股前外侧组织瓣临床应用112例分析

目的 总结分析股前外侧组织瓣解剖规律及其在组织缺损修复重建中的适应证和应用价值。方法1985年3月-2004年8月，对112例股前外侧组织瓣移植进行临床总结。其中男67例，女45例。年龄5～65岁，平均38．5岁。针对受区不同情况，将股前外侧组织瓣切取分为4类：吻合血管的游离皮瓣移植78例；吻合血管的游离脂肪筋膜瓣移植22例；带蒂顺行岛状皮瓣移位5例；远端为蒂逆行岛状皮瓣移位7例。对面、颈、肢体、躯干等部位的软组织缺损所致功能障碍或外观缺陷进行修复，并对术后效果和供区恢复情况进行评价。结果营养股前外侧组织瓣的动脉皮支出现率100％，具有肌间隙皮穿支（33％）和肌皮穿支（67％）两种基本解剖类型。组织瓣源血管均为旋股外侧动脉降支或横支。皮瓣移植成活107例，成活率达95．6％。术后33例获随访6个月～11年，远期随访效果满意率91％，供区无功能受限。结论股前外侧组织瓣解剖恒定，具有多种突出优点，是修复软组织缺损的理想材料。尤其是穿支皮瓣形式，可保持受区形态，降低供区损伤，成为应用趋势。

CLINICAL APPLICATION OF THE ANTEROLATERAL THIGH FLAP IN 112 PATIENTS

OBJECTIVE: To investigate the anatomic variations of the perforator vessels of anterolateral thigh (ALT) flap and the clinical indications. METHODS: From March 1985 to August 2004, the anterolateral thigh flap graft was performed in 112 patients. The clinical data were analyzed. There were 67 males and 45 females, aging from 5 to 65 years with an average of 38. 5 years. According to recipient site condition, four methods of flap harvesting were as follows: (1) 78 received free fasciocutaneous flaps; (2) 22 received free adipofascial flaps; (3) 5 received pedicled island fasciocutaneous flaps; (4) 7 received pedicled reverse-flow island fasciocutaneous flaps. Facial, neck, breast, extremity joint, plantar, and perineum defects were repaired and the effectiveness and donor site morbidity were evaluated. RESULTS: The blood supply of ALT flap came from the descending branch or transverse branch of the lateral circumflex femoral artery. The skin vessels were found to be septocutaneous perforators in 33% of flaps and to be musculocutaneous perforators in 77% of flaps. Of 112 flaps, 107 survived completely, the survival rate was 95.6% with little donor site morbidity. CONCLUSION: ALT flap is a versatile soft-tissue flap. If refined to perforator flap, it can achieve better results in reconstructing defect and minimizing donor-site morbidity.