Ulas Bali Zulfükar, Keçeci Yavuz, Pabuşcu Yüksel, Yoleri Levent
From the Departments of Plastic and Reconstructive Surgery.
Radiology, Manisa Celal Bayar University, Manisa, Turkey.
Ann Plast Surg. 2020 May;84(5):550-553. doi: 10.1097/SAP.0000000000002066.
Recently, anterolateral thigh flap has become one of the most commonly used free flaps in reconstructive surgery. Although its pedicle has relatively sufficient length, it falls short in some circumstances. Eccentric perforator location can be used to lengthen the pedicle, but flap tip viability can be a problem in this case. In addition, partial flap loss can be encountered in perforator flaps. The aim of this study was the use of multidetector computed tomographic angiography in preoperative mapping to overcome these problems.
Anterolateral thigh perforator flap was planned for various soft-tissue reconstructions in 19 patients. There were 15 males and 4 female patients with ages ranging from 19 to 65 years. These patients were evaluated with preoperative multidetector computed tomographic angiography to choose and to trace the course of the perforators. Flaps were designed according to the suprafascial course of the perforators. Perforators were safely located eccentrically when needed. Pedicle length and complications, such as infection, wound dehiscence, and partial or total flap loss, were recorded.
Perforators were located eccentrically in 8 patients and centrally in the other 11 patients. Eleven flaps were used in lower leg reconstruction, 2 flaps in popliteal region, and 6 flaps in head and neck. All flaps survived and any partial or total loss did not occur. There was not any infection and wound problem.
Multidetector computed tomographic angiography can reveal the suprafascial course of the perforator and help design anterolateral thigh perforator flap. By using this kind of mapping, perforators can be safely located eccentrically to lengthen the pedicle and partial flap loss can be prevented.
近年来，股前外侧皮瓣已成为重建手术中最常用的游离皮瓣之一。尽管其蒂部长度相对充足，但在某些情况下仍显不足。偏心穿支定位可用于延长蒂部，但在此情况下皮瓣尖端的存活可能会成为问题。此外，穿支皮瓣可能会出现部分皮瓣坏死。本研究的目的是利用多层螺旋计算机断层血管造影术在术前进行血管造影以克服这些问题。
为19例患者计划采用股前外侧穿支皮瓣进行各种软组织重建。其中男性15例，女性4例，年龄19至65岁。对这些患者进行术前多层螺旋计算机断层血管造影评估，以选择并追踪穿支的走行。根据穿支在筋膜上的走行设计皮瓣。必要时，安全地将穿支偏心定位。记录蒂部长度以及感染、伤口裂开和部分或全部皮瓣坏死等并发症。
8例患者的穿支偏心定位，另外11例患者的穿支中心定位。11例皮瓣用于小腿重建，2例用于腘窝区域，6例用于头颈部。所有皮瓣均存活，未发生任何部分或全部坏死。未出现任何感染和伤口问题。
多层螺旋计算机断层血管造影术可显示穿支在筋膜上的走行，有助于设计股前外侧穿支皮瓣。通过这种血管造影，可安全地将穿支偏心定位以延长蒂部，并可预防部分皮瓣坏死。
