Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Plast Reconstr Surg. 1998 Oct;102(5):1517-23. doi: 10.1097/00006534-199810000-00026.
We have transferred 74 free or pedicled anterolateral thigh flaps, including those combined with other flaps, for reconstruction of various types of defects. We report several anatomic variations of the lateral circumflex arterial system and discuss some technical problems with this flap. Septocutaneous perforators were found in 28 of 74 cases (37.8 percent), and no perforators were found in 4 cases (5.4 percent). In the 70 cases with perforators, 171 tiny cutaneous perforators (an average of 2.31 per case) were found. Musculocutaneous perforators (81.9 percent) were much more common than septocutaneous perforators (18.1 percent). Perforators were concentrated near the midpoint of the lateral thigh, and the selection of perforators as nutrient vessels for the anterolateral thigh flap was related to the length of the pedicle and the thickness of the skin flap. Anatomic variations of the branching pattern of perforators were classified into eight types. Flaps with perforators that arise directly from the profunda femoris artery are difficult to combine with other free flaps. Because the perforators are extremely small and tend to thrombose soon after congestion develops, these flaps are difficult to salvage with recirculation surgery. Therefore, several perforators should be included with the flap, if possible. The descending artery of the lateral circumflex femoral artery was always accompanied by two veins with different back-flow strengths. Therefore, veins for microsurgical anastomosis must be chosen carefully. Because it is nourished by several perforators arising from the descending artery, the vastus lateralis muscle can be combined with the anterolateral thigh flap. However, splitting the muscle longitudinally without harvesting its blood supply is complicated because its fibers are oblique. The rectus femoris muscle can also be combined with the anterolateral thigh flap, but its pedicle is short and its origin is very near the site of anastomosis. When the anterolateral thigh flap is combined with the tensor fasciae latae musculocutaneous flap, the large skin area of the lateral part of thigh can be transferred to repair the massive defects. The anterolateral thigh flap has many advantages and can be used to reconstruct many types of defect. However, anatomic variations must be considered if the flap is to be used safely and reliably.
我们共转移了74个游离或带蒂股前外侧皮瓣，包括那些与其他皮瓣联合使用的皮瓣，用于修复各种类型的缺损。我们报告了旋股外侧动脉系统的几种解剖变异，并讨论了该皮瓣的一些技术问题。在74例中有28例（37.8%）发现了隔皮穿支，4例（5.4%）未发现穿支。在有穿支的70例中，共发现171个微小皮穿支（平均每例2.31个）。肌皮穿支（81.9%）比隔皮穿支（18.1%）更为常见。穿支集中在大腿外侧中点附近，选择穿支作为股前外侧皮瓣的营养血管与蒂的长度和皮瓣厚度有关。穿支分支模式的解剖变异分为八类。直接起自股深动脉的穿支皮瓣难以与其他游离皮瓣联合。由于穿支极小，充血后很快就会血栓形成，这些皮瓣难以通过再灌注手术挽救。因此，如有可能，皮瓣应包含多个穿支。旋股外侧动脉降支总是伴有两条回流强度不同的静脉。因此，显微外科吻合的静脉必须仔细选择。由于股外侧肌由降支发出的多个穿支供血，故可与股前外侧皮瓣联合。然而，纵向劈开肌肉而不切断其血供很复杂，因为其纤维是斜行的。股直肌也可与股前外侧皮瓣联合，但蒂短，其起点非常靠近吻合部位。当股前外侧皮瓣与阔筋膜张肌肌皮瓣联合时，大腿外侧较大面积的皮肤可转移用于修复大面积缺损。股前外侧皮瓣有许多优点，可用于修复多种类型的缺损。然而，若要安全可靠地使用该皮瓣，必须考虑解剖变异。
