皮瓣坏死。1 例患者皮瓣远端部分坏死，延迟愈合。
股前外侧皮瓣是需要皮肤和软组织覆盖的大面积缺损的绝佳选择。皮瓣可以安全地扩展到尸体灌注研究建议的 240cm 以外的范围。包括阔筋膜张肌穿支可以增加皮瓣近端的血液供应；然而，通常情况下，单个穿支能够供应大腿外侧的大面积区域。
