Wong Chin-Ho, Goh Terence, Tan Bien-Keem, Ong Yee Siang
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
Ann Plast Surg. 2013 Mar;70(3):337-42. doi: 10.1097/SAP.0b013e318234e8e2.
Large defects around the knee remain challenging reconstructive problems. We report our experience with the use of the anterolateral thigh perforator flap for various defects in this area, based on the anatomy seen intraoperatively.
Eight knee defects were reconstructed with the anterolateral thigh flap in accordance with our algorithm. Of them, 6 were performed as pedicled flaps and 2 as free flaps. For the pedicled flaps, 1 patient was reconstructed with an anterolateral thigh rotation flap, 3 patients with a directly transposed distally based anterolateral thigh flap, 2 patients with a "propeller" distally based anterolateral thigh flap. In the 2 patients reconstructed with the free anterolateral thigh flaps, the intramuscular part of the descending branch of the lateral circumflex femoral artery was used as the recipient vessel.
Reconstruction was successfully performed in all patients. Defects limited to the patella and above can be covered by antegrade anterolateral thigh rotation flaps. For larger defects, the distally based flap is needed. This can be used in cases where the perforators arise from the descending branch of the lateral circumflex femoral artery, either as a direct advancement or propeller flaps. In cases where the perforators are not usable or arises from the oblique branch of the lateral circumflex femoral artery, reconstruction was completed as a free flap. In such instances, the distal descending branch provides a reliable recipient vessel.
The anterolateral thigh flap offers a versatile and reliable option for defects around the knee. Its use requires a certain degree of reconstructive flexibility as the anatomic variations of the flap may require the flap to be transferred as a free flap in some cases.
膝关节周围的大面积缺损仍然是具有挑战性的重建难题。我们基于术中所见的解剖结构，报告我们使用股前外侧穿支皮瓣修复该区域各种缺损的经验。
根据我们的方案，采用股前外侧皮瓣修复8例膝关节缺损。其中，6例采用带蒂皮瓣，2例采用游离皮瓣。对于带蒂皮瓣，1例患者采用股前外侧旋转皮瓣重建，3例患者采用远端蒂股前外侧直接移位皮瓣，2例患者采用远端蒂“推进”股前外侧皮瓣。在2例采用游离股前外侧皮瓣重建的患者中，旋股外侧动脉降支的肌内部分用作受区血管。
所有患者均成功完成重建。局限于髌骨及以上的缺损可由顺行股前外侧旋转皮瓣覆盖。对于较大的缺损，则需要远端蒂皮瓣。当穿支血管起源于旋股外侧动脉降支时，可将其作为直接推进皮瓣或推进皮瓣使用。在穿支血管不可用或起源于旋股外侧动脉斜支的情况下，则作为游离皮瓣完成重建。在这种情况下，远端降支提供了可靠的受区血管。
股前外侧皮瓣为膝关节周围缺损提供了一种多功能且可靠的选择。由于皮瓣的解剖变异可能在某些情况下需要将皮瓣作为游离皮瓣转移，因此其使用需要一定程度的重建灵活性。
