Zheng Xiaoju, Zhan Yi, Li Haijun, Zhang Zhong, Xue Xuewen, Wang Baoshan, Qi Jian
From the Department of Hand and Podiatric Microsurgery, Xian Fengcheng Hospital, Xian.
Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Ann Plast Surg. 2019 Dec;83(6):670-675. doi: 10.1097/SAP.0000000000001913.
Complex limb trauma often involves both soft tissue and vascular defects, and is challenging for surgeons. The traditional musculocutaneous flap cannot achieve a 3-dimensional wound repair. Here we report our experience with a single-stage reconstruction and revascularization performed on complex extremity injuries using a free flow-through chimeric anterolateral thigh perforator (ALTP) flap.
Seventeen patients (16 men; aged 19-55 years) with complex soft tissue defects attended our hospital from January 2010 to November 2017. All patients underwent reconstruction based on free flow-through chimeric ALTP flap for complex injuries in their extremities. The wound size ranged from 16 × 8 to 45 × 30 cm. The injured artery was flow-through anastomosed with the descending branch of the lateral femoral circumflex artery to regain blood flow. The muscle flap was used to fill the deep dead space on the injury site. The skin and fascial flaps were used for superficial cover. The donor site defects were sutured directly in 6 patients; simultaneous skin grafts were applied in the remaining 11 patients.
The ALTP flaps survived in 15 patients. Failure necessitated limb amputation in 2 patients. Six patients received both skin and fasciae flaps; 11 received flaps comprising the skin, fasciae, and vastus lateralis muscle. Partial necrosis after skin grafting was observed in 11 patients, and the wounds healed either by dressing change (1 patient) or second skin graft (10 patients). All donor sites healed without complications. All patients were followed up for 5 to 60 months (mean, 21.8 months).
The flow-through chimeric ALTP flap can be used for 1-stage reconstruction of 3-dimensional soft tissue defects and vascular gap. It is feasible for managing complex injuries of both the upper and lower extremities in emergency settings.
复杂肢体创伤常涉及软组织和血管缺损，对外科医生而言是一项挑战。传统的肌皮瓣无法实现三维创面修复。在此，我们报告使用游离穿支嵌合股前外侧皮瓣（ALTP）对复杂肢体损伤进行一期重建和血运重建的经验。
2010年1月至2017年11月，17例（16例男性；年龄19 - 55岁）伴有复杂软组织缺损的患者就诊于我院。所有患者均接受基于游离穿支嵌合ALTP瓣的重建手术，以修复其肢体的复杂损伤。创面大小为16×8至45×30厘米。将损伤动脉与旋股外侧动脉降支进行穿支吻合以恢复血流。肌瓣用于填充损伤部位的深部死腔。皮瓣和筋膜瓣用于浅表覆盖。6例患者的供区缺损直接缝合；其余11例患者同时进行了植皮。
15例患者的ALTP瓣存活。2例患者因皮瓣坏死而截肢。6例患者接受了皮肤和筋膜瓣；11例患者接受了包含皮肤、筋膜和股外侧肌的皮瓣。11例患者植皮后出现部分坏死，创面通过换药（1例患者）或再次植皮（10例患者）愈合。所有供区均顺利愈合，无并发症。所有患者均获随访5至60个月（平均21.8个月）。
穿支嵌合ALTP瓣可用于三维软组织缺损和血管间隙的一期重建。在急诊情况下，用于处理上下肢的复杂损伤是可行的。
