Turin Sergey Y, Spitz Jamie A, Alexander Karina, Ellis Marco F
Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois Hospital and Health Science System at Chicago, Chicago, Illinois.
Microsurgery. 2018 Sep;38(6):621-626. doi: 10.1002/micr.30317. Epub 2018 Mar 9.
The anterolateral thigh (ALT) flap is a workhorse flap for a variety of wounds. The primary disadvantage of ALT flaps is donor site morbidity associated with large skin paddle defects. We present a strategy of managing the donor site with the Keystone flap to avoid skin grafts in cases where primary closure is not possible.
A retrospective, multi-institutional review from December 2015 to March 2017 based on a single surgeon's experience was performed. Inclusion criteria were harvest of an ALT flap and closure of the thigh donor site with a keystone flap.
Six patients underwent reconstruction of the ALT donor site with a keystone flap. The average width of the ALT skin paddle was 7.8 cm (range 7-8 cm) and the defects could not be closed primarily or with wide undermining. Surface area of the ALT flaps averaged 96.8 cm (range 64-152 cm ). Mean patient BMI was 24.6 (range 16-37). Keystone flap dimensions averaged 9.5 × 17.8 cm. There were no major donor or recipient site complications, and one ×minor complication of delayed wound healing. No patients exhibited decreased range of motion at the hip or knee.
Primary closure of the ALT donor site is preferred, but becomes difficult as skin paddle width approaches 8 cm. Managing the ALT flap donor site with a keystone flap is safe, does not appear to have significant morbidity, and can allow the surgeon to avoid the morbidity and secondary donor site associated with skin grafting.
股前外侧（ALT）皮瓣是用于修复多种创面的常用皮瓣。ALT皮瓣的主要缺点是供区并发症，与大的皮岛缺损相关。我们提出一种用梯形皮瓣处理供区的策略，以避免在无法一期缝合的情况下进行植皮。
基于一位外科医生的经验，对2015年12月至2017年3月进行了一项回顾性、多机构研究。纳入标准为切取ALT皮瓣并用梯形皮瓣关闭大腿供区。
6例患者用梯形皮瓣修复ALT供区。ALT皮岛的平均宽度为7.8 cm（范围7 - 8 cm），缺损无法一期缝合或通过广泛潜行分离关闭。ALT皮瓣的表面积平均为96.8 cm²（范围64 - 152 cm²）。患者平均BMI为24.6（范围16 - 37）。梯形皮瓣尺寸平均为9.5×17.8 cm。没有主要的供区或受区并发症，有1例伤口愈合延迟的轻微并发症。没有患者出现髋部或膝部活动范围减小。
ALT供区一期缝合为佳，但当皮岛宽度接近8 cm时会变得困难。用梯形皮瓣处理ALT皮瓣供区是安全的，似乎没有明显的并发症，并且可使外科医生避免与植皮相关的并发症和二次供区问题。
