- 期刊
Technique Feasibility of Harvesting an Anterolateral Thigh Flap in the Prone Position - A Case Report
以趴姿進行大腿前外側皮瓣摘取術的技術可行性──病例報告
摘要
Background: The anterolateral thigh (ALT) flap is usually harvested with the patient in the supine position. However, this is not always possible. When the recipient and donor sites are on opposite sides of the body, the patient will inevitably have to change position during surgery, which increases the risk of complications, including airway stabilization, pedicle traction, and infection. Aim and Objectives: We describe a novel technique for harvesting the ALT flap when the patient is in the prone position, which is illustrated with a case report herein. No previous reports have described this innovative technique. Materials and Methods: We describe the case of a 37-year-old male patient who had sustained a Gustilo type IIIC injury to the popliteal fossa and posterior proximal aspect of the left leg. The injury had occurred 18 months earlier. Popliteal artery rupture had been repaired with a vein graft, and the soft tissue defect was covered immediately with a split-thickness skin graft. However, the skin graft had severe scarring with fibrotic change during follow-up. An unrepaired common peroneal nerve rupture injury was also observed. We planned to attempt complete functional restoration, along with scar tissue excision, and to cover the soft tissue defect with an ALT flap. Results: The ALT flap was marked out when the patient was in the supine position under general anesthesia. The patient was then turned to the prone position to allow two teams to work simultaneously-one preparing the recipient site and the other performing the flap harvest. Finally, the flap was harvested based on a 2-mm perforator with venae comitantes, which was anastomosed to the peroneal artery and vein. The total operative duration was 10 hours. The patient's recovery was uneventful, and fair distal circulation with an acceptable flap appearance were observed at the 3-months-follow- up. Conclusion: Harvesting the ALT flap when the patient is in the prone position is challenging but possible. The surgeon should be thoroughly familiar with the patient's anatomical details and should be willing to endure some position-related discomfort. Anesthesia risk is reduced because the patient does not need to be turned over or re-prepared. In addition, the operative duration can be minimized by using a two-team approach and performing the entire operation with the patient in the prone position.
並列摘要
背景：傳統上大腿前外側皮瓣摘取術是以躺姿進行，但是如果接受區在身體後側又要使用此皮瓣時，可能就要需要於術中變換病患姿勢做提供區及接受區的手術步驟，不僅需要花費比較多時間，不能兩個團隊同時進行，也增加手術風險，例如呼吸道的穩定，皮瓣血管拉扯或因姿勢變換增加感染風險，因此以趴姿進行大腿前外側皮瓣摘取術的技術可行性便值得提出討論。目的及目標：目前在文獻中沒有討論以趴姿取大腿外側皮瓣時會遇到的難題及結果。藉由這篇個案報告，我們想要介紹趴姿摘取大腿外側皮瓣的手術方法的可行性，及其中遇到的挑戰點。材料及方法：介紹一個37歲男性因為18個月前經歷機車車禍造成Gustilo type IIIC的開放性股骨骨折合併膝膕動脈斷裂，曾經在外院接受動脈修補手術及植皮手術但是後續發生疤痕攣縮及垂足來接受治療。為了把疤痕組織取代及修補神經，我們安排了大腿前外側皮瓣摘取術及神經重建手術。結果：病人以趴姿接受了對側大腿前外側自由皮瓣轉移手術，接受區及提供區兩個團隊一起進行，當一個團隊摘取皮瓣時另一團隊把疤痕鬆解以及進行接受區的準備。皮瓣順利摘取且移植至接受區進行覆蓋，同時神經減壓手術也順利完成，手術於10小時結束，術後狀況穩定，三年後病人功能恢復良好。結論：以趴姿取大腿前外側皮瓣並非不可行，只要外科醫師熟悉解剖的細節且可以忍受開刀姿勢的不適，就可以兩個團隊同時進行，減少大幅手術時間且減少手術中更換姿勢的必要性，減少病患手術及麻醉風險。