文章發表：Plast Reconstr Surg. 2009 Jun;123(6):1739-47.
大綱
一、背景：立即緊急補救游離皮瓣的定義為急診手術後，由於暴露主要重建的動脈，神經，骨骼和肌腱而直接進行的皮瓣。作者記錄了他們在立即重建複雜的上肢損傷中使用游離大腿前外側皮瓣的經驗。二、方法：從2000年1月至2006年10月，12例10至50歲併發複雜上肢外傷的患者接受了立即緊急補救的大腿前外側皮瓣移植。這些皮瓣進行覆蓋暴露的重要構造。皮瓣尺寸範圍從30 x 15到8 x 6厘米。使用了多樣化的皮瓣設計，包含六個流通皮瓣於上肢血行重建及三個闊筋膜張肌成分於滑動層面暴露的肌腱修復。手術時間約7.2小時到12.1小時，平均手術時間約9.6小時。住院時間約13天到34天，平均住院時間約27.7天。三、結果：所有皮瓣皆存活，無需重新探查。僅1例發生部分皮瓣壞死。三名患者創傷性傷口感染。四、結論：大腿前外側皮瓣已被廣泛用於軟組織重建的多功能皮瓣。它具有許多好處，包含較長的椎根，大區域皮膚，鑄造和嵌合的概念設計，兩者治療方法及無需更改位置。因此，它適合作為上肢的緊急補救皮瓣。
BACKGROUND:
Immediate emergency free flaps are defined as flaps performed directly following emergency surgery due to the exposure of major reconstructed arteries, major nerves, bones, and tendons. The authors document their experience in using free anterolateral thigh flaps in the immediate reconstruction of complex upper extremity injuries.
METHODS:
From January of 2000 to October of 2006, 12 patients ranging from 10 to 59 years old with complicated upper extremity traumatic injuries were treated with immediate emergency free anterolateral thigh flap transfers. These flaps were performed to cover the exposed vital structures. Flap sizes ranged from 30 x 15 to 8 x 6 cm. A variety of flap designs were used, including six flow-through flaps for upper limb revascularization and three tensor fasciae latae components for gliding planes of exposed repaired tendons. The operative times ranged from 7.2 to 12.1 hours, with an average operative time of about 9.6 hours. The hospital stay was from 13 to 34 days, with average stay of about 27.7 days.
RESULTS:
All of the flaps survived. No re-exploration was required. Partial flap necrosis occurred in only one case. Traumatized wound infection occurred in three patients.
CONCLUSIONS:
The anterolateral thigh flap has been popularized as the versatile flap for soft-tissue reconstruction. It has many advantages, including long pedicle length, large skin territory, flow-though and chimeric concept design, a two-team approach, and no need for changing the position. Thus, it is suitable as the immediate emergency flap for upper extremity salvage.
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