Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt.
Microsurgery. 2013 May;33(4):259-64. doi: 10.1002/micr.22074. Epub 2012 Dec 26.
Very limited literature described the use of the free anterolateral thigh (ALT) among other flaps for pediatric lower limb reconstruction. The aim of this study is to present our experience using the free ALT flap for reconstruction of soft tissue defects over the dorsum of the foot and ankle in children. The study included 42 children aged 2.5-13 years with a mean of 6.18 years. Three children had crush injuries while the rest were victims of run over car accidents. All of the flaps were vascularized by at least two perforators; 88.23% were musculocutaneous and 11.77 were septocutaneous perforators. All flaps were raised in a subfascial plane. Initial thinning was performed in five flaps and 35% required subsequent debulking. Mean Flap surface area was 117.11 cm(2). The recipient arteries were the anterior tibial artery in 38 cases and posterior tibial artery in four cases. Venous anastomosis was performed to one vena commitant and in nine cases the long saphenous vein was additionally used. Mean ischemia time of the flap was 2 hours while total operative time averaged 6.3 hours. About 41% of donor sites were closed primarily while 59% required skin grafting. Primary flap survival rate was 92.8% (39/42 cases). Three flaps showed venous congestion. After venous reanastomosis, two flaps showed partial loss and one flap was lost completely. Post-operative hospital stay averaged 7.5 days. The free ALT flap could be as safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss.
关于在其他皮瓣中应用游离股前外侧皮瓣（ALT）修复儿童下肢的文献非常有限。本研究旨在介绍我们使用游离 ALT 皮瓣修复儿童足踝背部软组织缺损的经验。研究纳入 42 名年龄为 2.5-13 岁的儿童，平均年龄为 6.18 岁。3 名患儿为碾压伤，其余为车祸碾压伤。所有皮瓣均由至少 2 个穿支血管供血；88.23%为肌皮瓣，11.77%为皮动脉穿支皮瓣。所有皮瓣均在筋膜下掀起。5 个皮瓣进行了初步减薄，35%的皮瓣需要进一步削薄。皮瓣平均面积为 117.11cm²。受区动脉为胫前动脉 38 例，胫后动脉 4 例。静脉吻合于 1 条伴行静脉，9 例同时使用大隐静脉。皮瓣平均缺血时间为 2 小时，总手术时间平均为 6.3 小时。约 41%的供区皮瓣直接缝合，59%的供区皮瓣需要植皮。皮瓣一期成活率为 92.8%（39/42 例）。3 个皮瓣出现静脉淤血。静脉再吻合后，2 个皮瓣出现部分坏死，1 个皮瓣完全坏死。术后住院时间平均为 7.5 天。游离 ALT 皮瓣可作为安全、可靠、美观的儿童创伤后足部/踝部软组织缺损修复方法。
