Scaglioni Mario F, Franchi Alberto, Giovanoli Pietro
Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
Microsurgery. 2018 May;38(4):423-426. doi: 10.1002/micr.30157. Epub 2017 Jan 23.
The anterolateral thigh (ALT) flap is one of the most commonly used flap worldwide, as both free flap and pedicled local flap. Here, we report the use of a pedicled chimeric sensitive ALT and vastus lateralis muscle (VLM) flap in a patient with a 12 cm × 8 cm contaminated soft tissue defect of the right inguinal region with exposed femoral vessels. The flap was harvested based on two perforators, one musculocutaneous and one pure muscular, each nourished separately a sensitive fasciocutaneous component and a vastus lateralis muscle component, respectively. The muscle part was tailored to wrap around the exposed vascular structures, while the innervated skin and fascia component of the flap provided a tension-free closure of the wound. The post-operative course was uneventful and the patient was discharged at 1 week post-operative. Even though it requires technical skills and experience in perforator dissection, we believe that the pedicled chimeric sensitive ALT and VLM flap may be one of the best solutions in case of exposed femoral vessels in contaminated wounds.
股前外侧（ALT）皮瓣是全球最常用的皮瓣之一，可作为游离皮瓣和带蒂局部皮瓣使用。在此，我们报告了一名右腹股沟区存在12 cm×8 cm污染性软组织缺损且股血管外露的患者，使用带蒂嵌合型敏感股前外侧皮瓣和股外侧肌（VLM）皮瓣的情况。该皮瓣基于两个穿支进行切取，一个是肌皮穿支，一个是纯肌穿支，分别单独滋养一个敏感的筋膜皮瓣成分和一个股外侧肌成分。肌肉部分经过修整以包裹外露的血管结构，而皮瓣的带神经支配的皮肤和筋膜成分实现了伤口的无张力闭合。术后过程顺利，患者术后1周出院。尽管切取穿支需要技术技巧和经验，但我们认为，对于污染伤口中股血管外露的情况，带蒂嵌合型敏感股前外侧皮瓣和股外侧肌皮瓣可能是最佳解决方案之一。
