Wang Danying, Zang Mengqing, Ma Hengyuan, Liu Yuanbo
Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Arch Plast Surg. 2022 May 27;49(3):444-447. doi: 10.1055/s-0042-1748661. eCollection 2022 May.
Reconstruction of soft tissue defects around the knee is challenging, and the most common solution is to use various locoregional flaps or, in some difficult cases, a free flap. The distally based anterolateral thigh (dALT) flap is a commonly used flap that relies on reverse blood flow from the descending branch of the lateral circumflex femoral artery (d-LCFA). Here, we present the case of an anteromedial knee reconstruction using a dALT flap after resection of a pleomorphic undifferentiated sarcoma. The tumor resection resulted in a 14 × 7 cm defect, and a dALT flap, measuring 20 × 8 cm was elevated. During the surgery, we found a robust oblique branch of the LCFA (o-LCFA) sending off two sizable perforators to the anterolateral thigh region, whereas the d-LCFA was relatively small with no usable perforators. Therefore, we harvested a dALT flap relying on reverse flow from the o-LCFA. The patient's postoperative course was uneventful, and the flap survived without complications. This report demonstrates that reverse flow from the o-LCFA may be an alternative to nourish a dALT flap in cases where the d-LCFA is hypoplastic or suitable perforators from the d-LCFA are unavailable.
膝关节周围软组织缺损的重建具有挑战性，最常见的解决方法是使用各种局部皮瓣，在一些困难病例中则使用游离皮瓣。远端蒂股前外侧（dALT）皮瓣是一种常用皮瓣，它依靠旋股外侧动脉降支（d-LCFA）的逆向血流供血。在此，我们报告一例在切除多形性未分化肉瘤后使用dALT皮瓣进行膝前内侧重建的病例。肿瘤切除后形成了一个14×7厘米的缺损，掀起了一个大小为20×8厘米的dALT皮瓣。手术过程中，我们发现旋股外侧动脉的一条粗大斜支（o-LCFA）向前外侧大腿区域发出两条粗大的穿支，而d-LCFA相对较细且没有可用的穿支。因此，我们采用依靠o-LCFA逆向血流供血的dALT皮瓣。患者术后恢复顺利，皮瓣存活且无并发症。本报告表明，在d-LCFA发育不良或无法从d-LCFA获得合适穿支的情况下，o-LCFA的逆向血流可能是滋养dALT皮瓣的一种替代方法。
