W Aesthetic Plastic Surgery, Mount Elizabeth Specialist Center, 329563 Singapore, Singapore.
Microsurgery. 2012 Nov;32(8):631-4. doi: 10.1002/micr.22011. Epub 2012 Jul 23.
A 67-year-old man with squamous cell carcinoma underwent reconstruction with a free anterolateral thigh myocutaneous flap. Unroofing the skin perforators found that the skin perforators originated from the oblique branch of the lateral circumflex femoral artery with no connections with the descending branch. Thus, the flap was harvested based on the oblique branch, leaving the descending branch in situ. Reconstruction was completed uneventfully and he had an excellent outcome at 1-year follow-up. The anterolateral thigh myocutaneous flap was reputed to be a technically easy flap to harvest. The perforators supplying the skin were visualized and a block of muscle incorporating the perforators harvested with the descending branch of the lateral circumflex femoral artery as the pedicle of the flap. However, not infrequently with this approach, the flap thus harvested has a well-perfused muscle component, whereas the skin component was not viable. This situation is explained anatomically by the potential occurrence of an alternative pedicle that supplies the anterolateral thigh flap, called the oblique branch of the lateral circumflex femoral artery. Our case presented here was a "classic" intraoperative finding of this potential trap and the importance of defining the anatomy before committing oneself to the harvest by unroofing all the skin perforators was emphasized.
一位 67 岁的男性患有鳞状细胞癌，接受了游离股前外侧肌皮瓣重建。在为皮穿支血管去顶时发现，皮穿支发自旋股外侧动脉的斜支，与降支无吻合。因此，根据斜支切取皮瓣，降支原位保留。重建过程顺利，患者在 1 年随访时恢复良好。股前外侧肌皮瓣被认为是一种技术上易于获取的皮瓣。可以看到供应皮肤的穿支，并切取包含旋股外侧动脉降支的皮穿支的肌块作为皮瓣的蒂。然而，在这种情况下，切取的皮瓣通常具有良好灌注的肌肉部分，而皮肤部分则没有活力。这种情况在解剖学上可以解释为供应股前外侧皮瓣的潜在替代蒂，即旋股外侧动脉斜支。我们在此处报告的病例是这种潜在陷阱的“经典”术中发现，强调在切开所有皮穿支以确定解剖结构之前，不要贸然进行皮瓣切取。
