Tang Juyu, Du Wei, Qing Liming, Wu Panfeng, Zhou Zhengbing, Yu Fang, Pang Xiaoyang, Zeng Lei, Pan Ding, Xiao Yongbing, Liu Rui
Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha Hunan, 410008,
Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China;Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Aug 15;32(8):1052-1055. doi: 10.7507/1002-1892.201802039.
To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities.
Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients' mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly.
All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction.
The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.
探讨穿支嵌合股前外侧皮瓣（ALTP）一期修复并重建四肢复杂缺损的可行性及疗效。
2014年5月至2017年6月，6例肢体软组织缺损合并死腔、骨缺损或肌腱及关节外露患者采用穿支嵌合股前外侧皮瓣进行重建。6例患者均为男性，平均年龄44岁（范围26 - 60岁）。致伤机制：交通事故4例，绞伤1例，重物砸伤1例。缺损位于下肢5例，上肢1例。创面面积7 cm×4 cm至26 cm×10 cm。骨缺损3例，关节及肌腱外露3例，慢性骨髓炎2例，主要动脉损伤2例。肌瓣植入深部死腔，穿支皮瓣修复浅表缺损。穿支皮瓣面积10 cm×5 cm至28 cm×11 cm，肌瓣面积5 cm×2 cm至20 cm×5 cm。供区缺损直接缝合。
所有皮瓣均存活，无感染及血管危象发生。受区及供区创面一期愈合。患者随访3 - 24个月（平均10个月），皮瓣色泽、质地良好。重建的主要动脉通畅，患肢末端血运良好。大腿供区仅留线状瘢痕，无功能障碍。
穿支嵌合股前外侧皮瓣可在不牺牲受区血管的情况下修复三维软组织缺损。穿支嵌合股前外侧皮瓣是修复四肢合并死腔且有或无主要血管损伤的复杂创面的可靠且理想方法。
