Mater Olbia Hospital, Strada Statale, Olbia, Sassari, Italy.
Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
J Reconstr Microsurg. 2021 Jun;37(5):436-444. doi: 10.1055/s-0040-1718550. Epub 2020 Oct 14.
After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap.
We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent).
In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group.
In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.
在股前外侧（ALT）皮瓣采集后，通常会对供体部位进行皮肤移植。当缺损宽度超过 8cm 或大腿周长的 16%时，可能会导致下肢功能受损和美观效果不佳。在我们的对比研究中，我们评估了与使用中厚皮片移植的 ALT 供区关闭相关的功能和美学结果与股前旋股外侧动脉皮瓣的比较。
我们纳入了 60 例 ALT 皮瓣供区患者。我们考虑了两种 ALT 供区重建方式：皮片组（30 例）采用中厚皮片移植，皮瓣组（30 例）采用局部穿支旋股外侧动脉皮瓣。我们评估了每位患者髋关节和膝关节的活动范围（ROM）、张力、麻木、感觉异常、触觉灵敏度和步态。关于对日常生活活动的影响，患者完成了下肢功能量表（LEFS）问卷。采用 5 分 Likert 量表（从非常差到优秀）评估患者对美学效果的满意度。
在旋股外侧动脉皮瓣组，髋关节和膝关节的 ROM 和 LEFS 评分显著更高。在 12 个月的随访中，皮片组有 23 例患者报告有张力，19 例有麻木，16 例有感觉异常，22 例触觉灵敏度降低，5 例步态改变，而旋股外侧动脉皮瓣组只有 5 例患者有感觉异常和 7 例触觉灵敏度降低。皮瓣组的美学效果满意度显著更高。
在高张力的 ALT 供区关闭中，应始终考虑使用旋股外侧动脉穿支皮瓣，以避免中厚皮片移植导致的相关功能和美学不良结果。
