Abstract：
The distally based anterolateral thigh (dALT) flap is associated with a high incidence of venous congestion. This study aimed to investigate factors associated with vascular compromise to improve the outcomes.
We retrospectively analyzed 41 dALT flap reconstructions performed between November 2010 and February 2023. The dALT flap was classified into type I, II, or III based on the origin (the descending, oblique, or transverse branch) of the chosen perforator. The distance from the pivot point to the superolateral patella, pedicle length, flap reach, complications, and loss rates were analyzed to identify different dALT flap characteristics.
The type Ⅰ flap had a shorter pedicle length (type Ⅰ vs. type Ⅱ, p = 0.000; type Ⅰ vs. type Ⅲ, p = 0.000) that primarily reached closer regions (distal third of the thigh anterior/lateral knee). Pedicle lengths were similar between type Ⅱ and Ⅲ flaps (p = 1.000), most of which reached more distal regions (medial/posterior knee or proximal third of the leg). However, the type Ⅲ flaps had a higher complication rate and flap loss rate, although no significant differences were observed (complication rate, p = 0.094; flap loss rate, p = 0.071).
To achieve more desirable outcomes using the dALT flap, preoperative assessment of flap pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary.
We retrospectively analyzed 41 dALT flap reconstructions performed between November 2010 and February 2023. The dALT flap was classified into type I, II, or III based on the origin (the descending, oblique, or transverse branch) of the chosen perforator. The distance from the pivot point to the superolateral patella, pedicle length, flap reach, complications, and loss rates were analyzed to identify different dALT flap characteristics.
The type Ⅰ flap had a shorter pedicle length (type Ⅰ vs. type Ⅱ, p = 0.000; type Ⅰ vs. type Ⅲ, p = 0.000) that primarily reached closer regions (distal third of the thigh anterior/lateral knee). Pedicle lengths were similar between type Ⅱ and Ⅲ flaps (p = 1.000), most of which reached more distal regions (medial/posterior knee or proximal third of the leg). However, the type Ⅲ flaps had a higher complication rate and flap loss rate, although no significant differences were observed (complication rate, p = 0.094; flap loss rate, p = 0.071).
To achieve more desirable outcomes using the dALT flap, preoperative assessment of flap pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary.
摘要：
背景：远端股前外侧（dALT）皮瓣与静脉充血的高发生率相关。本研究旨在调查与血管受损相关的因素，以改善预后。
方法：我们回顾性分析了2010年11月至2023年2月期间进行的41例dALT皮瓣重建。DALT皮瓣分为I型,II,或基于起源的III(下降，斜,斜或横向分支)所选穿孔器。从枢轴点到上外侧髌骨的距离，椎弓根长度，皮瓣到达，并发症,和损失率进行分析，以识别不同的dALT皮瓣特征。
结果：Ⅰ型皮瓣的椎弓根长度较短（Ⅰ型与Ⅱ型,p=0.000；Ⅰ型vs.Ⅲ型,p=0.000），主要到达较近的区域（大腿前/外侧膝盖的远端三分之一）。Ⅱ型和Ⅲ型皮瓣的椎弓根长度相似(p=1.000)，其中大部分到达更多的远端区域（内侧/后膝或腿的近端三分之一）。然而,Ⅲ型皮瓣有较高的并发症发生率和皮瓣丢失率，尽管没有观察到显著差异(并发症发生率，p=0.094；皮瓣损失率，p=0.071)。
结论：为了使用dALT皮瓣获得更理想的结果，术前评估皮瓣蒂长度和术中适当的操作，避免损害反向血液循环是必要的。
方法：我们回顾性分析了2010年11月至2023年2月期间进行的41例dALT皮瓣重建。DALT皮瓣分为I型,II,或基于起源的III(下降，斜,斜或横向分支)所选穿孔器。从枢轴点到上外侧髌骨的距离，椎弓根长度，皮瓣到达，并发症,和损失率进行分析，以识别不同的dALT皮瓣特征。
结果：Ⅰ型皮瓣的椎弓根长度较短（Ⅰ型与Ⅱ型,p=0.000；Ⅰ型vs.Ⅲ型,p=0.000），主要到达较近的区域（大腿前/外侧膝盖的远端三分之一）。Ⅱ型和Ⅲ型皮瓣的椎弓根长度相似(p=1.000)，其中大部分到达更多的远端区域（内侧/后膝或腿的近端三分之一）。然而,Ⅲ型皮瓣有较高的并发症发生率和皮瓣丢失率，尽管没有观察到显著差异(并发症发生率，p=0.094；皮瓣损失率，p=0.071)。
结论：为了使用dALT皮瓣获得更理想的结果，术前评估皮瓣蒂长度和术中适当的操作，避免损害反向血液循环是必要的。
