Sơn Trần Thiết, Dung Phạm Thị Việt, Thúy Tạ Thị Hồng, Nghĩa Phan Tuấn, Chiến Vũ Hồng
Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam.
Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam.
JPRAS Open. 2023 Nov 24;39:106-113. doi: 10.1016/j.jpra.2023.11.011. eCollection 2024 Mar.
Simultaneous repair of the extensor tendons and soft tissues in hand injuries remains challenging. The free chimeric anterolateral thigh (ALT) flap with fascia lata (FL) flap represents an alternative for hand reconstruction. This report describes the reconstruction of the extensor tendon and skin defects using free chimeric ALT flaps with FL.
Eight patients (one female and seven male) underwent reconstruction of complex hand defects with free chimeric ALT and FL flaps. The defects were caused by crushing injuries, burns, snakebite scars, and animal bite wounds. The average skin defect was 116 cm. Perforators were selected for the skin paddle and the FL flap. The thinning procedure was performed microsurgically.
The skin paddle size ranged from 12 to 23 cm in length and 6 to 11 cm in width, and the FL flaps ranged from 3 × 5 to 12 × 5 cm. The mean pedicle length was 7.88 cm. Nine extensor tendons were repaired with FL flaps. The flap thickness after thinning was only 3-6 mm. The donor site was closed primarily in six patients, and skin grafts were used in two cases. All flaps survived without complications. The follow-up period lasted from 17 to 80 months. Range of motion was achieved with satisfaction.
The chimeric-thinned ALT and FL flap is a valuable material, and it should be considered a reconstructive option for hand soft tissue and extensor tendon reconstruction. This technique allows us to achieve a good appearance and extensor function without donor-site morbidity.
手部损伤时同时修复伸肌腱和软组织仍然具有挑战性。带阔筋膜（FL）瓣的游离嵌合股前外侧（ALT）瓣是手部重建的一种选择。本报告描述了使用带FL的游离嵌合ALT瓣修复伸肌腱和皮肤缺损的情况。
8例患者（1例女性和7例男性）接受了带游离嵌合ALT和FL瓣的复杂手部缺损重建。缺损由挤压伤、烧伤、蛇咬伤瘢痕和动物咬伤伤口引起。平均皮肤缺损面积为116平方厘米。为皮瓣和FL瓣选择穿支血管。采用显微外科技术进行减薄操作。
皮瓣长度为12至23厘米，宽度为6至11厘米，FL瓣面积为3×5至12×5厘米。平均蒂长为7.88厘米。用FL瓣修复了9条伸肌腱。减薄后的瓣厚度仅为3至6毫米。6例患者的供区直接缝合，2例采用植皮。所有皮瓣均存活，无并发症。随访时间为17至80个月。活动范围达到满意效果。
嵌合减薄的ALT和FL瓣是一种有价值的材料，应被视为手部软组织和伸肌腱重建的一种重建选择。该技术使我们能够在不造成供区并发症的情况下获得良好的外观和伸肌功能。
