Rectus Femoris Necrosis After Free Anterolateral Thigh Flap Harvest - A Case Report

大腿前外側皮瓣摘取後造成的股直肌肌肉壞死－病例報告及文獻回顧

翁日升(Jih-Sen Wong) ； 許宏達(Honda Hsu) ； 鄭立福(Li-Fu Cheng) ； 李俊達(Jiunn Tat Lee)

《臺灣整形外科醫學會雜誌》 27卷2期 (2018/06) Pp. 134-140

摘要

Background: The free anterolateral thigh (ALT) flap is commonly used for reconstructive surgery after head and neck cancer. Compared with the free radial forearm flap, the ALT flap can provide more volume and, in particular, cause less donor site morbidity. The complication of rectus femoris necrosis after the harvest of the ALT flap is rare and seldom described in detail. Aim and Objectives: We reported a case of rectus femoris necrosis, a rare complication, after the harvest of free anterolateral thigh flap for head and neck reconstructive surgery. In addition, to prevent such complications, we reviewed the vascular anatomy of the rectus femoris and the relationship to the anterolateral thigh flap. Materials and Methods: A 57-year-old man was admitted due to right buccal squamous cell carcinoma, cT4bN2bM0. A wide excision of the tumor and reconstructive surgery were performed. We used the free anterolateral thigh myocutaneous flap for the reconstruction of the defect. The flap was harvested using the standard procedure with a medial approach. During the harvest of the anterolateral thigh flap, the major vessel nourishing the rectus femoris was ligated to obtain a longer anterolateral thigh flap pedicle. After the reconstruction, a split-thickness skin graft was applied to the donor site due to the considerable tension in the residual skin. Results: After the surgery, partial femoris rectus muscle necrosis was noted. The necrotic muscle was then debrided, and the STSG was re-applied onto the defect. The wound healed gradually without functional loss. Conclusion: Though rarely documented, the incidence of major rectus femoris necrosis could occur after the harvest of the anterolateral thigh flap. Precautions should be made to preserve the vessels nourishing the rectus femoris and avoid over-retraction of the rectus muscle as possible.

關鍵字

ALT complications ； rectus femoris ； anterolateral thigh flap

並列摘要

背景：大腿前外側皮瓣是最常用於頭頸部癌重建的皮瓣之一。與游離橈側前臂皮瓣相比，它可以提供更多的體積，更重要的是，可以減少供皮部位的併發症。摘取前外側皮瓣後造成的股直肌壞死的併發症相當少見且文獻上少有詳盡報告。目的及目標：在本文中，我們報告一例罕見的並發症：股直肌壞死－發生於用於頭頸部重建的游離大腿前外側皮瓣摘取後。材料及方法：一名57歲男性主訴右側頰部有一不癒合的傷口已經超過2個月。經過腫瘤檢查後診斷為右側頰部的扁平細胞癌，cT4bN2bM0。病患在2017年1月16日接受腫瘤廣泛切除和重建。我們使用游離的大腿前外側皮瓣進行重建。在分離皮瓣的血管時，大腿近端的一個供應股直肌的血管分支被結紮以摘取較長的皮瓣的椎弓根。重建順利完成，而由於供皮區殘餘皮膚的張力很大，我們使用皮膚移植用於大腿傷口的覆蓋。結果：手術後發現大腿有部分的股直肌壞死，範圍約在中段的三分之一。之後我們清除了壞死的肌肉並再次使用皮膚移植進行傷口覆蓋。術後的傷口癒合良好。 結論：總結來說，雖然大腿前外側皮瓣摘取後造成的股直肌肌肉壞死不常發生，如果供應股直肌的椎弓根被結紮，加上手術中過度地拉扯股直肌，這樣的併發症仍可能發生。