Ann Plast Surg. 2023 Aug 1;91(2):238-244. doi: 10.1097/SAP.0000000000003612. Epub 2023 Jun 29.
Reconstructing complex soft tissue defects of the finger requires both functional and aesthetic aspects. There are many free tissue transfers as suitable options for digital resurfacing. The anterolateral thigh (ALT) flap is not the first choice for reconstruction of this area because it has the disadvantage that the subcutaneous tissue is too thick; however, its use as a thinned form has yet to be described much. This study presents the flap thinning technique in the small-sized ALT flap for the finger soft tissue defect.
From May 2009 to March 2018, 10 patients with complete circumferential or semicircumcision defects in the fingers underwent reconstructive procedures that included thinned ALT flap transfer. Finger soft tissue damage due to contusion trauma includes loss of skin and exposure of the bone and tendon. The flap is thinned in 2 different ways: peripheral thinning and total microsurgical thinning, which is selected based on the perforator vessel structure of the flap.
The ALT flap sizes, averaging 4-9 cm wide and 6-12 cm long, were thinned to 4-7 mm. One perforator was included in the flaps with a pedicle length average of 6.1 cm. The flaps survived entirely in all patients except one with a 30% area in the distal part of the thinned ALT flap that became necrotic because of venous occlusion. Donor sites were closed primarily for all patients. No patients required secondary flap defatting.
The small thinned ALT perforator flap can be an excellent option for full circumferential or semicircumferential soft tissue defects of the finger. Follow-up showed this as an excellent alternative for finger reconstruction in terms of aesthetic appearance and functional outcome.
重建手指的复杂软组织缺损需要考虑功能和美观两个方面。有许多游离组织转移可供选择，适用于手指再植。股前外侧皮瓣（ALT）不是该区域重建的首选，因为它的皮下组织太厚；然而，将其作为变薄形式的应用尚未得到充分描述。本研究介绍了用于手指软组织缺损的小尺寸股前外侧皮瓣的皮瓣变薄技术。
2009 年 5 月至 2018 年 3 月，10 例手指完全环形或半环形缺损患者接受了包括变薄 ALT 皮瓣转移在内的重建手术。由于挫伤创伤导致的手指软组织损伤包括皮肤丧失和骨与肌腱暴露。皮瓣通过两种不同的方式变薄：周边变薄和全显微外科变薄，这取决于皮瓣的穿支血管结构进行选择。
ALT 皮瓣大小平均为 4-9cm 宽，6-12cm 长，被变薄至 4-7mm。皮瓣包含 1 个穿支，蒂长平均为 6.1cm。除 1 例因静脉阻塞导致变薄的 ALT 皮瓣远端 30%面积坏死外，所有患者的皮瓣均完全存活。所有患者的供区均直接闭合，无需进行二次皮瓣去脂。
小尺寸变薄的 ALT 穿支皮瓣是手指全环形或半环形软组织缺损的绝佳选择。随访结果表明，在美学外观和功能结果方面，这是手指重建的一个极好选择。
