Tian Jia, Chen Zhen-Bing, Li Jin
Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Curr Med Sci. 2020 Aug;40(4):739-744. doi: 10.1007/s11596-020-2235-8. Epub 2020 Aug 29.
Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction. Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure, especially in an extensive wound, or in a complex trauma combined with vascular injury. From April 2014 to March 2018, we retrospectively reviewed patients with traumatic/post-traumatic, oncologic, and electrical wounds in the lower extremity. Those treated with muscle feeding artery as recipient vessels were included. The latissimus dorsi (LD) muscle free flap, anterior lateral thigh (ALT) perforator free flap, and deep inferior epigastric perforator (DIEP) free flap were raised. The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle, concomitant veins, and great saphenous vein were used as recipient vessels. Injuries included in the study were caused by tumour in 2 cases, car accident in 3 cases, crushing in 3 cases, burns in one case, and electrical injury in one case. The wound size varied from 14 cm × 6 cm to 30 cm × 20 cm. LD, ALT, and DIEP free flaps were used in 6, 3, and 4 patients, respectively. The muscle feeding arteries to medial head of gastrocnemius muscle, to sartorius muscle, and to vastus lateral muscle were used as recipient arteries in 4, 5, and one patient, respectively. Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients, respectively. Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses, particularly when the wound is located proximal to the mid-third of the lower leg.
显微外科游离组织移植在下肢重建中仍发挥着重要作用。在显微外科手术中，找到合适的供吻合的受体动脉至关重要，尤其是在大面积伤口或合并血管损伤的复杂创伤中。2014年4月至2018年3月，我们回顾性研究了下肢创伤性/创伤后、肿瘤性和电烧伤患者。纳入以肌肉供血动脉作为受体血管进行治疗的患者。切取背阔肌（LD）游离皮瓣、股前外侧（ALT）穿支游离皮瓣和腹壁下深动脉穿支（DIEP）游离皮瓣。以股外侧肌和腓肠肌内侧头的肌肉供血动脉、伴行静脉和大隐静脉作为受体血管。研究纳入的损伤原因包括：肿瘤2例、车祸3例、挤压伤3例、烧伤1例、电击伤1例。伤口大小从14 cm×6 cm到30 cm×20 cm不等。分别有6例、3例和4例患者使用了LD、ALT和DIEP游离皮瓣。分别有4例、5例和1例患者以腓肠肌内侧头、缝匠肌和股外侧肌的肌肉供血动脉作为受体动脉。分别有10例和4例患者以伴行静脉和大隐静脉作为受体静脉。使用肌肉供血动脉可避免损伤主要动脉，便于解剖和吻合，尤其是当伤口位于小腿中下段近端时。
