Son Tran Thiet, Dung Pham Thi Viet, Huy Le Anh
Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam; Department of Plastic Surgery, Saint Paul Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam; Department of Plastic and Reconstructive Surgery, Hanoi Medical University Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam.
Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam.
Int J Surg Case Rep. 2022 Jan;90:106693. doi: 10.1016/j.ijscr.2021.106693. Epub 2021 Dec 27.
Massive facial defects remain a reconstructive challenge because of the region's unique character and the limitation of a well-matched donor site. Pre-expanded free anterolateral thigh (ALT) flap provides a good alternative for reconstructing massive skin and soft tissue defects.
A 21-year-old male patient presented to our department with a massive right facial degloving wound caused by a sharp edged-weapon attack. The patient left the hospital after 3 weeks of wound care, and only came back to us after 2 months with large defects at the nasal, cheek, and upper and lower right lip regions. The procedure of ALT flap expansion surgery was performed for 2 months. The pre-expanded ALT flap was used for reconstruction of the patient's facial defects. Two-year follow-up showed that the flap at the reconstructed area resembled the contour of the nasal tip, facial skin color similarities in the cheeks and lips, and the patient's mouth had normal function.
The combined pre-expanded and composite ALT free flap techniques allow simultaneous reconstruction of many different anatomic units. Flap debulking helps to improve the nasal contour from the original defect. The lip separation technique and flap debulking procedure help enhance aesthetic reconstructive outcomes of the skin flap.
The surgical reconstruction using a pre-expanded ALT free flap for the patient with a massive facial defect was safe. In particular, sufficient skin and soft tissue ensured facial aesthetics and oral function for the patient when using this method.
由于面部区域的独特特征以及匹配良好的供区有限，巨大面部缺损仍然是重建手术中的一项挑战。预扩张游离股前外侧（ALT）皮瓣为重建巨大皮肤和软组织缺损提供了一种良好的选择。
一名21岁男性患者因锐器攻击导致右侧面部大面积脱套伤前来我院就诊。经过3周的伤口护理后患者出院，2个月后因鼻、面颊及右侧上下唇区域出现大面积缺损再次前来。ALT皮瓣扩张手术进行了2个月。使用预扩张的ALT皮瓣对患者的面部缺损进行重建。两年随访显示，重建区域的皮瓣形似鼻尖轮廓，面颊和唇部的皮肤颜色相近，患者的口部功能正常。
预扩张复合游离ALT皮瓣技术可同时重建多个不同的解剖单元。皮瓣减容有助于改善由原始缺损造成的鼻部轮廓。唇部分离技术和皮瓣减容手术有助于提高皮瓣的美学重建效果。
采用预扩张游离ALT皮瓣对巨大面部缺损患者进行手术重建是安全的。特别是，使用该方法时，充足的皮肤和软组织确保了患者的面部美观和口腔功能。
