Supercharged Reversed Anterolateral Thigh Flap for Reconstruction of A Complicated Knee Defect-A Case Report

使用增強血流的股前外側反轉皮瓣於一個複雜性膝關節缺損重建－病例報告

廖力穎(Li-Ying Liao) ； 陳宏基(Hung-Chi Chen)

《臺灣整形外科醫學會雜誌》 23卷4期 (2014/12) Pp. 372-378

摘要

背景：重建膝蓋軟組織缺損對於許多外科醫師具有挑戰性。近十年來，大腿前外側反轉皮瓣（rALT flap）已逐漸受到廣泛使用於膝蓋軟組織缺損的重建。優點為它可提供術後良好外觀輪廓及早期膝關節的活動。然而，動脈供血不足和靜脈鬱血是常見併發症。在本文中，我們分享了使用增強血流的大腿前外側反轉皮瓣於右膝上輻射後的軟組織缺損重建案例。目的及目標：希望藉此描述這個具有挑戰性的膝蓋軟組織缺損案例，使用增流大腿前外側反轉皮瓣。並提出手術方法，圖像描述和相關文獻回顧。材料及方法：一名73歲的男性曾患有右膝關節惡性肉瘤，於17年前接受腫瘤切除和輔助性放射治療及植皮手術。近來於右大腿遠端靠近膝蓋處出現慢性潰瘍超過半年。在病灶切除後，我們採用右大腿前外側反轉皮瓣修復右膝缺陷。術中發現皮瓣動脈供血不足，於是以一段移植靜脈吻合近端及遠端的降支旋股外側動脈以增強動脈血流。還進行了額外的靜脈增強。皮瓣術後狀況良好，患者復原迅速，在一個月恢復右下肢功能。結果：處理反覆開刀及經歷輻射傷害這類型相對複雜的傷口，採用股前外側反轉皮瓣於傷口重建可以是另一種選擇。但，需小心評估皮瓣的血流，當面臨動脈供血不足或靜脈鬱血應考慮加做動脈及靜脈的血流增強手術。

並列摘要

Background: Reconstruction of soft tissue defect over the knee is a challenge to many surgeons. Reversed anterolateral thigh (rALT) flap has gained wide popularity in recent decade in reconstruction of defect around the knee based on its advantages of good contour and early mobilization of knee joint. However, arterial insufficiency and venous congestion were major complications that may contribute to failures on partial loss of the rALT. In this article, we report our experience using supercharged rALT flap to reconstruct soft tissue defect of a post-radiation right distal thigh. Aim and Objectives: We want to share our experience in reconstructing and a challenging knee defect with supercharged rALT. The history, surgery, and images are described and the literature is reviewed. Materials and Methods: A 73-year-old man had history of right knee sarcoma which was treated with wide excision and STSG, then adjuvant radiation therapy 17 years ago. He presented with chronic ulcer over right distal thigh close to the knee. Reversed ALT flap was used to repair the defect. Arterial insufficiency was confronted intra-operatively, we elected to supercharge the flap to augment its blood supply via anastomosis of proximal and distal descending branch of lateral femoral circumflex artery(DLFCA) with vein graft. An additional venous augmentation was also performed. The flap had total survival with no evidence of skin necrosis. The patient has prompt recovery with restoration of function in a month. Conclusion: To reconstruct defect with previous wide excisions following radiation injury, rALT flap could be an alternative choice. However circulatory competency should be taken into consideration. Arterial supercharge and venous anastomosis can be performed when confronted with flap-threatening arterial insufficiency or venous congestion.

並列關鍵字

reverse-flow anterolateral thigh flap ； distally based anterolateral thigh flap ； supercharged reversed anterolateral thigh flap