Du Qingyan, Liu Yuanbo, Zang Mengqing, Zhu Shan, Li Shanshan, Chen Zixiang, Han Tinglu
From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Plast Reconstr Surg. 2024 Mar 1;153(3):728-738. doi: 10.1097/PRS.0000000000010814. Epub 2023 Jun 7.
The distally based (d) anterolateral thigh (ALT) flap is an effective option for soft-tissue reconstruction around the knee; however, unexpected situations may occur intraoperatively, impeding flap harvest. The authors proposed an algorithm for surgical conversion for unexpected situations encountered intraoperatively.
Between 2010 and 2021, 61 dALT flap harvests were attempted for soft-tissue defect reconstruction around the knee; 25 patients underwent surgical conversion for anomalies, including lack of a suitable perforator, hypoplasia of the descending branch, and compromised reverse flow from the descending branch. After excluding improper cases, 35 flaps were harvested as planned (group A) and 21 surgical conversion cases (group B) were finally enrolled for analysis. An algorithm was developed based on the cases in group B. Outcomes, including complication and flap loss rates, were compared between groups to verify the algorithm's rationality.
In group B, the dALT flap was converted to a distally based anteromedial thigh flap ( n = 8), bipedicled dALT flap ( n = 4), distally based rectus femoris muscle flap ( n = 3), free ALT flap ( n = 2), or other locoregional flap that required additional incision ( n = 4). No differences in outcomes were observed between the two groups.
The proposed contingency planning algorithm for dALT flap surgery proved rational, as surgical conversion could be made by means of the same incision in most cases, and outcomes generated by the algorithm were acceptable.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
以远端为蒂的股前外侧（d）皮瓣是膝关节周围软组织重建的有效选择；然而，术中可能会出现意外情况，妨碍皮瓣切取。作者提出了一种针对术中遇到的意外情况进行手术转换的算法。
2010年至2021年期间，尝试切取61例dALT皮瓣用于膝关节周围软组织缺损重建；25例患者因出现异常情况而进行了手术转换，这些异常情况包括缺乏合适的穿支、降支发育不全以及降支逆向血流受损。排除不恰当的病例后，35例皮瓣按计划切取（A组），最终纳入21例手术转换病例（B组）进行分析。根据B组病例制定了一种算法。比较两组的结果，包括并发症和皮瓣丢失率，以验证该算法的合理性。
在B组中，dALT皮瓣被转换为以远端为蒂的股前内侧皮瓣（n = 8）、双蒂dALT皮瓣（n = 4）、以远端为蒂的股直肌肌皮瓣（n = 3）、游离股前外侧皮瓣（n = 2）或其他需要额外切口的局部皮瓣（n = 4）。两组在结果方面未观察到差异。
所提出的dALT皮瓣手术应急计划算法被证明是合理的，因为在大多数情况下可以通过相同的切口进行手术转换，并且该算法产生的结果是可以接受的。
临床问题/证据水平：治疗性，IV级。
