He Jiqiang, Wu Panfeng, Zhou Zhengbing, Kalsi Richa, Yu Fang, Qing Liming, Tang Juyu
Department of Hand & Microsurgery, Xiangya Hospital of Central South University, Changsha, China.
Department of General Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
Microsurgery. 2020 Sep 10. doi: 10.1002/micr.30644.
Compound anterolateral thigh flaps are popular for three-dimensional reconstruction of complex soft tissue defects. We present our 10-year experience using compound vastus lateralis (VL) muscle and anterolateral thigh musculocutaneous perforator (ALTP) flaps, and introduce three versatile customizations of this flap for individualized reconstruction of complex three-dimensional soft tissue defects.
From May 2008 to June 2017, compound VL muscle and ALTP flaps were performed in 67 consecutive patients aged 14-75 years (62 men and 5 women). The defects were in either the lower (n = 53) or upper extremity (n = 14), and ranged in size from 8 × 4 cm to 25 × 6 cm. Dead space volume ranged from 4 × 2 × 1 cm to 20 × 3 × 2 cm, and all flaps were harvested from patients' thighs as one of three types. In type A, a single perforator supplied both the skin and muscle components, with the vascular bundle penetrating the muscle component. In type B, a single perforator supplied both skin and muscle components with separate branches to the skin and muscle. In type C, separate vessels supplied the skin and muscle.
In the 67 patients, 65 flaps survived, and the donor site was closed directly. Vascular compromise occurred in four patients on the first postoperative day. Two flaps were salvaged after emergency re-exploration. Flap loss occurred in two patients, and these defects were repaired using other flaps. The follow-up period ranged from 8 to 60 months (mean, 11.9 months). All flaps had satisfactory appearance and texture, and no patients experienced limited hip and knee joint mobility from the donor site operation.
Compound VL muscle and ALTP flaps are a reliable option to reconstruct complex defects of the extremities. Identifying three flap types allowed for more precise customization to cover complex defects with limited donor site morbidity.
复合股前外侧皮瓣常用于复杂软组织缺损的三维重建。我们介绍了我们使用复合股外侧肌（VL）肌瓣和股前外侧肌皮穿支皮瓣（ALTP）的10年经验，并介绍了该皮瓣的三种通用改良方法，用于个体化重建复杂的三维软组织缺损。
2008年5月至2017年6月，连续67例年龄在14 - 75岁的患者（62例男性，5例女性）接受了复合VL肌瓣和ALTP皮瓣手术。缺损位于下肢（n = 53）或上肢（n = 14），大小从8×4 cm至25×6 cm不等。死腔体积从4×2×1 cm至20×3×2 cm不等，所有皮瓣均从患者大腿获取，分为三种类型。A型中，单一穿支供应皮肤和肌肉成分，血管束穿透肌肉成分。B型中，单一穿支供应皮肤和肌肉成分，分别有分支至皮肤和肌肉。C型中，皮肤和肌肉由独立血管供应。
67例患者中，65例皮瓣存活，供区直接缝合。4例患者在术后第1天出现血管危象。2例皮瓣经急诊再次探查后挽救。2例患者出现皮瓣坏死，这些缺损用其他皮瓣修复。随访时间为8至60个月（平均11.9个月）。所有皮瓣外观和质地均令人满意，且无患者因供区手术出现髋关节和膝关节活动受限。
复合VL肌瓣和ALTP皮瓣是重建四肢复杂缺损的可靠选择。确定三种皮瓣类型可实现更精确的定制，以覆盖复杂缺损，同时减少供区并发症。
