Barreiro Guilherme C, Fioravanti Alex B, Borges Luiz H S, Snider Chelsea C
Division of Plastic and Reconstructive Surgery, State University of Campinas, Campinas, São Paulo, Brazil.
Institute for Plastic Surgery, Southern Illinois University School of Medicine, Southern Illinois University, Springfield, Illinois.
J Reconstr Microsurg. 2018 Oct;34(8):658-668. doi: 10.1055/s-0038-1667130. Epub 2018 Jul 24.
The anterolateral region of the thigh is one of the most used donor areas for flaps. However, there are cases in which large defects require more than the conventional skin island provided by the anterolateral thigh flap (ALT). For an extended skin island flap, we developed a new boomerang thigh flap (BTF), in which a boomerang design includes perforators from multiple branches of the lateral circumflex femoral artery (LCFA), providing a single-pedicle, large, reproducible, and reliable flap. We report the anatomical study and the use of the new BTF in a clinical series.
We dissected 20 flaps in fresh cadavers to determine the anatomical landmarks, vascular pedicle pattern, perforator distribution, and BTF flap dissection technique. After achieving a reproducible and reliable technique, with primary closure of the donor site based on the pinch test, the BTF was applied for microsurgical reconstructions in the head and neck, lower limb, and upper limb regions.
The BTF corresponds to a 45° confluence of the ALT and the tensor fascia lata (TFL) elliptical skin islands. It includes the perforators from the transverse/ascending and the descending branches of the LCFA , which conjoined into a single arterial LCFA pedicle in 85% (17) of the cadaver dissections. All the venous branches drained into a single lateral circumflex femoral vein. ALT perforator distribution followed literature descriptions, while TFL perforators were mainly septocutaneous and projected into a virtual rectangle of 6 × 4 cm at the lateral margin of the TFL. Average BTF dimensions were 40 × 8.6 cm. For the clinical cases, flap dimensions and pedicle characteristics were equivalent to the anatomical findings. The BTF was separated into two skin islands in four cases and no major complications were reported.
The BTF is a reliable, reproducible, and divisible flap that provides extended skin island for reconstruction of large defects.
大腿前外侧区域是皮瓣最常用的供区之一。然而，在某些情况下，大面积缺损所需的皮瓣面积超过了传统的股前外侧皮瓣（ALT）所提供的皮肤岛面积。为了获得更大面积的皮肤岛皮瓣，我们设计了一种新的回旋镖形大腿皮瓣（BTF），其回旋镖形设计包含来自旋股外侧动脉（LCFA）多个分支的穿支，可提供单蒂、大面积、可重复且可靠的皮瓣。我们报告了这项解剖学研究以及新BTF在一系列临床病例中的应用情况。
我们在20具新鲜尸体上解剖皮瓣，以确定解剖标志、血管蒂模式、穿支分布以及BTF皮瓣的解剖技术。在掌握了可重复且可靠的技术，并根据捏皮试验对供区进行一期缝合后，将BTF应用于头颈部、下肢和上肢区域的显微外科重建手术。
BTF相当于ALT和阔筋膜张肌（TFL）椭圆形皮肤岛呈45°汇合而成。它包含来自LCFA横支/升支和降支的穿支，在85%（17例）的尸体解剖中，这些穿支汇合形成单一的LCFA动脉蒂。所有静脉分支均汇入单一的旋股外侧静脉。ALT穿支分布符合文献描述，而TFL穿支主要为肌间隔皮穿支，在TFL外侧缘投影到一个6×4 cm的虚拟矩形区域内。BTF平均尺寸为40×8.6 cm。在临床病例中，皮瓣尺寸和蒂部特征与解剖学研究结果相符。4例患者的BTF被分为两个皮肤岛，未报告重大并发症。
BTF是一种可靠、可重复且可分割的皮瓣，可为大面积缺损的重建提供更大面积的皮肤岛。
