OBJECTIVE: To compare the clinical outcomes of anterolateral femoral interregional flap with turbocharge technique and traditional anterolateral femoral flap in repair of limblarge wound surface.
METHODS: Clinical data of 38 patients withlimb large wound surface (11 cm×39 cm-16 cm× 65 cm) admitted to the Department of Prosthetics and Reconstruction of Sir Run Run Shaw Hospital from May 2018 to May 2022 were retrospectively analyzed. Eighteen patients were treated by anterolateral femoral perforator flap and superficial circumflex iliac artery
flap (ALTP-SCIAP) with turbocharge technique (interregional
flap group); while 20 patients were treated with unilateral or bilateral anterolateral femoral flaps, combined with skin grafting if necessary (traditional anterolateral femoral flap group). The survival of skin flap, repair of donor area, complications and patient satisfaction were compared between the two groups.
RESULTS: In interregional
flap group, 18 flaps were harvested and transplanted, the
flap width, length and the viable area were (9.9±2.0) cm, (44.2±3.5) cm and (343.2±79.9) cm2, respectively. In traditional anterolateral femoral
flap group and 29 flaps were harvested and transplanted, the
flap width, length and the viable area were (11.0-2.8) cm (21.7-3.2) cm and (186.4-49.2) cm2, respectively. There were significant differences in the flap length and survival area between the two groups (t=22.365 and 8.345, P<0.05), but not significant difference in the flap width (t=1.525, P>0.05). In the interregional flap group, the donor site of flap was closed by direct suture in 11 cases, by skin retractor assisted suture in 6 cases, and by skin grafting in 1 case. In traditional anterolateral femoral
flap group, the donor site of
flap was closed by direct suture in 12 flaps, by skin retractor assisted suture in 11 flaps, and by skin grafting in 6 flaps. No significant difference was found between the two groups (χ2=2.657, P>0.05). The interregional flap group had lower postoperative complications rate (5.6% vs. 35.0%, χ2=4.942, P<0.05) and higher patient satisfaction rate (94.4% vs. 70.0%, χ2=4.448, P<0.05) than traditional anterolateral femoral flap group.
CONCLUSIONS: Compared with the traditional anterolateral thigh flap, the anterolateral femoral interregional
flap with turbocharge technique has a larger
flap area, less complications, and higher patient satisfaction rate. With sacrificing only one donor area and sharing a set of vascular pedicles, it can repair \"super long\", \"super large\" or irregular limb wound defects maximally. At the same time, most of the donor areas of the flap can be sutured directly without skin grafting.
目的: 对比结合内增压技术的股前外侧跨区皮瓣与传统股前外侧皮瓣在修复肢体较大创面软组织缺损中的临床疗效。方法: 回顾性分析2018年5月—2022年5月浙江大学医学院附属邵逸夫医院收治的肢体较大创面缺损共38例患者(缺损面积达到11 cm×39 cm~16 cm×65 cm),按照修复方式的不同,分为跨区皮瓣修复组(18例)和传统皮瓣修复组(20例)。跨区皮瓣修复组采用结合内增压技术的股前外侧穿支皮瓣联合旋髂浅动脉皮瓣(ALTP-SCIAP)治疗,传统皮瓣修复组采用单侧或双侧股前外侧皮瓣,必要时联合植皮。比较两组术后皮瓣存活情况、供区修复、并发症、患者满意度等。结果: 跨区皮瓣修复组共18例患者,切取移植皮瓣18例次,瓣宽为(9.9±2.0)cm,瓣长为(44.2±3.5)cm,存活面积为(343.2±79.9)cm2。传统皮瓣修复组共20例患者,切取移植皮瓣29例次(11例患者切取单侧股前外侧皮瓣联合刃厚植皮修复,9例患者切取双侧股前外侧皮瓣进行修复),瓣宽为(11.0±2.8)cm,瓣长为(21.7±3.2)cm,存活面积为(186.4±49.2)cm2。两组皮瓣瓣宽差异无统计学意义(t=1.525,P>0.05),瓣长和存活面积跨区皮瓣修复组显著大于传统皮瓣修复组(t=22.365和8.345,均P<0.05)。跨区皮瓣修复组皮瓣供区采用直接缝合11例次,皮肤牵拉器辅助下缝合6例次,部分植皮修复1例次。传统皮瓣修复组皮瓣供区采用直接缝合12例次,皮肤牵拉器辅助下缝合11例次,部分植皮修复6例次。两组差异无统计学意义(χ2=2.657,P>0.05)。跨区皮瓣修复组中出现并发症1例,患者满意度达到94.4%;而传统皮瓣修复组中出现并发症7例,患者满意度为70.0%且明显低于跨区皮瓣修复组(χ2=4.448,P<0.05)。结论: 与传统股前外侧皮瓣相比,结合内增压技术的股前外侧跨区皮瓣切取面积更大,并发症更少,患者满意度更高,只牺牲一个供区,共用一组血管蒂,就可以最大限度的修复“超长”、“超大”或不规则的肢体创面缺损,而皮瓣供区大多可Ⅰ期直接缝合,不需要植皮修复。.