Department of Hand & Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Department of Hand & Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China.
Injury. 2021 Jul;52(7):1771-1777. doi: 10.1016/j.injury.2021.04.067. Epub 2021 May 4.
Complex soft tissue defects in the upper extremities are challenging to reconstruct. The purpose of this study was to share our experience with using four variants of double skin paddle Anterolateral Thigh Perforator (ALT) flap to achieve the customized reconstruction of the complex defects.
From January 2007 to December 2019, 15 patients (14 male and 1 female) aged 15-61 years underwent double skin paddle ALT flap reconstruction of the upper extremities. 10 wounds were located in the wrist or hand, while four wounds were located in the forearm, and one wound in the elbow. All the wounds were large with non-adjacent defects and with or without a dead space. Four variants of double skin paddle anterolateral thigh perforator flaps were harvested according to the patient's needs.
The flaps received were consisted of 7 classic double skin paddle ALT flap, 4 vastus lateralis muscle-chimeric double skin paddle ALT flap, 2 microdissected thin double skin paddle ALT flap, and 2 flow-through double skin paddle ALT flap. The size of the skin flap ranged from 6 × 6 cm to 26 × 7 cm, and the size of the muscle segment ranged from 5 × 2 × 1 cm to 16× 6 × 2 cm. Flap necrosis related to the pedicle kinking was observed in one patient, while the rest of the flaps survived without complications. The follow-up period ranged from 7 to 54 months, with a median of 15.6 months. The mean value of the qDASH scores at the last follow-up was 27.12 ± 16.51 (range, 11.4-59.1). None of the patients showed wrist flexion deformity. Postoperatively, three patients developed finger joint stiffness, which correlated with the severity of the injury.
Variants of double skin paddle ALT flaps provide versatile design and allow customized reconstruction of complex soft tissue defects in the upper extremities with limited donor site morbidity. We believe that the algorithm provided will help the surgeons with deciding among variants of double skin paddle ALT flap.
上肢的复杂软组织缺损的重建具有挑战性。本研究旨在分享我们使用四种变体的双皮瓣股前外侧穿支皮瓣（ALT）来实现复杂缺损的定制重建的经验。
2007 年 1 月至 2019 年 12 月，15 名 15-61 岁的患者（男 14 例，女 1 例）接受了双皮瓣股前外侧穿支皮瓣重建上肢。10 个伤口位于手腕或手部，4 个伤口位于前臂，1 个伤口位于肘部。所有伤口均较大，有非相邻缺损且有或无死腔。根据患者的需要，采集了四种变体的双皮瓣股前外侧穿支皮瓣。
所接受的皮瓣包括 7 个经典的双皮瓣 ALT 皮瓣、4 个股外侧肌嵌合双皮瓣 ALT 皮瓣、2 个微解剖薄双皮瓣 ALT 皮瓣和 2 个血流通过双皮瓣 ALT 皮瓣。皮瓣大小从 6×6cm 到 26×7cm 不等，肌段大小从 5×2×1cm 到 16×6×2cm 不等。1 例患者因蒂扭转出现皮瓣坏死，其余皮瓣均无并发症存活。随访时间 7-54 个月，中位数 15.6 个月。末次随访时 qDASH 评分平均值为 27.12±16.51（范围 11.4-59.1）。所有患者均无腕关节屈曲畸形。术后 3 例患者发生手指关节僵硬，与损伤严重程度相关。
双皮瓣股前外侧穿支皮瓣的变体提供了多样的设计，并允许对上肢的复杂软组织缺损进行定制重建，同时最大限度地减少供区的发病率。我们相信，所提供的算法将有助于外科医生在双皮瓣股前外侧穿支皮瓣的变体之间做出决策。
