Kim Jin Soo, Lee Ho Hyung, Koh Sung Hoon, Lee Dong Chul, Roh Si Young, Lee Kyung Jin
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea.
Arch Plast Surg. 2024 Feb 7;51(1):87-93. doi: 10.1055/a-2161-7419. eCollection 2024 Jan.
This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis ( < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.
本研究旨在分析采用终末穿支与指动脉吻合的股前外侧（ALT）游离皮瓣进行手部重建的病例。纳入2011年1月至2021年8月期间接受终末穿支与指动脉吻合的ALT游离皮瓣移植进行手部重建的患者。通过回顾病历和照片，对穿支和静脉的数量、长度和直径、皮瓣大小及手术时间进行调查。分析动脉血栓形成、静脉血栓形成、动脉痉挛及皮瓣坏死的发生率。本研究共纳入50例患者。穿支的平均直径和长度分别为0.68mm和3.25cm，平均吻合静脉数量为1.88条，平均直径为0.54mm。并发症包括4例动脉血栓形成、1例静脉血栓形成、7例部分坏死及1例皮瓣完全坏死。回归分析显示，穿支较长与动脉血栓形成相关，而皮瓣尺寸较大及吻合静脉数量较多与部分坏死相关（P＜0.05）。终末穿支与指动脉吻合在使用蒂短的紧凑型游离皮瓣覆盖手部小缺损方面具有优势。
