Qing Liming, Li Xiaoxiao, Wu Panfeng, Zhou Zhengbing, Yu Fang, Tang Juyu
Department of orthopedic, Xiangya Hospital of Central South University, Changsha 410008, China; Department of Neurosurgery, Maryland University of Medicine School, Baltimore, United States.
Department of orthopedic, Xiangya Hospital of Central South University, Changsha 410008, China.
J Plast Reconstr Aesthet Surg. 2019 Dec;72(12):1909-1916. doi: 10.1016/j.bjps.2019.08.004. Epub 2019 Sep 7.
Complex soft-tissue defects of upper extremities still have a high rate of amputation, as the reconstruction of complex soft-tissue defects is always difficult even with the largest conventional free flap. The anterolateral thigh perforator (ALTP) flap is one of the most popular procedures used for the coverage of complex soft-tissue defects of extremities. However, problems associated with donor-site morbidity and inability to repair complex soft-tissue defects in a one-stage procedure persist. The purpose of this study was to present a novel design of using chain-linked bilateral ALTP flap and its various designs for customized reconstruction of complex soft-tissue defects in the hands and forearms.
From June 2009 to June 2017, we retrospectively analyzed 15 patients with complex soft-tissue defects in the hands and forearms. All patients in this series underwent extremity reconstruction using the chain-linked bilateral ALTP flaps. Three different types of chain-linked bilateral ALTP flaps were created in this study based on wound characteristics and the maximum available skin paddle size at all donor sites.
The chain-linked bilateral ALTP flaps were successfully harvested for the reconstruction of complex soft-tissue defects in the hands and forearms. Among them, ten cases were repaired with chain-linked bipaddle ALTP flaps, two cases were treated with chain-linked tripaddle ALTP flaps, and the remaining three cases were used with chain-linked multi-lobed ALTP chimeric flaps. The sizes of the skin paddles ranged from 11 cm × 7 cm to 42 cm × 8 cm. The areas of the total flaps ranged from 245 cm to 650 cm (mean 419.6 cm). Only one case required re-exploration because of the venous congestion. The donor sites were closed directly. The mean follow-up time was 16.4 months. Most cases showed satisfactory contour.
The chain-linked bilateral ALTP flap is a reliable option for one-stage reconstruction of complex soft-tissue defects in the hands and forearms with limited donor-site morbidity. It also provides various flap designs, which allow for more individualized treatment approaches.
上肢复杂软组织缺损的截肢率仍然很高，因为即使使用最大的传统游离皮瓣，复杂软组织缺损的重建也总是很困难。股前外侧穿支皮瓣（ALTP）是用于覆盖四肢复杂软组织缺损的最常用手术方法之一。然而，与供区并发症相关的问题以及无法在一期手术中修复复杂软组织缺损的情况仍然存在。本研究的目的是提出一种使用链式双侧ALTP皮瓣的新颖设计及其各种设计，用于手部和前臂复杂软组织缺损的定制重建。
2009年6月至2017年6月，我们回顾性分析了15例手部和前臂复杂软组织缺损的患者。本系列所有患者均采用链式双侧ALTP皮瓣进行肢体重建。根据伤口特征和所有供区最大可用皮瓣大小，本研究设计了三种不同类型的链式双侧ALTP皮瓣。
链式双侧ALTP皮瓣成功切取用于手部和前臂复杂软组织缺损的重建。其中，10例采用链式双叶ALTP皮瓣修复，2例采用链式三叶ALTP皮瓣治疗，其余3例采用链式多叶ALTP嵌合皮瓣。皮瓣大小范围为11 cm×7 cm至42 cm×8 cm。总皮瓣面积范围为245 cm至650 cm（平均419.6 cm）。仅1例因静脉淤血需要再次探查。供区直接缝合。平均随访时间为16.4个月。大多数病例外形满意。
链式双侧ALTP皮瓣是手部和前臂复杂软组织缺损一期重建的可靠选择，供区并发症有限。它还提供了各种皮瓣设计，允许采用更个体化的治疗方法。
