串联皮瓣修复大面积颅骨外露

目的:研究应用游离皮瓣修复合并颅骨外露的大面积头皮缺损的治疗方法.方法:2005年1月～2011年1月笔者应用串联的前臂皮瓣和股前外侧游离皮瓣,修复合并颅骨外露的大面积头皮缺损6例,采用游离前臂皮瓣近端与甲状腺上动脉和颈内静脉吻合,远端与股前外侧皮瓣血管吻合.两游离皮瓣串联吻合.无骨外露部分游离植皮.结果:6例手术皮瓣均存活良好;植皮愈合良好.头皮外观良好,质地柔软.结论:前臂和股前外侧游离皮瓣串联吻合,修复头皮缺损效果满意.     

联合应用带血管蒂胸脐皮瓣与股前外侧皮瓣修复前臂皮肤缺损

目的探讨带血管蒂胸脐与股前外侧皮瓣联合应用修复前臂及手部大面积皮肤缺损的临床疗效。方法应用联合带血管蒂胸脐皮瓣和股前外侧皮瓣治疗前臂大面积缺损7例。结果7例14个联合应用皮瓣全部成活，术后预期断蒂，取得良好效果。结论前臂手部大面积皮肤缺损应用联合带血管蒂皮瓣的移植，有效解决了皮肤缺损和无可供吻合血管问题。     

游离股前外侧皮瓣在儿童软组织缺损修复中的应用

目的探讨游离股前外侧皮瓣修复儿童患者软组织缺损的可行性及适应证。方法应用游离股前外侧皮瓣移植修复儿童足踝部组织缺损4例,修复头皮大面积缺损颅骨外露2例,切取皮瓣大小为10 cm×8 cm～18 cm×15 cm。结果所有皮瓣均成活,术后无血管危象,肢体功能恢复良好,头部外形修复满意。结论股前外侧皮瓣由于其血管解剖恒定,血管较粗大易吻合,可安全地应用于修复儿童较大面积的软组织缺损；由于儿童的代偿能力强,应用游离组织修复的肢体无论功能和外形的恢复均较成人理想。     

头皮缺损颅骨外露的修复

我科１９８０～１９９１年收治外伤性或颅面部肿瘤切除后头皮缺损颅骨外露９例，分别应用吻合血管的游离大网膜结合中厚皮片移植、游离皮瓣或轴型皮瓣转位结合皮片移植修复。讨论了修复时机、修复方法以及手术注意事项。认为双侧股前外侧游离皮瓣是修复全头皮缺损颅骨外露的可取方法，而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

头皮缺损颅骨外露的修复

我科1980～1991年收治外伤性或颅面部肿瘤切除后头皮缺损颅骨外露9例,分别应用吻合血管的游离大网膜结合中厚皮片移植、游离皮瓣或轴型皮瓣转位结合皮片移植修复。讨论了修复时机、修复方法以及手术注意事项。认为双侧股前外侧游离皮瓣是修复全头皮缺损颅骨外露的可取方法,而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

游离股前外侧皮瓣修复烧伤致头部大面积颅骨外露三例

游离股前外侧皮瓣由于其解剖位置恒定，可供吻合的血管粗大，已在四肢软组织缺损的修复中得到了广泛应用。烧伤所致的大面积颅骨外露一直是临床治疗的难点，笔单位近3年来应用游离股前外侧皮瓣移植修复烧伤至大面积颅骨外露3例，骨外露得到一期修复，外形满意，特报告如下。     

头皮缺损颅骨外露的修复

我科１９８０－１９９１年收治外伤性或颅面部肿切除后头皮缺损颅骨外露９例，分别应用吻合血管的游离大网膜结合中厚皮片移植，游离皮瓣或轴型皮转位结合皮片移植修复。讨论了修复时机，修复方法以及手术注意事项，认为双侧股前外侧游离皮瓣是修复头皮缺损颅骨外露的可取方法，而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

以腓肠肌内侧血管供血的游离股前外侧皮瓣修复小腿皮肤软组织严重缺损

目的：探讨小腿严重软组织缺损的显微外科治疗方法及临床效果。方法采用患肢腓肠肌内侧血管供血的游离股前外侧皮瓣移植修复小腿胫前严重皮肤软组织缺损7例。结果7例皮瓣全部成活,效果良好。结论对小腿主干血管损伤伴骨外露、骨髓炎的大面积皮肤、软组织缺损患者,采用患肢腓肠肌内侧血管供血的游离股前外侧皮瓣可避免采用健侧血管供血的桥式皮瓣修复,有效地保护了健侧小腿的胫后动脉,缩短疗程,减少双腿固定的痛苦。     

游离移植股前外侧皮瓣修复胫前骨外露组织缺损

目的探讨应用游离股前外侧皮瓣修复胫前较大面积骨外露创面的临床疗效。方法应用股前外侧游离皮瓣移植修复胫前软组织缺损导致骨外露创面8例,创面面积为11 cm×7 cm～14 cm×9 cm,皮瓣切取面积12 cm×8 cm～15 cm×10 cm。结果术后无血管危象发生,移植皮瓣全部成活。8例均获随访,时间1～24个月。皮瓣生长良好,外形满意,弹性好,创面完全修复稳定。结论股前外侧皮瓣血管蒂恒定,直径粗,切取面积大,效果可靠,是修复胫前较大面积骨外露创面的理想皮瓣之一。     

股前外侧游离皮瓣移植修复大面积四肢骨外露创面

目的探讨应用股前外侧游离皮瓣移植修复大面积四肢骨外露创面的技术要点和临床效果。方法分析2001年1月-2005年12月5年间应用股前外侧游离皮瓣移植手术修复四肢大面积骨外露创面的病例11例，其中新鲜损伤2例，陈旧性损伤9例。切取股前外侧游离皮瓣，显微吻合旋股外侧动静脉与受区血管，皮瓣覆盖创面。结果所有移植皮瓣均顺利成活。病例术后随访9-12个月，无严重不良反应，皮瓣功能及外观均令患者满意。结论游离股前外侧皮瓣移植是修复四肢大面积骨外露创面的理想术式之一。     

Scalp free flap reconstruction using anterolateral thigh flap pedicle for interposition artery and vein grafts

We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4×3 cm and 6×5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested.The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.     

Free anterolateral thigh flap for reconstruction of head and neck defects: preliminary results and a comparison with the radial forearm flap

BACKGROUND: The authors present their personal preliminary experience with the free anterolateral thigh flap in the reconstruction of head and neck defects and compare these first cases with the radial forearm flaps. METHODS: Seventeen patients undergoing free flap reconstruction between December 1998 and September 2001 have been selected for this retrospective study and evaluated. In fourteeen patients reconstruction was performed with a radial forearm flap. In three patients an anterolateral thigh flap was used. Six dissections on cadavers have also been performed in order to study the anatomical variations of the perforators of the lateral circumflex femoral system. RESULTS: All flaps survived, without any major vascular impairment. CONCLUSIONS: Despite a laborious dissection of the pedicle the anterolateral thigh is a versatile flap, with a minimal morbidity of the donor area. Even if the radial forearm is overall accepted as the gold standard for head and neck reconstruction, the anterolateral thigh flap is suggested as a good and safe surgical option, especially when a large flap is requested or in female patients concerned with the cosmetic result in the forearm donor area.     

游离股前外侧皮瓣在复杂头皮软组织缺损中的应用

目的 探讨游离股前外侧皮瓣修复复杂头皮软组织缺损的临床疗效。方法 应用游离股前外侧皮瓣修复20例复杂头皮软组织缺损患者,其中合并颅骨外露6例,颅骨缺损3例,合并感染4例,合并头皮疤痕挛缩9例。头皮缺损面积6 cm×10 cm～22 cm×13 cm,颅骨外露6 cm×8 cm～21 cm×12 cm。结果 术后随访6个月～2年,19例皮瓣均完全成活,皮瓣柔软,无明显色素沉着。其中1例小儿患者术后第3天出现皮瓣远端颅顶部部分发黑,予以换药、温盐水热敷、蒂部缝线拆除后皮瓣成活,但遗留色素沉着。20例患者中,仅1例发生供区发生植皮边缘坏死,予以换药处理后创面愈合。结论 旋股外侧动脉降支与颞浅动脉口径相当,应用游离股前外侧皮瓣可有效修复创伤及肿瘤所致复杂头皮软组织缺损。     

The earlier clinic experience of the reverse-flow anterolateral thigh island flap.

Since Song first reported the anterolateral thigh flap in 1984, this flap has been applied widely in clinical practice. In 1997, we found that the proximal end of the vascular pedicle of the anterolateral thigh flap showed active bleeding. We therefore believed that this flap could form the reverse-flow flap, which can be used clinically. From 1997 to 2002, two patients who suffered from soft tissue defects in their lower extremities have been repaired successfully with the reversed flow anterolateral thigh island flaps. The reverse-flow anterolateral thigh island flap with reliable blood supply and long vascular pedicle can be designed to repair soft tissue defects around ipsilateral knee joint or contralateral distal rejoins of the leg, especially in the difficulty cases.     

Use of fascia component of the anterolateral thigh flap for different reconstructive purposes

The anterolateral thigh flap is commonly used for reconstruction of soft-tissue defects located at various sites of the body. This versatile flap offers many advantages to the reconstructive microsurgeons for the treatment of difficult defects. From 2000 to 2005, 70 anterolateral thigh flaps were transferred to reconstruct soft-tissue defects. We retrospectively reviewed these patients and found that the fascia lata component of the flap was used for different purposes in 19 patients. The fascia lata component of the flap was used for suspension of the flap in lip reconstruction in 12 patients, for reconstruction of dural defect in the scalp in 2 patients, for reconstruction of tendon defects in the forearm in 3 patients, and for reconstruction of fascia defect in the abdominal wall in the remaining 2. Complete loss of the flap was seen in an anterolateral thigh flap (5.2%) that was used for lower lip reconstruction. One flap necrosed partially (5.2%), and it was treated with surgical debridement and transposition of latissimus dorsi musculocutaneous flap. The objective of this study is to focus on the reliability of the fascial component of the anterolateral thigh flap. Although many authors have described other advantages of the anterolateral thigh flap extensively, this peculiarity has not been stressed adequately. Anterolateral thigh flap offers a thick and vascular fascial component with large amounts that can be used for different reconstructive purposes, and it should be taken into consideration as an important advantage of the flap, together with other well-known advantages.     

旋股外侧动脉横支为蒂的股前外侧皮瓣重建肘部复合组织缺损的临床应用

目的 探讨以旋股外侧动脉横支为蒂的股前外侧皮瓣,游离移植修复肘部肱动脉伴皮肤软组织缺损的临床疗效.方法 2000年3月-2008年2月,对8例肘部肱动脉损伤伴皮肤软组织缺损的患者,急诊一期采用旋股外侧动脉横支为蒂的股前外侧皮瓣游离移植修复,同时用横支血管桥接缺损的肱动脉(3～7cm),皮瓣切取面积为12cm×6cm～20cm×10 cm.结果 8例肢体及皮瓣均顺利存活,术后随访10～21个月,肘部皮瓣无明显臃肿及瘢痕挛缩现象,肘关节屈伸活动度平均为105°(95°～125°),8例患侧肢体前臂远端尺、桡动脉搏动强度与健侧相同,B超显示患侧肱动脉血流与健侧基本相同.结论 切取股前外侧皮瓣时,如发现旋股外侧动脉降支有变异,可切取以旋股外侧动脉横支为蒂的股前外侧皮瓣,重建肘部肱动脉损伤和软组织缺损.     

Vascularized femoral nerve graft with anterolateral thigh true perforator flap for massive defects after cancer ablation in the upper arm

Massive resection of soft-tissue sarcoma in the elbow region often results in loss of long segments of the brachial artery and median nerve, as well as a wide soft-tissue defect. With conventional nerve grafts and revascularization of the arm, forearm and hand function is poor because nerves cannot be regenerated over the long nerve gap in the high elbow region. The authors used a long vascularized nerve graft and found it effective for reconstruction of upper arm function. This paper describes the first application of a free vascularized femoral nerve graft and a free anterolateral thigh true perforator flap based on the lateral circumflex femoral system, to repair elbow and forearm function. Long vascularized femoral nerve grafts of over 12 cm can be obtained, and an anterolateral thigh flap can be harvested from the same donor area.     

游离股前外侧穿支皮瓣修复胫前皮肤软组织缺损

目的探讨应用游离股前外侧穿支皮瓣移植修复胫前皮肤、软组织缺损的临床效果。方法对14例胫前皮肤、软组织缺损伴骨外露患者,应用游离股前外侧穿支皮瓣移植修复,皮瓣切取面积14cm×6cm～23cm×12cm,供区直接缝合或以全厚皮片植皮修复。结果术后14例皮瓣全部存活,创面一期愈合,术后随访3～24个月(平均8个月),皮瓣质地优良,无溃疡发生,8例获保护性感觉,骨折愈合后下肢可负重行走。结论股前外侧穿支皮瓣是修复胫前皮肤、软组织缺损的有效方法。     

游离皮瓣在颅骨外露的头皮缺损中的应用

目的:报告应用游离皮瓣修复头皮缺损致颅骨外露的方法和临床疗效。方法:本组5例患者年龄5～58岁,平均35岁,因创伤、肿瘤等原因造成头皮部分缺损并颅骨外露,缺损面积在8cm×10cm～15cm×10cm;缺损部位为颞部、顶部及额部。分别选用游离胸脐皮瓣、旋股外侧皮瓣和胫后动脉皮瓣等移植修复创面。结果:本组5例患者移植皮瓣Ⅰ期成活,其中2例移植皮瓣后行头皮扩张术,术后扩张头皮全部覆盖创面,毛发生长良好。术后随访6～18个月,患者皮瓣除臃肿外,创面Ⅰ期愈合,外形效果好。结论:采用吻合血管的游离皮瓣移植修复颅骨缺损,可以在短期内完全覆盖裸露的颅骨,确保了颅骨的成活。皮瓣成活后,可以Ⅱ期手术修整或头皮扩张术,既修复创面又能恢复头部外观,是一种理想的修复方式。