Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia.
Microsurgery. 2012 Feb;32(2):87-95. doi: 10.1002/micr.20952. Epub 2012 Jan 20.
Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction, focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique.
Ninety-two patients were treated using a free ALT musculocutaneous flap. Reconstructed areas included tongue, oropharynx, mandible, maxilla, hypopharynx, cheek, and skull base.
Flap survival rate was 97.8%. Donor site morbidity consisted in two cases of partial necrosis of the skin graft used its closure with a final donor site complication rate of 2.2%. Overall results showed an 89% of patients returned to a normal or a soft diet. Speech was good or intelligible in 88% and cosmesis resulted good or acceptable in 89% of cases.
The free ALT musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the use of skin grafts have to be considered as supplementary minor drawbacks.
与筋膜皮瓣或穿支皮瓣相比，游离股前外侧肌皮瓣的应用在很大程度上被低估了。本文作者批判性地回顾了一位外科医生在头颈部重建中应用游离股前外侧肌皮瓣的经验，重点介绍了该技术在不同头部区域的应用以及该技术的优缺点。
92 例患者采用游离股前外侧肌皮瓣治疗。重建区域包括舌、口咽、下颌骨、上颌骨、下咽、颊和颅底。
皮瓣存活率为 97.8%。供区并发症包括两例皮片部分坏死，最终供区并发症发生率为 2.2%。总体结果显示，89%的患者恢复正常或软食。88%的患者言语良好或清晰，89%的患者美容效果良好或可接受。
游离股前外侧肌皮瓣在头颈部重建中具有独特的优势，包括在需要时提供足够的体积、消除死腔、支撑面部软组织、供区并发症发生率低、无需穿支解剖即可进行采集，从而实现最佳的患者预后。在欧美人群中，该技术的主要缺点是皮下组织过多和过厚，最后男性患者大腿区域毛发皮肤的高发率和皮片使用相关的供区瘢痕被认为是次要的缺点。
