文章發表：Plast Reconstr Surg. 2009 Aug;124(2):500-9.
大綱
一、背景：在具有較大腹壁缺損的特定患者中，游離皮瓣有著獨特的作用。它們為棘手的腹部傷口提供了單階段自體移植的重建方案於蒂皮瓣的不足。二、方法：從1996年到2005年，有5名複雜的腹壁缺損患者使用游離皮瓣進行重建。所有患者均患有多種合併症，因此禁忌使用同種異體材料。使用的皮瓣包括游離橈前臂皮瓣一名，闊筋膜張肌皮瓣兩名，游離的大腿前外側肌皮瓣一名，最後一名患者的游離皮瓣結合闊筋膜張肌和大腿前外側肌。三、結果：平均缺損大小為470平方厘米（136至875平方厘米）。如果無法在腹部找到合適的血管，股動脈和大隱靜脈則能可靠地提供受者血管。可以建立一條大隱靜脈到股動脈的暫時動靜脈廔管。隨後將其分開以提供受體動脈和靜脈。皮瓣併發症為傷口邊緣壞死，血腫，感染和靜脈血栓形成。所有患者均順利控制且沒有皮瓣失敗。平均住院時間為64天（41至128天）。位於外側旋股骨系統的大腿外側皮瓣是我們首選的供體部位。可使用大量軟組織，強筋膜和受支配的肌肉，從而對整個前腹壁進行單階段自體移植重建。四、結論：游離皮瓣可為複雜的腹壁缺損提供可靠的單階段解決方案。使用這些技術，即使是最具挑戰性的缺陷也可以完全用自體移植的組織重建。
BACKGROUND:
Free flaps have a distinct role in a select group of patients with large abdominal wall defects. They offer a completely autologous reconstructive solution in a single stage for difficult abdominal wounds for which pedicled flaps would be inadequate.
METHODS:
From 1996 to 2005, five patients with complex abdominal wall defects underwent reconstruction using free flaps. All patients had multiple comorbidities, making the use of alloplastic materials relatively contraindicated. Flaps used included a free radial forearm flap in one patient, a tensor fasciae latae myocutaneous flap in two patients, a free anterolateral thigh myocutaneous flap in one patient, and free conjoined tensor fasciae latae and anterolateral thigh myocutaneous flaps in the last patient.
RESULTS:
The mean defect size was 470 cm (range, 136 to 875 cm). The femoral artery and long saphenous vein reliably provided recipient vessels in cases for which suitable vessels could not be located within the abdomen. A temporary arteriovenous shunt of the long saphenous vein to the femoral artery could be created. This was later divided to provide a recipient artery and vein. Flap complications were wound edge necrosis, hematoma, infection, and venous thrombosis. All were successfully managed and there were no flap failures. The average length of hospitalization was 64 days (range, 41 to 128 days). Lateral thigh flaps based on the lateral circumflex femoral system are our preferred donor site. A large amount of soft tissue, strong fascia, and innervated muscle are available, enabling single-stage autologous reconstruction of the entire anterior abdominal wall.
CONCLUSIONS:
Free flaps offer a reliable single-stage solution to complex abdominal wall defects. With these techniques, even the most challenging defects can be reconstructed with completely autologous tissue.
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