From the Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
My Houston Surgeons, Houston, TX.
Ann Plast Surg. 2024 Apr 1;92(4):412-417. doi: 10.1097/SAP.0000000000003878.
Free flap selection in extremity reconstruction can be challenging. The ideal flap has to be thin and pliable to achieve optimal contour and function. We explore the role of the fascia-only anterolateral thigh (fALT) flap in extremity reconstruction.
We conducted a retrospective review of our experience using fALT-free flap for extremity reconstruction over a 2-year period. Patient demographics, mechanism of injury, flap characteristics, complications- and follow-up were recorded. Descriptive statistics were calculated.
Twelve patients were included. The median (interquartile range [IQR]) age was 34 (28-52) years. One fALT flap was used for upper extremity reconstruction, while 11 flaps were used for lower extremity reconstruction (4 for lower third of the leg, 4 for dorsum of foot, and 3 for heel). The median (IQR) flap surface area was 90 (63-120) cm2 and time from injury to reconstruction was 10 (6-16) days. The postoperative course was uneventful for all flaps except for 1 flap failure and 1 delayed healing. The median (IQR) follow-up was 2 (1-4) months. In all cases, durable soft tissue reconstruction was achieved with no need for revisions.
The fALT-free flap can be successfully used in extremity reconstruction. The ALT fascia has robust perfusion that allows for the harvest of a large flap that can be surfaced with a split thickness skin graft. Its thin pliable tissue provides excellent contour for the hand, distal leg, and foot that does not require future thinning, optimizing the cosmetic and functional result.
在肢体重建中选择游离皮瓣具有挑战性。理想的皮瓣必须薄而柔韧，以达到最佳的轮廓和功能。我们探讨了仅包含前外侧大腿筋膜（fALT）的游离皮瓣在肢体重建中的作用。
我们对过去 2 年中使用 fALT 游离皮瓣进行肢体重建的经验进行了回顾性研究。记录了患者的人口统计学资料、损伤机制、皮瓣特征、并发症和随访情况。进行了描述性统计分析。
共纳入 12 例患者。年龄中位数（四分位距 [IQR]）为 34 岁（28-52 岁）。1 例 fALT 皮瓣用于上肢重建，11 例皮瓣用于下肢重建（4 例用于小腿下段，4 例用于足背，3 例用于足跟）。皮瓣表面积中位数（IQR）为 90（63-120）cm2，从损伤到重建的时间为 10（6-16）天。除 1 例皮瓣失败和 1 例延迟愈合外，所有皮瓣的术后过程均顺利。中位（IQR）随访时间为 2（1-4）个月。所有病例均实现了持久的软组织重建，无需进行修复。
fALT 游离皮瓣可成功用于肢体重建。ALT 筋膜具有强大的灌注，允许采集大的皮瓣，并可使用中厚皮片覆盖。其薄而柔韧的组织为手、小腿下段和足部提供了极好的轮廓，无需进一步减薄，从而优化了美容和功能结果。
