Conjoint Anterolateral Thigh Fasciocutaneous and Vastus Lateralis Muscle Free Flaps for Reconstruction of Head and Neck Defects: A More Reliable and Versatile Alternative

股前外側皮瓣為用於軟組織重建首選之一。和股外側肌合併時，肌皮瓣抑或併合式瓣這兩種自由瓣其特性及優劣，則需進一步闡明。本篇針對8名患者，其中7位為切除惡性腫瘤後之重建，1位為外傷後感染導致左額顳部頭皮及硬腦膜壞死之重建。股前外側筋皮瓣主要用於修補口腔粘膜、頰部、或頭皮硬腦膜缺損，股外側肌則用於剩餘上額竇填塞、頰部凹陷復型或增進局部血循。所有筋皮瓣均由一可靠的穿通枝提供血循，股外側肌瓣至少有一套血管供應，其均來自股外側迴旋血管之下降枝，皆探一動脈一靜脈顯微接合以重建血循。手術結果均成功，無局部壞死，平均追蹤11.1個月，8名患者均存活。和股前外側肌皮瓣相較，併合式股前外側筋皮及股外側肌瓣有各自由瓣較易精準安置、較好的顱顏部外觀、更為可靠、易於設計及潛在較少供應部罹病率之優點。其或有皮瓣穿通枝之複雜解剖結構、須具備足夠臨床經驗及偶而因血管變異，需術中變更設計或雙自由瓣之考量，然對於廣泛、複雜、立體的頭頸部缺損之重建為一良好的方法。

關鍵字

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並列摘要

The anterolateral thigh (ALT) free flap is one of the most preferred options for soft-tissue reconstruction. Combined with the vastus lateralis (VL) muscle, either musculocutaneous flap or conjoint flap can be used. However, these are two distinct entities that need to be further elucidated. Between July and August of 2004, 8 patients underwent reconstruction using the conjoint ALT fasciocutaneous and VL muscle free flaps for head and neck defects. These procedures were indicated in 7 patients for immediate reconstruction following cancer ablation and in 1 patient for simultaneous reconstruction of scalp and dural defect resulted from post-traumatic infection. The ALT fasciocutaneous flaps were used to resurface the defects of oral lining, external cheek or scalp and dura. The VL muscle components were used for cheek augmentation, obliteration of the maxillary antrum, or improvement of local vascularity. For each flap, the skin and muscle vessels independently arose from the descending branch of lateral circumflex femoral (LCF) source vessel. One-arterial-and-one-venous anastomosis was performed in every case. All flaps were successful without any vascular compromise necessitating re-exploration. The median follow-up time was 11.1 months (range, 10 to 12 months), and all patients were alive at the time of evaluation. Compared with the ALT myocutaneous flap, use of the conjoint flaps for reconstruction of complex head and neck defects has several advantages: (1) easy three-dimensional insetting, (2) better aesthetic appearance, (3) more reliability, (4) design with least effort, and (5) possibly reduced donor site morbidity. The disadvantages include (1) the complicated anatomy of the perforators, (2) the learning-curve requirement for their use, and (3) the occasional need for changing the flap outline, or shifting to double flaps. It was concluded that the conjoint ALT fasciocutaneous and VL muscle free flaps provide a good option for reconstruction of composite and three-dimensional head and neck defects.

並列關鍵字

anterolateral thigh ALT flap ； chimeric flap ； conjoint flap ； vastus lateralis VL muscle

國際替代計量

Conjoint Anterolateral Thigh Fasciocutaneous and Vastus Lateralis Muscle Free Flaps for Reconstruction of Head and Neck Defects: A More Reliable and Versatile Alternative

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