Zhu Yueliang, Yin Zuoming, Wang Jiaxiang, Lü Qian, Zhao Zeyu, Pu Shaoquan, Shi Jian, Xu Yongqing
Department of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming Yunnan, 650032, P.R.China.
Department of Orthopaedics, General Hospital of Tibet Military Area, Lhasa Tibet, 850000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jan 15;31(1):57-61. doi: 10.7507/1002-1892.201607112.
To improve the harvesting techniques of anterolateral thigh perforator flap, and to reduce the operation time.
Between January 2008 and June 2015, 400 patients undergoing repair with anterolateral thigh perforator flap were included to analyze the technical factors, including 370 cases (92.5%) obtaining primary healing and 30 cases (7.5%) receiving re-exploration. Combined with the literature, a modified flap dissection was made: reverse tracing and sequential dissection of the descending branch of the lateral circumflex femoral artery. Between June 2015 and June 2016, the modified free anterolateral thigh perforator flap was used in 100 cases. Of 100 cases, 76 were male and 24 were female, aged from 11 to 71 years (mean, 35.6 years). The wound size ranged from 8 cm×5 cm to 23 cm×9 cm. The time between injury and surgery ranged from 5 to 31 days (mean, 14.3 days).
The operation time of modified flap dissection was reduced to (30.1±19.3) minutes from (85.0±30.2) minutes (unmodified flap dissection). Postoperatively, 94 flaps survived uneventfully, and incision healed by first intention. Six flaps received re-exploration surgery because of vascular compromise; the flap survived after removal of thrombosis in 4 cases of vein thrombosis; the flap necrosed in 2 cases of vein and artery thrombosis, and skin grafting was performed. Ninety-four patients whose flaps survived were followed up 3-12 months (mean, 6.3 months); the flaps had good color and appearance, and second stage operation was performed to make the flap thinner in 21 cases.
Improved harvesting technique of free anterolageral thigh perforator flap could decrease surgery time and difficulty in dissection.
改进股前外侧穿支皮瓣的切取技术，减少手术时间。
纳入2008年1月至2015年6月间400例行股前外侧穿支皮瓣修复的患者，分析技术因素，其中370例（92.5%）一期愈合，30例（7.5%）接受再次探查。结合文献，进行改良皮瓣解剖：逆行追踪并依次解剖旋股外侧动脉降支。2015年6月至2016年6月，100例应用改良游离股前外侧穿支皮瓣。100例中，男76例，女24例，年龄11至71岁（平均35.6岁）。创面大小为8 cm×5 cm至23 cm×9 cm。受伤至手术时间为5至31天（平均14.3天）。
改良皮瓣解剖的手术时间从（85.0±30.2）分钟（未改良皮瓣解剖）降至（30.1±19.3）分钟。术后，94例皮瓣顺利存活，切口一期愈合。6例皮瓣因血管危象接受再次探查手术；4例静脉血栓形成经清除血栓后皮瓣存活；2例动静脉血栓形成皮瓣坏死，行植皮术。94例皮瓣存活患者随访3至12个月（平均6.3个月）；皮瓣色泽及外观良好，21例行二期手术使皮瓣变薄。
改良游离股前外侧穿支皮瓣切取技术可缩短手术时间，降低解剖难度。
