目的 探讨股前外侧（anterolateral thigh，ALT）穿支螺旋桨皮瓣的临床应用和手术替代方案。 方法 回顾在2009年11月至2023年12月期间，计划实施ALT穿支螺旋桨皮瓣手术45例，修复自腹股沟到膝关节范围内的缺损，分析ALT穿支螺旋桨皮瓣的临床应用效果，并总结该皮瓣不可用时采用的替代方案。 结果 45例患者中，按计划成功实施的ALT穿支螺旋桨皮瓣手术共39例（86.7%）；因不存在合适的ALT区穿支血管，手术变更为其他穿支螺旋桨皮瓣手术，共6例（13.3%），其中，其他穿支螺旋桨皮瓣的穿支血管的源血管包括股直肌支者2例，旋股外侧动脉横支，股动脉，股深动脉，膝上外侧动脉各1例。2块皮瓣出现静脉回流障碍，1块皮瓣经保守治疗后成活；1块皮瓣远端部分坏死，应用腓动脉穿支螺旋桨皮瓣修复清创后继发创面。 结论 ALT穿支螺旋桨皮瓣可修复自腹股沟到膝关节范围内的缺损；在ALT区穿支血管不可用时，以来自股直肌支、股动脉、膝上外侧动脉或股深动脉等邻近的穿支血管为蒂，同样可以切取螺旋桨皮瓣修复缺损。
Abstract
Objective To explore the clinical applications of the anterolateral thigh (ALT) perforator propeller flap and its alternatives in repairing different regions. Methods Between November 2009 and December 2023, a total of 45 patients were prepared for the harvest of the ALT propeller flap and reviewed. The clinical application and alternatives of the ALT perforator propeller flap were summarized. Results Of the 45 patients, 39 cases of (86.7%) ALT perforator propeller flap were harvested as planned; six (13.3%) were converted to other perforator propeller flap due to lack of suitable perforators in the ALT region. Among them, the source blood vessels of other perforating branch of propeller flap included femoral rectus branch in 2 cases. one case from the transverse branch of the lateral circumflex femoral artery, one case of the femoral artery, one case of the profunda femoris artery, and one case of the superior lateral genicular artery, respectively. Two flaps developed obstruction of venous congestion, one survived after conservative treatment, and one had distal flap necrosis, which was salvaged with a peroneal artery perforator propeller flap. Conclusions The ALT perforator propeller flap can be used to reconstruct defects located from the groin to the knee. When the perforators in the ALT region are not available, perforators from the rectus femoris branch, femoral artery, superior lateral genicular artery, or profunda femoris artery can be used as the pedicle for harvesting a perforator propeller flap which can be used for defect reconstruction.
关键词
股前外侧皮瓣 /
穿支血管 /
螺旋桨皮瓣 /
软组织修复 /
替代方案
Key words
Anterolateral thigh flap /
/
/
Perforator vessel /
/
/
Propeller flap /
/
/
Soft-tissue reconstruction /
Alternative solution
中图分类号：
R658.3
R616.2
R622.1
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基金
中国医学科学院医学与健康科技创新工程项目（2021-I2M-C&T-B-077）；首都卫生发展科研专项（2022-1-4041）
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