An Unusual Anatomical Variation of the Vascular Pedicle of the Anterolateral Thigh Flap

背景：大腿前外側皮瓣是由來自旋股外側動脈的中隔穿通枝或是肌肉皮膚穿通枝來進行營養供應。它最初是在1984年由宋應元教授所提出，之後Koshima等教授推廣而廣泛運用。已經有許多文章討論支配大腿前外側皮瓣的血管在解剖學上的變異。本文所描述血管穿通枝的類型則是從未被發表過的。目的及目標：報告一個變異類型的大腿前外側皮瓣，其血管穿通枝之一直接橫越股直肌。材料及方法：一位65歲的女病人因左腳踩內側和腳跟粉碎撕裂傷入院。由於嚴重軟組織缺損與骨骼和神經血管束外露，進行右大腿前外側自由皮瓣轉移術。手術過程中發現兩組血管穿通枝，其中一組直接橫越股直肌上方，而另一組為股外肌肌肉皮膚穿通枝。為保留兩組完整的血管穿通枝，我們進行暫時性切斷股直肌而後修復。結果：此皮瓣有良好的血液循環，而皮瓣供應區復原良好。在六個月後的門診追蹤，並無發現功能性障礙。結論：雖然在手術前很難預測大腿前外側皮瓣穿通枝的起源和位置，藉由對大腿前外側皮瓣的穿通枝的認識，吾人仍可以安全的取得大腿前外側皮瓣。此外，經由完善的肌肉修復，暫時性切斷股直肌不會影響膝關節功能。

關鍵字

無資料

並列摘要

Background:The anterolateral thigh flap is a fasciocutaneous flap based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral artery. It was first described in 1984 by Song et al and was widespreadly used as it was popularized by Koshima et al. Its variety in vascular anatomy is well-known and many anatomical variations of the vascular pedicle, which lead to difficulty in flap harvest, have been described. To our knowledge, a vascular pedicle overpassing the rectus femoris muscle was not described before, so we would like to share our intraoperative finding.Aim and Objectives:To report an unusual variation that a septocutaneous perforator crosses over the rectus femoris muscle.Materials and Methods:A 65-year-old female patient sustained left medial ankle crush and heel avulsion injury. Due to severe soft tissue loss with bone and neurovascular bundle exposure, further reconstruction with right free anterolateral thigh flap transfer was performed. An unusal variation, a septocutaneous perforator above the rectus femoris muscle and another musculocutaneous perforator beneath it, let us decide to cut the rectus femoris muscle to preserve both perforators. The donor site was closed with mesh skin graft.Results:The flap was well perfused and the donor site healed well without functional deficit. In this patient, the extension of right knee was full and there was no functional deficit in 6-month follow-up.Conclusion:Although it is difficult to predict the exact location and origin of the perforator, the anterolateral thigh flap can still be harvested safely to reconstruct complicated defects. Besides, in the event that the rectus femoris is cut, the knee function is still not comprimised if the muscle is repaired delicately.

並列關鍵字

anterolateral thigh flap ； variation ； vascular anatomy

國際替代計量

An Unusual Anatomical Variation of the Vascular Pedicle of the Anterolateral Thigh Flap

全文下載

主題瀏覽