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交叉腿微血管游离股前外侧皮瓣作为血管耗竭肢体重建的一种安全、可行且备用的选择。

Cross-Leg Microvascular Free Anterolateral Thigh Flap as a Safe, Viable, and Reserve Option for Reconstruction in a Vessel-Depleted Limb.

作者信息

Ss Sonika, Sharma Mukesh Kumar, Babu Vaddi Suman, Samraj Catherine, Boyidi Bulli Babu

机构信息

Department of Burns and Plastic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

出版信息

Indian J Plast Surg. 2024 Oct 3;57(Suppl 1):S118-S122. doi: 10.1055/s-0044-1790531. eCollection 2024 Dec.

DOI:10.1055/s-0044-1790531
PMID:39741732
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11684970/
Abstract

We present the case of a 36-year-old male patient with a posttraumatic composite defect of the lower two-thirds of the anterior aspect of the left leg with exposed necrotic tibia in an old, neglected type 3b fracture of the tibia of 9-month duration. The options for definitive soft-tissue cover include microvascular free tissue transfer and cross-leg flaps. In trauma cases, the surrounding tissue is usually damaged, and the recipient vessels are frequently implicated, ruling out the use of a microvascular free flap. Cross-leg flaps are unachievable due to large defect sizes and lack of appropriate donor tissue. In this case report, we highlight the use of cross-leg microvascular free anterolateral thigh (ALT) flap cover for the composite leg defect. By presenting our case, we aim to advocate the clinical application of cross-leg free flap surgery in vessel-depleted limbs as a safe and viable option.

摘要

我们报告了一例36岁男性患者，其左腿前侧下三分之二处存在创伤后复合缺损，伴有9个月病程的陈旧性、被忽视的胫骨3b型骨折，胫骨坏死外露。确定性软组织覆盖的选择包括游离微血管组织移植和交腿皮瓣。在创伤病例中，周围组织通常受损，受区血管常受累，排除了使用游离微血管皮瓣的可能性。由于缺损面积大且缺乏合适的供区组织，交腿皮瓣无法实施。在本病例报告中，我们重点介绍了使用交腿游离微血管股前外侧（ALT）皮瓣覆盖腿部复合缺损。通过展示我们的病例，我们旨在倡导在血管条件差的肢体中临床应用交腿游离皮瓣手术，作为一种安全可行的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/5762ccb8d9b4/10-1055-s-0044-1790531-i2462884-8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/21876669429a/10-1055-s-0044-1790531-i2462884-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/65809ef93a20/10-1055-s-0044-1790531-i2462884-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/32b3e63ec831/10-1055-s-0044-1790531-i2462884-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/5bf4e2c91ed2/10-1055-s-0044-1790531-i2462884-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/c37048f0d952/10-1055-s-0044-1790531-i2462884-5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/c8770219d70a/10-1055-s-0044-1790531-i2462884-6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/f702fce6f486/10-1055-s-0044-1790531-i2462884-7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/5762ccb8d9b4/10-1055-s-0044-1790531-i2462884-8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/21876669429a/10-1055-s-0044-1790531-i2462884-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/65809ef93a20/10-1055-s-0044-1790531-i2462884-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/32b3e63ec831/10-1055-s-0044-1790531-i2462884-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/5bf4e2c91ed2/10-1055-s-0044-1790531-i2462884-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/c37048f0d952/10-1055-s-0044-1790531-i2462884-5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/c8770219d70a/10-1055-s-0044-1790531-i2462884-6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/f702fce6f486/10-1055-s-0044-1790531-i2462884-7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca99/11684970/5762ccb8d9b4/10-1055-s-0044-1790531-i2462884-8.jpg

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本文引用的文献

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The cross-leg free flap: A systematic review of the literature.交叉腿游离皮瓣：文献系统综述
Microsurgery. 2024 Feb;44(2):e31144. doi: 10.1002/micr.31144.
2
Reliability of Long Vein Grafts for Reconstruction of Massive Wounds.用于大面积伤口重建的长静脉移植物的可靠性
J Clin Med. 2023 Sep 26;12(19):6209. doi: 10.3390/jcm12196209.
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Reliability and Safety of Cross-Leg Free Latissmus Dorsi Muscle Flap in Reconstruction of Mutilating Leg Injuries Using End-to-Side Anastomosis.采用端侧吻合技术的交叉腿游离背阔肌肌皮瓣修复下肢毁损性损伤的可靠性与安全性
Arch Plast Surg. 2023 Oct 5;50(5):507-513. doi: 10.1055/a-2126-7058. eCollection 2023 Sep.
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Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls.游离皮瓣重建中的静脉移植物：适应证回顾和机构经验。
Plast Reconstr Surg. 2022 Mar 1;149(3):742-749. doi: 10.1097/PRS.0000000000008856.
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Advancements in Reconstructive Surgery Broaden Opportunities for Salvage of the Injured Lower Extremity.重建外科的进展拓宽了挽救下肢损伤的机会。
Ann Plast Surg. 2020 Feb;84(2):238-245. doi: 10.1097/SAP.0000000000001977.
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Review of Cross-Leg Flaps in Reconstruction of Posttraumatic Lower Extremity Wounds in a Microsurgical Unit.显微外科单元中交叉腿皮瓣修复创伤后下肢伤口的综述
Indian J Plast Surg. 2019 Jan;52(1):117-124. doi: 10.1055/s-0039-1688521. Epub 2019 May 20.
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Breakthrough Technique for Free Tissue Transfer of Poorly Vascularized Lower Extremity: Arteriovenous Loop Revisited.下肢血运不佳时游离组织移植的突破性技术：重新审视动静脉环
Arch Plast Surg. 2015 Sep;42(5):652-5. doi: 10.5999/aps.2015.42.5.652. Epub 2015 Sep 15.
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Cross-leg as salvage procedure after free flaps transfer failure: a case report.游离皮瓣移植失败后采用交叉腿皮瓣作为挽救手术：1例病例报告
Case Rep Orthop. 2012;2012:205029. doi: 10.1155/2012/205029. Epub 2012 Mar 29.
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Cross-leg flap: Its role in limb salvage.交腿皮瓣：其在肢体挽救中的作用。
Indian J Orthop. 2008 Oct;42(4):439-43. doi: 10.4103/0019-5413.43394.
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Cross-leg free anterolateral thigh perforator flap: a case report.交腿游离股前外侧穿支皮瓣：一例报告
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