Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany.
Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany.
Microsurgery. 2024 Sep;44(6):e31212. doi: 10.1002/micr.31212.
A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options.
Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared.
A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9).
The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.
游离股外侧肌（VL）肌皮瓣是一种广泛用于胸壁重建的重建选择，可以单独进行，也可以与阔筋膜张肌前外侧皮瓣（cVLALT）和/或股外侧肌筋膜皮瓣（cVLTFL）联合进行。我们旨在直接比较这些重建选择的结果。
本回顾性研究纳入了 2010 年 2 月至 2022 年间接受游离 VL、cVLALT 或 cVLTFL 皮瓣胸壁重建的患者。评估了患者的人口统计学、手术特征以及医疗和重建结果。比较了肌皮瓣 VL、cVLALT 和 cVLTFL 瓣重建的手术结果。
共有 41 例患者接受了游离肌皮瓣 VL（n=25；61%）、cVLALT（n=14；34%）或 cVLTFL 胸壁重建。整个队列中有 3 例（3/41，7%）发生急性皮瓣血栓形成，1 例肌皮瓣 VL 皮瓣因再发性静脉血栓形成而失败。2 例（5%；VL 皮瓣：n=1；cVLALT 皮瓣：n=1）出现总皮瓣坏死，1 例 VL 皮瓣（1/25，4%）和 3 例 cVLALT 皮瓣的远端 ALT 部分（3/14，21%）出现部分皮瓣坏死。孤立 VL 与联合 VL 皮瓣之间的部分（p=0.28）或总皮瓣坏死率（p=0.9）无显著差异。
游离（联合）VL 皮瓣为消灭死腔提供了可靠的结果，为复杂胸壁缺损的持久重建提供了保障。
