Hsu Chung-Chen, Lin Yu-Te, Lin Cheng-Hung, Lin Chih-Hung, Wei Fu-Chan
Taipei, Taiwan From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University.
Plast Reconstr Surg. 2009 Jun;123(6):1739-1747. doi: 10.1097/PRS.0b013e3181a65b00.
Immediate emergency free flaps are defined as flaps performed directly following emergency surgery due to the exposure of major reconstructed arteries, major nerves, bones, and tendons. The authors document their experience in using free anterolateral thigh flaps in the immediate reconstruction of complex upper extremity injuries.
From January of 2000 to October of 2006, 12 patients ranging from 10 to 59 years old with complicated upper extremity traumatic injuries were treated with immediate emergency free anterolateral thigh flap transfers. These flaps were performed to cover the exposed vital structures. Flap sizes ranged from 30 x 15 to 8 x 6 cm. A variety of flap designs were used, including six flow-through flaps for upper limb revascularization and three tensor fasciae latae components for gliding planes of exposed repaired tendons. The operative times ranged from 7.2 to 12.1 hours, with an average operative time of about 9.6 hours. The hospital stay was from 13 to 34 days, with average stay of about 27.7 days.
All of the flaps survived. No re-exploration was required. Partial flap necrosis occurred in only one case. Traumatized wound infection occurred in three patients.
The anterolateral thigh flap has been popularized as the versatile flap for soft-tissue reconstruction. It has many advantages, including long pedicle length, large skin territory, flow-though and chimeric concept design, a two-team approach, and no need for changing the position. Thus, it is suitable as the immediate emergency flap for upper extremity salvage.
即刻急诊游离皮瓣是指在因主要重建动脉、主要神经、骨骼和肌腱暴露而进行的急诊手术后直接进行的皮瓣手术。作者记录了他们使用游离股前外侧皮瓣即刻重建复杂上肢损伤的经验。
2000年1月至2006年10月，对12例年龄在10至59岁之间的复杂上肢创伤患者进行了即刻急诊游离股前外侧皮瓣转移术。这些皮瓣用于覆盖暴露的重要结构。皮瓣大小从30×15厘米到8×6厘米不等。采用了多种皮瓣设计，包括6个用于上肢血管重建的穿支皮瓣和3个用于暴露修复肌腱滑动平面的阔筋膜张肌成分。手术时间从7.2小时到12.1小时不等，平均手术时间约为9.6小时。住院时间为13至34天，平均住院时间约为27.7天。
所有皮瓣均存活。无需再次手术探查。仅1例发生部分皮瓣坏死。3例患者发生创伤伤口感染。
股前外侧皮瓣已作为多功能皮瓣用于软组织重建而得到推广。它具有许多优点，包括蒂长、皮肤面积大、穿支和嵌合概念设计、双组手术方式以及无需改变体位。因此，它适合作为上肢挽救的即刻急诊皮瓣。
