Taipei, Taiwan; and Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, and the Department of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical System.
Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e395-e407. doi: 10.1097/PRS.0b013e3181bcf05c.
In the last two decades, the anterolateral thigh flap has emerged as one of the most popular reconstructive options for multiple body sites. Based on a perforator flap harvest concept, the flap encompasses the advantages of versatility, pliability, and potential for composite tissue replacement. Although numerous anatomical variations exist, these are well-described, and flap safety remains uncompromised if certain anatomical boundaries are respected. Careful preoperative planning and identification of perforators remain the cornerstone of successful flap harvest. Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom-made flaps tailored to fit almost any defect. A suprafascial dissection allows for "ultra-thin" flaps ideal for folding, tubing, or packing purposes. The versatility of the lateral circumflex femoral artery branches can be exploited to include muscle, iliac bone, tendon, fascia, or nerve in extended designs. The anterolateral thigh flap is currently the frontline choice for head and neck reconstruction, including intraoral, mandibular-maxillary, tongue, and facial defects, and is gaining popularity in abdominal and pelvis reconstruction. It can also be used as a pedicled flap in phallus or perineum reconstruction. More recently, the flap has proved to be extremely useful in skin resurfacing and even functional reconstruction in traumatic wounds. This review summarizes the anatomy, planning, flap harvest, donor morbidity, and clinical applications of the anterolateral thigh flap. An algorithm is proposed that facilitates a clear, problem-based approach for the use of this versatile reconstructive option.
在过去的二十年中，股前外侧皮瓣已成为多个身体部位最受欢迎的重建选择之一。基于穿支皮瓣采集概念，该皮瓣具有多功能性、柔韧性和复合组织替代的潜力。尽管存在许多解剖学变异，但这些都得到了很好的描述，如果遵守某些解剖学边界，皮瓣的安全性就不会受到影响。仔细的术前规划和穿支的识别仍然是成功采集皮瓣的基石。一旦确定了穿支，皮瓣的设计变化允许多种皮瓣配置、中央或偏心方向，以及定制的皮瓣，以适应几乎任何缺陷。筋膜上解剖允许“超薄”皮瓣，非常适合折叠、管状或填充目的。旋股外侧动脉分支的多功能性可以被利用，以包括肌肉、髂骨、肌腱、筋膜或神经的扩展设计。股前外侧皮瓣目前是头颈部重建的首选，包括口腔内、下颌骨-上颌骨、舌和面部缺陷，并在腹部和骨盆重建中越来越受欢迎。它也可以作为阴茎或会阴重建的带蒂皮瓣使用。最近，该皮瓣在创伤性伤口的皮肤修复甚至功能重建方面也被证明非常有用。这篇综述总结了股前外侧皮瓣的解剖学、规划、皮瓣采集、供区并发症和临床应用。提出了一种算法，该算法为这种多功能重建选择的使用提供了一种清晰的、基于问题的方法。
