Acar Mehmet Ali, Güleç Ali, Aydin Bahattin Kerem, Erkoçak Ömer Faruk, Yilmaz Güney, Şenaran Hakan
Department of Orthopedics and Traumatology, Medical School of Selcuk University, Konya, Turkey.
J Reconstr Microsurg. 2015 Mar;31(3):225-32. doi: 10.1055/s-0034-1395888. Epub 2015 Jan 28.
There are a limited number of published studies describing reconstruction with an anterolateral thigh (ALT) flap following lower extremity injury in pediatric patients. The aim of this study was to present our experiences with the application of a free ALT flap not only in the reconstruction of soft tissue defects around the pediatric foot and ankle but also in patients with bone, tendon, and ligament injuries that require repair.
Reconstruction with a free ALT flap was performed in 11 pediatric patients (mean age, 8.9 years; range, 3-15 years) between November 2010 and February 2013. The modes of injury were as follows: six traffic accidents, three firearm accidents, one agricultural machinery accident, and one bicycle chain accident. A retrospective evaluation of the applied surgical procedures was performed: flap size, perforator type and number, placement area, site of anastomosis, closure of the donor site, complications, and flap survival.
The mean size of the skin flap was 83.2 mm(2) (range, 48-117 mm(2)). Except for two patients, there were two perforators in the obtained flaps, which were 75% musculocutaneous and 25% septocutaneous. To strengthen the Achilles tendon in one patient, the ALT, together with the fascia lata, was raised as a composite flap. This flap was used as a "sensate flap" in three patients with defects in the heel area and as a "perforator flap" in seven patients. Anastomosis was performed in the anterior tibial artery in five patients and in the posterior tibial artery in six patients. Primary closure was performed for the donor site in all patients. Due to venous thrombus after 24 hours in one patient, reexploration was performed, and blood flow was regained with a vein graft. In the same patient, partial necrosis developed on the lateral edge of the flap; after debridement of the necrotic areas, closure was performed with a split thickness skin graft. After the ALT flap procedure, the primary flap survival rate was 90.9%.
The free ALT flap could be a safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss. The ALT flap can cover a far greater area and provide the versatility needed to optimize soft-tissue coverage.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Level IV.
关于小儿患者下肢损伤后采用股前外侧（ALT）皮瓣进行重建的已发表研究数量有限。本研究的目的是介绍我们应用游离ALT皮瓣的经验，不仅用于小儿足踝周围软组织缺损的重建，还用于需要修复骨骼、肌腱和韧带损伤的患者。
2010年11月至2013年2月期间，对11例小儿患者（平均年龄8.9岁；范围3 - 15岁）进行了游离ALT皮瓣重建。损伤方式如下：6例交通事故，3例火器伤，1例农业机械事故，1例自行车链条伤。对应用的手术操作进行回顾性评估：皮瓣大小、穿支类型和数量、放置区域、吻合部位、供区闭合、并发症及皮瓣存活情况。
皮瓣平均大小为83.2平方毫米（范围48 - 117平方毫米）。除2例患者外，所获皮瓣中有2个穿支，其中75%为肌皮穿支，25%为隔皮穿支。为加强1例患者的跟腱，将ALT与阔筋膜一起掀起作为复合皮瓣。该皮瓣在3例足跟区缺损患者中用作“感觉皮瓣”，在7例患者中用作“穿支皮瓣”。5例患者在胫前动脉进行吻合，6例患者在胫后动脉进行吻合。所有患者的供区均进行了一期闭合。1例患者术后24小时出现静脉血栓，进行了再次探查，通过静脉移植恢复了血流。同一患者皮瓣外侧边缘出现部分坏死；坏死区域清创后，采用中厚皮片进行闭合。ALT皮瓣手术后，皮瓣一期存活率为90.9%。
游离ALT皮瓣对于小儿创伤性软组织缺损后足/踝部皮肤重建可能是一种安全、可靠且美观的选择。ALT皮瓣可覆盖更大面积，并提供优化软组织覆盖所需的多功能性。
临床问题/证据级别：四级。
