股前外侧游离穿支皮瓣修复头面部和四肢肿瘤切除后软组织缺损

目的探讨应用股前外侧穿支皮瓣,修复头面部和四肢肿瘤切除术后的方法及其效果。方法2004年4月-2006年4月,收治头面部及四肢肿瘤切除术后造成的软组织缺损,采用股前外侧穿支皮瓣游离移植共16例,男13例,女3例;年龄26-72岁。头面部肿瘤9例,其中头顶部基底细胞癌1例,面部鳞状细胞癌4例（包括肿瘤复发1例）,腮腺癌4例;软组织缺损范围8cm×6cm-20cm×13cm,病程6-24个月。四肢肉瘤7例,其中上肢2例,下肢4例,小腿复发1例;软组织缺损范围10cm×7cm-21cm×12cm,病程2-18个月。结果16例应用股前外侧穿支皮瓣游离移植修复,15例皮瓣全部成活,1例皮瓣远端约2.5cm宽范围缺血坏死;14例创口期愈合;2例创口期愈合,其中1例经切除坏死组织,直接缝合后期愈合,另1例创口有3cm裂口,经换药后期愈合。术后随访1-18个月,肿瘤无复发,供受区外观良好,平整,无明显瘢痕及功能影响;受区修复效果满意。结论股前外侧穿支皮瓣游离移植,修复效果好,对供区损伤小,是一种较理想的修复头面和四肢肿瘤切除术后软组织缺损的方法。

ANTEROLATERAL THIGH PERFORATOR FREE FLAPS FOR RECONSTRUCTION OF HEAD AND FOUR LIMB SOFT TISSUE DEFECTS AFTER TUMOR RESECTION

OBJECTIVE: To investigate the method, effectiveness, and clinical application of the anterolateral thigh perforator free flaps for reconstruction of the soft tissue defects in the head and the four limbs after tumor resection. METHODS: From April 2004 to April 2006, 16 patients (13 males, 3 females; aged 26-72 years) with the soft tissue defects in the head (9 patients) and the four limbs (7 patients) underwent reconstructive operations with the anterolateral thigh perforator free flaps after their tumor resection. The defects ranged in area from 8 cm x 6 cm to 20 cm x 13 cmin the head with the process of diseases from 6 to 24 months, and the defects ranged in area from 10 cm x 7 cm to 21 cm x 12 cm in the four limbs with the process of diseases from 2 to 18 months. The technique for the anterolateral thigh perforator flap free grafting, the degree of the injury in the donor sites, and the appearance of the donor and recipient sites, and the influence on the anatomy and function in the both local sites were analyzed. RESULTS: In the 16 patients with the soft tissue defects in the head and the four limbs after tumor resection, 14 had a primary wound healing (Stage I ), and 2 had a delayed wound healing (Stage II). Fifteen flaps survived completely but two flaps had a partial failure. The flap appearance was good and smooth without any severe scarring, and there was a minimal effect on the function at the donor and recipient sites. CONCLUSION: Because of the less morbidity at the donor site, the better result at the recipient site, and the use of the anterolateral thigh perforator flap free grafting, this kind of the technique for reconstruction of the head and four-limb soft tissue defects after tumor resection is well acceptable.