Srinivas Jammula S, Panagatla Prakash, Damalacheru Mukunda Reddy
Department of Plastic Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Indian J Plast Surg. 2018 Jan-Apr;51(1):33-39. doi: 10.4103/ijps.IJPS_75_15.
Reconstruction of complex abdominal wall defects is both challenging and technically demanding for plastic surgeon. Objectives in abdominal wall reconstruction are consistent and include restoration of abdominal wall integrity, protection of intra abdominal viscera and prevention of herniation.
We conducted a retrospective study on five patients in whom lateral thigh flaps such as anterolateral thigh (ALT) flaps and tensor fascia lata (TFL) myocutaneous flaps as pedicled or free flaps were used for complex abdominal wall Type II defects over a 5- years period between 2007 and 2012.
In two patients, free flaps were used for reconstruction of the upper abdomen and both were ALT. In three patients of lower abdominal defects, one patient had bilateral pedicled ALT flaps, one pedicled TFL myocutaneous and one free TFL myocutaneous in view of ipsilateral electric burn scars. There were no flap losses. Patients were followed up beyond 6 months and found to have a good abdominal contour and only one of five had clinical evidence of herniation.
It can be concluded that flap from the Lateral thigh (ALT or TFL) is flap of choice for large Type II abdominal defects. Including vascularised fascia in the flap maintains abdominal wall integrity and use of synthetic mesh is not necessary. Upper abdominal defects need free flaps and in lower abdominal defects a pedicled flap suffices.
复杂腹壁缺损的重建对整形外科医生来说既具有挑战性，技术要求也很高。腹壁重建的目标是一致的，包括恢复腹壁完整性、保护腹腔内脏器和预防疝形成。
我们对2007年至2012年5年间5例使用外侧大腿皮瓣（如股前外侧皮瓣和阔筋膜张肌肌皮瓣）作为带蒂或游离皮瓣修复复杂Ⅱ型腹壁缺损的患者进行了回顾性研究。
2例患者使用游离皮瓣修复上腹部，均为股前外侧皮瓣。3例下腹部缺损患者中，1例使用双侧带蒂股前外侧皮瓣，1例使用带蒂阔筋膜张肌肌皮瓣，1例因同侧电烧伤瘢痕使用游离阔筋膜张肌肌皮瓣。无皮瓣丢失。患者随访6个月以上，腹部外形良好，5例中仅1例有疝形成的临床证据。
可以得出结论，外侧大腿皮瓣（股前外侧皮瓣或阔筋膜张肌皮瓣）是修复大型Ⅱ型腹壁缺损的首选皮瓣。皮瓣中包含带血管的筋膜可维持腹壁完整性，无需使用合成补片。上腹部缺损需要游离皮瓣，下腹部缺损带蒂皮瓣即可。
