Saad Noah H, Rosso Kelly, Wang Howard, Cromack Douglas, Karamanos Efstathios
Division of Plastic and Reconstructive Surgery and the Department of Orthopedic Surgery, UT Health San Antonio, San Antonio, Tex.
Banner MD Anderson, Phoenix, Ariz.
Plast Reconstr Surg Glob Open. 2021 May 27;9(5):e3584. doi: 10.1097/GOX.0000000000003584. eCollection 2021 May.
In the field of plastic and reconstructive surgery, soft tissue reconstruction of Gustilo 3B with peripheral vascular disease or 3C fractures is a complex treatment algorithm. The concomitant issue of soft tissue coverage with vascular reconstruction is the main challenge when opting for free tissue transfer. The flow-through flap offers the surgeon the ability to treat a vascular injury or high-grade stenosis to maintain distal perfusion, while also providing soft tissue coverage. In this study, we present a case series of 3 patients who underwent flow-through anterolateral thigh free flap for lower extremity soft tissue coverage. Each patient had a history of trauma and either single vessel runoff or a dominant branch with diminutive secondary blood flow to the foot. All patients successfully underwent free flap reconstruction of lower extremity wounds while concomitantly reconstructing diseased arterial supply. Only 1 patient suffered partial flap loss postoperatively that was treated with debridement and split thickness skin grafting. Flow-through free tissue transfer is a valuable treatment option not only in Gustilo 3C fractures requiring soft tissue coverage, but also in patients with Gustilo 3B fractures with peripheral vascular disease.
在整形与重建外科领域，对于伴有外周血管疾病的Gustilo 3B型或3C型骨折进行软组织重建是一种复杂的治疗方案。在选择游离组织移植时，软组织覆盖与血管重建这一伴随问题是主要挑战。穿支皮瓣使外科医生有能力治疗血管损伤或重度狭窄以维持远端血供，同时还能提供软组织覆盖。在本研究中，我们展示了一个病例系列，包括3例接受穿支股前外侧游离皮瓣进行下肢软组织覆盖的患者。每位患者都有外伤史，且存在单支血管流出道或足部主要分支伴次要血流微小的情况。所有患者均成功接受了下肢伤口的游离皮瓣重建，同时对病变的动脉供血进行了重建。仅1例患者术后出现部分皮瓣坏死，经清创和断层皮片移植治疗。穿支游离组织移植不仅是需要软组织覆盖的Gustilo 3C型骨折的一种有价值的治疗选择，对于伴有外周血管疾病的Gustilo 3B型骨折患者也是如此。
