Scomacao Isis, Vijayasekaran Aparna, Fahradyan Vahe, Aliotta Rachel, Drake Richard, Gurunian Raffi, Djohan Risal
From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH.
Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN.
Ann Plast Surg. 2021 May 1;86(5):557-561. doi: 10.1097/SAP.0000000000002490.
Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch.
Ten fresh cadavers were dissected with a designed chimeric thigh flap including ALT and RF flaps. Anterolateral thigh was designed and raised with the lateral femoral cutaneous nerve integrated, and the descending branch of the lateral circumflex femoral artery was preserved. Rectus femoris was elevated and the common pedicle was dissected up to the femoral origin. Accompanying motor nerve branches were carefully dissected to their femoral origin.
Twenty RF flaps were dissected and 9 were harvested as a true chimeric flap with ALT. The mean number of neurovascular bundles associated with RF flap was 2.11 ± 0.47, and the mean primary motor nerve average length was 9.40 ± 2.42 cm. The common vascular bundle in all 9 chimeric flaps was ligated, and the flap was rotated toward the abdomen pedicled only by primary motor nerve of the RF muscle. Nerve length was adequate for reach up to xiphoid area in all 20 flaps.
This study demonstrates the feasibility of the chimeric ALT/RF muscle free flap pedicled only by the motor nerve branch, with adequate flap rotation. Even with the limitations in a live patient, this flap would be an excellent option for FAWR in the right patient.
动态功能性腹壁重建（FAWR）仍然是一项复杂的挑战。理想的皮瓣应使供区并发症降至最低，并能覆盖大面积且具备运动和感觉功能。目的是研究仅以运动神经分支为蒂的带有股前外侧（ALT）和股直肌（RF）成分的游离嵌合皮瓣的可行性。
对10具新鲜尸体进行解剖，设计包含ALT和RF皮瓣的嵌合大腿皮瓣。设计并掀起股前外侧皮瓣，保留股外侧皮神经，保留旋股外侧动脉降支。掀起股直肌，将共同蒂解剖至股部起点。仔细解剖伴行的运动神经分支直至其股部起点。
解剖了20个RF皮瓣，其中9个作为与ALT的真正嵌合皮瓣进行采集。与RF皮瓣相关的神经血管束平均数量为2.11±0.47，主要运动神经平均长度为9.40±2.42cm。所有9个嵌合皮瓣的共同血管束均被结扎，皮瓣仅以RF肌肉的主要运动神经为蒂向腹部旋转。在所有20个皮瓣中，神经长度足以到达剑突区域。
本研究证明了仅以运动神经分支为蒂的ALT/RF肌肉游离嵌合皮瓣具有可行性，且皮瓣旋转充分。即使在活体患者中有局限性，对于合适的患者，该皮瓣仍是FAWR的极佳选择。
