Toronto, Canada From the Division of Plastic Surgery and Department of Surgical Oncology, University Health Network; and Department of Surgery, University of Toronto.
Plast Reconstr Surg. 2011 Feb;127(2):677-688. doi: 10.1097/PRS.0b013e3181fed714.
The anterolateral thigh flap was described by Song et al. in 1984. Although more usually used as a free flap, it also has remarkable versatility as a pedicled flap. There are, however, no well-established guidelines that exist to define the extent of defects that can be reconstructed using this flap. In this article, the authors evaluate their experience with consecutive cases of the pedicled anterolateral thigh flap in complex abdominal and pelvic reconstruction.
A retrospective review of medical records and photographic archives was performed looking at 28 proximally pedicled anterolateral thigh flaps in 27 patients.
The authors identified the arcs of rotation achieved, the types of defects reconstructed, points of surgical technique that enhanced their results, and some pitfalls of this flap. Useful points of surgical technique identified included suprafascial flap harvesting, extended harvesting of fascia, utilization of fascia to protect the pedicle, harvesting as a composite flap with the vastus lateralis, prudent preservation of large perforators that transgress the lateral aspect of the rectus femoris, synergistic use with a sartorius "switch," complete flap deepithelialization to fill dead space, and simple conversion to a free flap when pedicle length is inadequate. Pitfalls identified included the increased risk of pedicle avulsion in the morbidly obese, the risk of atherosclerotic plaque embolization in an atheromatous pedicle, and the potential inadequacy of thigh fascia for reconstituting abdominal wall integrity.
This versatile flap has a wide arc of rotation. Multiple surgical modifications can be employed to tailor the flap to individual patient needs.
Song 等人于 1984 年描述了股前外侧皮瓣。虽然它通常被用作游离皮瓣，但作为带蒂皮瓣也具有显著的多功能性。然而，目前还没有确立的指南来定义可以使用该皮瓣重建的缺陷范围。在本文中，作者评估了他们在复杂腹部和骨盆重建中使用连续的带蒂股前外侧皮瓣的经验。
对 27 名患者的 28 个近端带蒂股前外侧皮瓣的病历和照片档案进行回顾性研究。
作者确定了可达到的旋转弧、重建的缺陷类型、提高手术效果的技术要点以及该皮瓣的一些缺陷。确定了一些有用的手术技术要点，包括筋膜上皮瓣的采集、筋膜的广泛采集、利用筋膜保护蒂、与股外侧肌复合采集、谨慎保留跨越股直肌外侧的大穿支、与缝匠肌“切换”协同使用、完整的皮瓣去上皮化以填充死腔、当蒂长度不足时简单转换为游离皮瓣。发现的缺陷包括病态肥胖患者蒂的易撕脱风险、粥样斑块蒂的动脉粥样硬化斑块栓塞风险以及大腿筋膜重建腹壁完整性的潜在不足。
这种多功能皮瓣具有广泛的旋转弧。可以采用多种手术改良方法来根据患者的个体需求定制皮瓣。
