Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
Microsurgery. 2022 Nov;42(8):783-792. doi: 10.1002/micr.30958. Epub 2022 Sep 10.
For successful microsurgical reconstruction using free tissue transfer, healthy recipient vessels must be obtained from outside the zone of injury. Securing an appropriate length pedicle length is also essential, and various techniques for lengthening a vascular pedicle have been developed. Herein, we present our experience using the descending branch (DB) of the lateral circumflex femoral vessels (LCFVs) with a thigh flap as an extender graft for consecutive second flap.
We reconstructed the complex and vessel-depleted defects of nine patients. The mean age was 47.6 years. The defects were located in the lower leg in four patients, in the perineum in two patients and in the forearm in three patients. The two patients who suffered from Fournier's gangrene underwent a pedicled anteromedial thigh (pAMT) flap with the DB of the LCFVs and seven patients, five who suffered high-energy trauma and two who had scar contracture, underwent a free anterolateral thigh (ALT) flap with the distal run-off DB of the LCFVs. In all patients, second consecutive free latissimus dorsi or thoracodorsal artery perforator flaps were prepared and the thoracodorsal vessels of the second flap were anastomosed to the distal DB of the LCFVs.
The total length of the thigh flap pedicles measured from both ends of the DB of the LCFVs varied from 15 to 20 cm, which was sufficient for use as a vascular conduit. Of the 18 flaps, 17 survived completely without any complications and 1 pAMT flap showed partial necrosis, which was covered with a perineal perforator-based island flap. The mean follow-up period was 16.7 months. Unfortunately, one patient, who suffered a total amputation below the knee and had replantation surgery, underwent amputation due to venous congestion in the distal leg. However, the previous two flaps survived and were used for coverage of the stump.
Using a thigh flap as a vascular extender graft for second flap may be an alternative option in vessel-depleted reconstructions.
为了成功进行游离组织移植的显微重建，必须从损伤区域外获取健康的受区血管。确保适当的蒂长也是至关重要的，因此已经开发了各种延长血管蒂的技术。在此，我们介绍使用股外侧皮血管（LCFV）降支与股前外侧皮瓣联合作为连续第二个皮瓣的血管延长移植物的经验。
我们重建了 9 例复杂且血管耗竭的缺损患者。平均年龄为 47.6 岁。4 例患者的缺损位于小腿，2 例位于会阴，3 例位于前臂。2 例患有 Fournier 坏疽的患者接受了带 LCFV 降支的带蒂股前内侧皮瓣（pAMT），7 例患者（5 例高能量创伤患者和 2 例瘢痕挛缩患者）接受了带 LCFV 降支远侧流出道的游离股前外侧皮瓣（ALT）。在所有患者中，准备了第二个连续的游离背阔肌或胸背动脉穿支皮瓣，将第二个皮瓣的胸背血管吻合到 LCFV 降支的远侧。
从 LCFV 降支的两端测量，股皮瓣蒂的总长度为 15-20cm，足以用作血管移植物。18 个皮瓣中，17 个完全存活，无任何并发症，1 个 pAMT 皮瓣出现部分坏死，用会阴穿支皮瓣覆盖。平均随访时间为 16.7 个月。不幸的是，1 例患者因膝下完全截肢和再植手术而接受截肢，由于小腿远端静脉淤血而截肢。然而，之前的两个皮瓣存活并用于覆盖残端。
使用股皮瓣作为第二个皮瓣的血管延长移植物可能是血管耗竭重建的一种替代选择。
