Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China.
Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China.
J Plast Reconstr Aesthet Surg. 2021 Mar;74(3):530-539. doi: 10.1016/j.bjps.2020.10.006. Epub 2020 Oct 22.
This study describes our experience using individually designed double skin paddle anterolateral thigh perforator (ALTP) flaps to reconstruct complex soft tissue defects. An anatomical study of double skin paddle ALTP flaps was conducted in six fresh cadavers (12 thighs). We also performed a retrospective cohort study of 36 patients who underwent reconstruction using double skin paddle ALTP flaps from January 2009 to June 2019. The soft tissue defects were large or non-adjacent defects that could not be repaired by a single flap. Three types of double skin paddle ALTP flaps were designed. In type I, separate perforators supplied each flap: one perforator from the transverse branch of the lateral circumflex femoral artery (LCFA) and one from the descending branch of the LCFA (d-LCFA). In type II, both perforators were from the d-LCFA. In type III, a single perforator from the d-LCFA had two branches that each supplied one flap. In the cadaver study, type I was observed in 11 thighs, type II in 10, and type III in six. All patients were successfully treated using double skin paddle ALTP flaps. Four patients received type I flaps, 23 received type II, and nine received type III. Vascular compromise occurred in one patient, and the flap was saved by emergency revascularization. Most patients had satisfactory contours and functional recovery during follow-up. Individually designed double skin paddle ALTP flaps is a reliable option for reconstructing complex soft tissue defects. Moreover, we created an algorithm for microvascular reconstruction of complex soft tissue defects.
本研究描述了我们使用个体化设计的双皮瓣股前外侧穿支皮瓣（ALTP）修复复杂软组织缺损的经验。在 6 具新鲜尸体（12 条大腿）上进行了双皮瓣 ALTP 皮瓣的解剖学研究。我们还对 2009 年 1 月至 2019 年 6 月期间使用双皮瓣 ALTP 皮瓣进行重建的 36 例患者进行了回顾性队列研究。这些软组织缺损较大或不相邻，无法通过单个皮瓣修复。设计了三种类型的双皮瓣 ALTP 皮瓣。在 I 型中，每个皮瓣由单独的穿支供血：来自外侧旋股动脉（LCFA）横支的一个穿支和来自 LCFA 降支的一个穿支。在 II 型中，两个穿支均来自 d-LCFA。在 III 型中，来自 d-LCFA 的单个穿支有两个分支，每个分支供应一个皮瓣。在尸体研究中，11 条大腿观察到 I 型，10 条大腿观察到 II 型，6 条大腿观察到 III 型。所有患者均成功使用双皮瓣 ALTP 皮瓣治疗。4 例患者接受 I 型皮瓣，23 例患者接受 II 型皮瓣，9 例患者接受 III 型皮瓣。1 例患者发生血管危象，通过紧急血运重建挽救了皮瓣。大多数患者在随访期间具有满意的轮廓和功能恢复。个体化设计的双皮瓣 ALTP 皮瓣是修复复杂软组织缺损的可靠选择。此外，我们创建了一个用于复杂软组织缺损的微血管重建算法。
