Odstock Centre for Burns, Plastic and Maxillofacial Surgery, Salisbury District Hospital, Salisbury SP2 8BJ, UK.
J Plast Reconstr Aesthet Surg. 2011 Dec;64(12):1621-6. doi: 10.1016/j.bjps.2011.07.015. Epub 2011 Aug 15.
The free anterolateral thigh flap (ALT) is now used as a 'workhorse flap'. The donor site morbidity is thought to be minimal, although most evidence derives from questionnaire-based studies rather than rigorous objective clinical assessment. In particular, robust quantitative data on thigh sensibility and quadriceps function is lacking. The aim of this study was to provide a comprehensive clinical assessment of donor site morbidity.
We performed a prospective study of consecutive free ALT perforator flaps performed at Salisbury Foundation Trust between March 2008 and April 2010. The donor site was assessed at six months including a questionnaire (symptoms, function), scar analysis (Vancouver Scar Scale, VSS), and evaluation of quadriceps power and lateral thigh sensibility (compared with the contralateral unoperated thigh).
One hundred ALT flaps were performed on 97 patients (mean age 46.8 years). The donor site was closed directly in 88 cases and using a split skin graft in 12 cases. At follow-up (n=68), tingling was the most common reported symptom (59%), whereas pain, itching and muscle herniation were reported infrequently. Donor site scars were mostly flat, pale and soft but widened. Pathological scarring was rare. Sensibility was reduced in donor thighs (p<0.001) and correlated with flap width but peak quadriceps contraction was similar between donor and unoperated thighs.
There was a high throughput and diverse application of ALT flap reconstructions during the study period. Reduced sensibility was common around the scar but rarely troublesome. Quadriceps function was not affected even when dissection of intramuscular perforators was required. The ALT is a versatile flap that can deliver a large skin paddle with minimal impact on thigh function.
游离股前外侧皮瓣（ALT）现在被用作“主力皮瓣”。虽然大多数证据来自问卷调查研究，而不是严格的客观临床评估，但认为供区的发病率很低。特别是，大腿感觉和股四头肌功能的有力定量数据缺乏。本研究旨在全面评估供区的发病率。
我们对 2008 年 3 月至 2010 年 4 月在索尔兹伯里基金会信托基金进行的连续游离 ALT 穿支皮瓣进行了前瞻性研究。在 6 个月时评估供区，包括问卷调查（症状、功能）、疤痕分析（温哥华疤痕量表，VSS）以及股四头肌力量和外侧大腿感觉评估（与对侧未手术的大腿相比）。
97 例患者共行 100 例 ALT 皮瓣（平均年龄 46.8 岁）。88 例直接关闭供区，12 例采用皮片游离移植。在随访（n=68）时，刺痛是最常见的报告症状（59%），而疼痛、瘙痒和肌肉疝出则很少见。供区疤痕大多平坦、苍白和柔软，但变宽。病理性瘢痕罕见。供区大腿感觉减退（p<0.001），与皮瓣宽度相关，但供区和未手术大腿的股四头肌峰值收缩相似。
研究期间 ALT 皮瓣重建的应用具有较高的吞吐量和多样性。在疤痕周围感觉减退很常见，但很少引起麻烦。即使需要解剖肌内穿支，股四头肌功能也不受影响。ALT 是一种多功能皮瓣，可提供大面积皮瓣，对大腿功能影响最小。
