Fox Paige, Endress Ryan, Sen Subhro, Chang James
From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA.
Ann Plast Surg. 2014 May;72 Suppl 1:S9-13. doi: 10.1097/SAP.0000000000000146.
The ability to use the anterolateral thigh (ALT) flap as a vascularized fascial flap, without skin or muscle, was first documented by Koshima et al in 1989. The authors mention the possibility of using the fascia alone for dural reconstruction. Despite its description more than 20 years ago, little literature exists on the application of the ALT flap as a vascularized fascial flap. In our experience, the ALT flap can be used as a fascia-only flap for thin, pliable coverage in extremity reconstruction.
After approval from the institutional review board, the medical records and photographs of patients who had undergone fascia-only ALT free flaps for extremity reconstruction were reviewed. Photographic images of patients were then matched to patients who had undergone either a muscle-only or a fasciocutaneous free flap reconstruction of an extremity. Photographs of the final reconstruction were then given to medical and nonmedical personnel for analysis, focusing on aesthetics including color and contour.
Review of cases performed over a 2-year period demonstrated similar ease of harvest for fascia-only ALT flaps compared to standard fasciocutaneous ALT flaps. Fascia-only flaps were used for thin, pliable coverage in the upper and lower extremities. There was no need for secondary procedures for debulking or aesthetic flap revision. In contrast to muscle flaps, which require muscle atrophy over time to achieve their final appearance, there was a similar flap contour from approximately 1 month postoperatively throughout the duration of follow-up. When a large flap is required, the fascia-only ALT has the advantage of a single-line donor-site scar. Photograph comparison to muscle flaps with skin grafts and fasciocutaneous flaps demonstrated improved color, contour, and overall aesthetic appearance of the fascia-only ALT over muscle and fasciocutaneous flaps.
The fascia-only ALT flap provides reliable, thin, and pliable coverage with improved contour and color over muscle and fasciocutaneous flaps. The fascia-only ALT is another excellent option for reconstructive surgery of the extremities.
1989年小岛等首次报道了将股前外侧（ALT）皮瓣用作不带皮肤和肌肉的带血管筋膜瓣的能力。作者提到了单独使用筋膜进行硬脑膜重建的可能性。尽管在20多年前就有了相关描述，但关于ALT皮瓣作为带血管筋膜瓣应用的文献却很少。根据我们的经验，ALT皮瓣可作为仅含筋膜的皮瓣用于肢体重建中的薄而柔韧的覆盖。
经机构审查委员会批准后，对接受仅含筋膜的游离ALT皮瓣进行肢体重建的患者的病历和照片进行了回顾。然后将患者的照片与接受肢体单纯肌肉或筋膜皮瓣游离重建的患者的照片进行匹配。然后将最终重建的照片交给医学和非医学人员进行分析，重点关注包括颜色和轮廓在内的美学效果。
对2年期间进行的病例回顾表明，与标准筋膜皮瓣ALT皮瓣相比，仅含筋膜的ALT皮瓣的切取同样容易。仅含筋膜的皮瓣用于上下肢薄而柔韧的覆盖。无需进行二次减容手术或皮瓣美学修复。与肌肉皮瓣不同，肌肉皮瓣需要随着时间推移发生肌肉萎缩才能达到最终外观，而术后约1个月至整个随访期间皮瓣轮廓相似。当需要大面积皮瓣时，仅含筋膜的ALT皮瓣具有单线供区瘢痕的优势。与带皮肤移植的肌肉皮瓣和筋膜皮瓣的照片比较显示，仅含筋膜的ALT皮瓣在颜色、轮廓和整体美学外观方面优于肌肉皮瓣和筋膜皮瓣。
仅含筋膜的ALT皮瓣提供可靠、薄且柔韧的覆盖，在轮廓和颜色方面优于肌肉皮瓣和筋膜皮瓣。仅含筋膜的ALT皮瓣是肢体重建手术的另一个极佳选择。
