Zhang Y J, Li H, Wu X K, Wu B H, Xiao S E, Wei Z R, Deng C L
Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2025 May 20;41(5):447-453. doi: 10.3760/cma.j.cn501225-20241108-00438.
To summarize the clinical application and Zunyi Classification of free anterolateral thigh chimeric flaps. This study was a retrospective observational study. From June 2021 to June 2024, 200 patients who underwent free anterolateral thigh chimeric flap transplantation and met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University, including 106 males and 94 females, aged 3 to 77 years. The wound types included mechanical trauma wounds in 175 cases, chronic wounds in 18 cases, and other wounds (postoperative infection, burns, etc.) in 7 cases. The wounds were located distal to the ankle or wrist joints in 171 cases; between the knee and above the ankle or between the elbow and above the wrist in 24 cases; and between the sacrum and above the knee, or between the shoulder and above the elbow in 5 cases. The application of free anterolateral thigh chimeric flaps with different tissue components for repairing various defects was analyzed to sum up the classification of free anterolateral thigh chimeric flaps. The Zunyi Classification of free anterolateral thigh chimeric flaps was successfully established, including 68 cases of type Ⅰ, 81 cases of type Ⅱ, 23 cases of type Ⅲ, and 28 cases of type Ⅳ. type Ⅰ chimeric flaps were composed of 1 type of tissue, such as bilobed, trilobed, or other lobed flaps, which were suitable for patients requiring repair of simple skin defects. Type Ⅱ chimeric flaps were composed of 2 types of tissue and were further classified into subtypes Ⅱa and Ⅱb based on the presence or absence of lobed skin. They were suitable for patients requiring repair of skin defects along with reconstructing the function of another tissue type. Type Ⅲ chimeric flaps were composed of 3 or more types of tissue and were further classified into subtypes Ⅲa and Ⅲb based on the presence or absence of lobed skin. They were suitable for patients requiring repair of skin defects along with reconstructing the function of 2 or more types of tissue. Type Ⅳ chimeric flaps required microsurgical construction via vascular anastomosis. These flaps could be flexibly designed with customized tissue combinations to meet specific wound reconstruction needs. They were indicated for patients with extensive skin defects, specialized tissue defects, or anatomical regions where reconstruction cannot be achieved by a single anterolateral thigh donor site, necessitating harvest of additional donor tissues. The Zunyi Classification of free anterolateral thigh chimeric flaps based on tissue sources of chimeric flaps emphasizes the functional requirements of recipient sites, which helps guide the repair of various complex wounds and facilitates clinical promotion.
总结游离股前外侧嵌合皮瓣的临床应用及遵义分类。本研究为回顾性观察性研究。2021年6月至2024年6月，遵义医科大学附属医院收治200例行游离股前外侧嵌合皮瓣移植且符合纳入标准的患者，其中男性106例，女性94例，年龄3至77岁。伤口类型包括机械创伤伤口175例、慢性伤口18例、其他伤口（术后感染、烧伤等）7例。伤口位于踝关节或腕关节远端者171例；膝关节至踝关节上方或肘关节至腕关节上方者24例；骶骨至膝关节上方或肩关节至肘关节上方者5例。分析应用不同组织成分的游离股前外侧嵌合皮瓣修复各种缺损情况，总结游离股前外侧嵌合皮瓣的分类。成功建立游离股前外侧嵌合皮瓣的遵义分类，其中Ⅰ型68例，Ⅱ型81例，Ⅲ型23例，Ⅳ型28例。Ⅰ型嵌合皮瓣由1种组织构成，如双叶、三叶或其他叶状皮瓣，适用于需修复单纯皮肤缺损的患者。Ⅱ型嵌合皮瓣由2种组织构成，根据有无叶状皮肤进一步分为Ⅱa和Ⅱb亚型。适用于需修复皮肤缺损并重建另一种组织类型功能的患者。Ⅲ型嵌合皮瓣由3种或更多种组织构成，根据有无叶状皮肤进一步分为Ⅲa和Ⅲb亚型。适用于需修复皮肤缺损并重建2种或更多种组织功能的患者。Ⅳ型嵌合皮瓣需通过血管吻合进行显微构建。这些皮瓣可根据定制的组织组合灵活设计，以满足特定的伤口重建需求。适用于有广泛皮肤缺损、特殊组织缺损或单一股前外侧供区无法实现重建的解剖区域，需要获取额外供区组织的患者。基于嵌合皮瓣组织来源的游离股前外侧嵌合皮瓣遵义分类强调了受区的功能需求，有助于指导各种复杂伤口的修复并促进临床推广。
