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采用股直肌游离皮瓣挽救计划中的ALT皮瓣用于小儿下肢重建：1例示范病例报告

Salvage of planned ALT flap with rectus femoris free flap for pediatric lower extremity reconstruction: A demonstrative case report.

作者信息

Gelidan Adnan G

机构信息

The Division of Plastic Surgery, King Saud University, P.O. Box 7805, Riyadh, 11462, Saudi Arabia.

出版信息

Int J Surg Case Rep. 2018;51:67-70. doi: 10.1016/j.ijscr.2018.08.005. Epub 2018 Aug 9.

DOI:10.1016/j.ijscr.2018.08.005
PMID:30144713
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6108076/
Abstract

INTRODUCTION

Free tissue transfer in children represents a good option for reconstruction in skilled hands despite the technical difficulties, and represent a significant challenge in microsurgery. With Anteriorlateral thigh flap is a popular option even in pediatric age group.

PRESENTATION OF CASE

We report here a case of 9 year old girl that sustained a lower extremity trauma with exposed ankle joint secondary to Motor Vehicle Crash, That was planned for (ALT) Anterior Lateral Thigh flap reconstruction, and was not completed and salvaged by rectus femoris flap as an alternative option on table to complete the reconstruction.

DISCUSSION

Such case was successfully reconstructed by rectus femoris muscle free flap when ALT (Anterior lateral thigh) flap could not be completed as planned although it's the workhorse flap in majority of cases, due to absence of perforator utilizing the same vascular anatomical blood supply with no significant donor site morbidity.

CONCLUSION

Based on this case report the rectus femoris flap was successfully performed, and we believe it's an effective and reliable backup option to reconstruct complex lower extremity wound even in pediatric age group.

摘要

引言

尽管存在技术难题，但对于技术娴熟的医生来说，儿童游离组织移植是一种很好的重建选择，也是显微外科手术中的一项重大挑战。股前外侧皮瓣即使在儿童年龄组中也是一种常用的选择。

病例介绍

我们在此报告一例9岁女孩，因机动车碰撞导致下肢创伤，踝关节外露，计划采用股前外侧皮瓣（ALT）进行重建，但手术未完成，术中改用股直肌皮瓣作为替代方案完成重建。

讨论

尽管股前外侧皮瓣在大多数情况下是常用皮瓣，但在本病例中，由于缺乏穿支血管，无法按计划完成股前外侧皮瓣移植，最终成功采用股直肌游离皮瓣进行重建，利用相同的血管解剖血供，供区并发症不明显。

结论

基于本病例报告，股直肌皮瓣移植手术成功，我们认为即使在儿童年龄组中，它也是重建复杂下肢伤口的一种有效且可靠的备用选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/08ad62aab842/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/8a6f2516872c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/b0e76015e491/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/f0018493a233/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/f0210feac1c4/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/bf6953e51066/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/04c8c802e0f9/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/08ad62aab842/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/8a6f2516872c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/b0e76015e491/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/f0018493a233/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/f0210feac1c4/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/bf6953e51066/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/04c8c802e0f9/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebab/6108076/08ad62aab842/gr7.jpg

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本文引用的文献

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A protocol for the development of reporting criteria for surgical case reports: The SCARE statement.手术病例报告报告标准制定方案：SCARE声明。
Int J Surg. 2016 Mar;27:187-189. doi: 10.1016/j.ijsu.2016.01.094. Epub 2016 Jan 29.
2
Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction.下肢重建中缺乏合适穿支的股前外侧皮瓣的算法式处理方法。
Plast Reconstr Surg. 2015 May;135(5):1476-1485. doi: 10.1097/PRS.0000000000001168.
3
Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients.
小儿患者游离股前外侧皮瓣修复足踝部缺损
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Perforator transfer in the antero-lateral thigh flap.
J Plast Reconstr Aesthet Surg. 2013 Jul;66(7):1012-3. doi: 10.1016/j.bjps.2013.01.020. Epub 2013 Feb 8.
5
Vascular anatomy of the anterolateral thigh flap: a systematic review.股前外侧皮瓣的血管解剖：系统评价。
Plast Reconstr Surg. 2012 Dec;130(6):1254-1268. doi: 10.1097/PRS.0b013e31826d1662.
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Revisiting vascular supply of the rectus femoris and its relevance in the harvest of the anterolateral thigh flap.重新审视股直肌的血管供应及其在股前外侧皮瓣切取中的相关性。
Ann Plast Surg. 2013 Nov;71(5):586-90. doi: 10.1097/SAP.0b013e318255a2ac.
7
Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients.使用股前内侧皮瓣替代股前外侧皮瓣用于癌症患者头颈部缺损的重建。
Ann Plast Surg. 2013 Oct;71(4):375-9. doi: 10.1097/SAP.0b013e31824f20bb.
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Free anterolateral thigh flap in pediatric patients.小儿患者的游离股前外侧皮瓣
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Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery.股前外侧皮瓣的替代血管蒂：旋股外侧动脉斜支。
Plast Reconstr Surg. 2009 Feb;123(2):571-577. doi: 10.1097/PRS.0b013e318195658f.
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Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available.对于没有可用的大尺寸皮肤穿支血管的病例，股前外侧皮瓣切取的替代重建选择。
Head Neck. 2009 May;31(5):571-5. doi: 10.1002/hed.20995.