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  • Title: [Technique and clinical application of free lobed anteromedial thigh perforator flap].
    Author: Song D, Li Z, Zhang Y.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Mar 15; 37(3):336-342. PubMed ID: 36940993.
    Abstract:
    OBJECTIVE: To introduce the technique and clinical application of free lobed anteromedial thigh perforator flap. METHODS: Between October 2017 and December 2021, 65 patients with buccal and oral cancer penetrating defects were planned to treat with free lobed anterolateral thigh flap transplantation, of which 15 cases were found that the sole anterolateral thigh perforator was actually a branch of the anteromedial thigh perforator, and then the free lobed anteromedial thigh perforator flap was harvested for repair. There were 12 males and 3 females with an average age of 34.6 years (range, 29-55 years). According to Union for International Cancer Control (UICC) TNM staging, there were 7 cases of T 4N 0M 0, 4 cases of T 4N 1M 0, 2 cases of T 3N 1M 0, and 2 cases of T 3N 2M 0. The disease duration was 1-10 months (mean, 6.3 months), and the area of secondary soft tissue defect left after radical resection of buccal and oral cancer was from 5 cm×4 cm to 10 cm×6 cm. The anterolateral thigh skin flap ranged from 5 cm×4 cm to 13 cm×6 cm, and the anteromedial thigh skin flap ranged from 5 cm×3 cm to 10 cm×6 cm. The free trilobed anteromedial thigh flap was prepared according to the actual branches of the main trunk of the anteromedial thigh perforator in 4 cases, and the vastus medialis muscle flap was used to fill the cavity defect of the floor of mouth in 7 cases. Among the 15 patients, the vessel pedicles of the anteromedial thigh perforators were derived from the main femoral artery and vein in 8 cases, from the main descending branch of the lateral femoral circumflex artery in 4 cases, and from the main lateral femoral circumflex artery in 3 cases. RESULTS: Hematoma occurred in 2 cases after operation, which was successfully saved after emergency exploration. No vascular crisis occurred, and partial necrosis of anterolateral femoral skin island occurred in 1 case, which was healed with debridement. The remaining flaps survived successfully, and the wounds and donor site incisions healed by first intention. All the patients were followed up 12-36 months (mean, 14.6 months). The appearance of the flap was satisfactory, and no obvious swelling was found; the mouth opening and language function were satisfactory; only linear scar was left in the donor area, and the thigh function was not significantly affected. Local recurrence occurred in 3 cases, and the defect after tumor resection was repaired with pedicled pectoralis major myocutaneous flap. Four patients with neck lymph node metastasis, including ipsilateral side in 3 patients and contralateral side in the other 1 patient, all underwent neck lymph node dissection again. The 3-year survival rate was 86.7% (13/15). CONCLUSION: The anteromedial thigh perforator vessels distributed in the anterolateral region of the thigh can be used to prepare the anterolateral thigh split lobed flap to repair the buccal and oral cancer penetrating defects. 目的: 探讨游离分叶股前内侧穿支蒂皮瓣的切取技巧和临床应用效果。. 方法: 2017年10月—2021年12月收治65例口颊癌洞穿性缺损患者，拟采用游离分叶股前外侧皮瓣移植修复，其中15例术中发现股前外侧穿支实际为股前内侧穿支的分支，转而制备游离分叶股前内侧穿支蒂皮瓣修复。男12例，女3例；年龄29～55岁，平均34.6岁。按国际抗癌联盟（UICC）TNM分期：T 4N 0M 0 7例，T 4N 1M 0 4例，T 3N 1M 0 2例，T 3N 2M 0 2例。病程1～10个月，平均6.3个月。行口颊癌肿瘤根治术后遗留软组织缺损范围为5 cm×4 cm～10 cm×6 cm。股前外侧皮岛切取范围为5 cm×4 cm～13 cm×6 cm，股前内侧皮岛范围为5 cm×3 cm～10 cm×6 cm。4例根据股前内侧穿支主干的实际分支情况制备游离三叶股前内侧皮瓣，7例穿支血管蒂同时携带股内侧肌瓣用于填塞口底腔隙缺损。15例患者中，股前内侧穿支血管蒂来自于股动静脉主干8例、旋股外侧动脉降支主干4例、旋股外侧动脉主干3例。. 结果: 术后发生血肿2例，急诊探查后成功挽救皮瓣；无1例发生血管危象。1例发生股前外侧皮岛部分坏死，采用清创缝合后愈合。其余皮瓣顺利成活，创面及供区切口均Ⅰ期愈合。15例患者均获随访，随访时间12～36个月，平均14.6个月。皮瓣外观满意，未见明显臃肿；张口、语言功能满意；供区仅遗留线性瘢痕，大腿功能未见明显影响。3例发生肿瘤局部复发，再次行肿瘤根治术并以带蒂胸大肌皮瓣移位修复。4例发生颈部淋巴结转移（同侧3例、对侧1例），再次行颈部淋巴结清扫术。患者3年生存率为86.7%（13/15）。. 结论: 股前内侧穿支血管在皮下发出分布于股前外侧区域的分支，可被用于制备股前区分叶皮瓣，修复口颊癌根治手术后遗留的洞穿性缺损。.
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