Reconstruction of Soft Tissue Defect of Distal Tibia Using Reverse-Flow Descending Branch of Lateral Circumflex Femoral Artery as Recipient Vessels with Contralateral Anterolateral Thigh Flap- A Case Report

以側旋支股動脈之下降枝回流血管作為對側大腿前外側皮瓣受體血管重建遠端脛骨軟組織缺損－病例報告

林奕伶(Yi-Ling Lin) ； 蔡岳錤(Yueh-Chi Tsai) ； 陳彥瑋(Yen-Wei Chen) ； 賴志昇(Chih-Sheng Lai) ； 呂俊德(Chen-Te Lu) ； 顏榮信(Jung-Hsing Yen) ； 陳伊呈(I-Chen Chen)

《臺灣整形外科醫學會雜誌》 27卷2期 (2018/06) Pp. 153-163

摘要

Background: Reconstruction for complex traumatized lower leg is challenging, especially when large soft tissue defect and bone exposure have occurred in the trauma area. Recipient vessels may be unavailable near the trauma zone and aggressive dissection to identify vessels might harm the perfusion of distal leg and venous return. Aim and Objectives: This study discusses possible reconstruction plans for bone exposure and severe soft tissue loss with nerve and vessel injury in the distal lower leg. We recommend an alternative for recipient vessels during free tissue transfer. Material and Methods: A 22-year-old man with Gustilo IIIB open fracture of the distal third of the left tibial bone received a reversed-flow descending branch of the lateral circumflex femoral artery (LCFA) as a recipient vessel for free flap reconstruction. Results: The flap survived well with minimal flap loss which healed with skin grafting alone. This alternative recipient vessel with reversed-flow descending branch of the LCFA played an important role in limb salvage in this case. Based on the outcome in the present case and our review of the literature, we believe the method described herein is reliable and may provide an option for reconstruction of the lower third of the leg, possibly even extending to the ankle or heel area. Conclusion: Use of reversed-flow descending branch of the LCFA as a recipient vessel for free flap reconstruction was effective in performing severely traumatized lower leg reconstruction.

關鍵字

reverse flow ； descending branch of lateral circumflex femoral artery ； limb salvage ； anterolateral thigh flap ； open tibial fracture

並列摘要

背景：嚴重下肢損傷之重建常具有挑戰性，尤其是在合併大量軟組織缺損及骨暴露等情況。因組織傷害嚴重及積極探查可能損害遠端循環或靜脈回流，在受損嚴重的區域中供重建使用的受體血管有時無法取得。目的及目標：本研究討論在遠端下肢開放性骨折伴軟組織缺損時可能之重建計畫，並嘗試提供另一個受體血管的選擇以供游離皮瓣重建使用。材料及方法：22歲男性因蓋氏三B遠端脛骨開放性骨折接受以側旋支股動脈之下降枝回流血管作為皮瓣受體血管的重建。結果：手術後皮瓣有部分壞死但以補皮重建即可。選擇側旋支股動脈之下降枝回流血管作為受體血管在本案例中扮演極重要之角色。經過文獻回顧，我們亦發現類似案例可證明此重建方式可做為遠端下肢、甚至是腳踝或足跟的重建方式選項。結論：以回流的側旋支股動脈之下降枝作為皮瓣受體血管對創傷後下肢之組織缺損重建非常有用。