| Background:Repair and reconstruction of oral and maxillofacial malignant tumors after resection is a great challenge for surgeons.With the development and progress of microvascular anastomosis technology,vascularized free tissue flap transplantation makes it possible to repair and reconstruct defects after malignant tumors resection in head and neck.At present,the vascularized free soft tissue flaps used in clinical practice are radial forearm flap,deep inferior epigastric artery perforator flap,thoracodorsal artery perforator flap,deep iliac circumflex artery perforator flap,anterolateral thigh flap,etc.Among them,anterolateral thigh flap has become the "workhorse" flap for reconstruction of defcts after tumor ablation because of its excellent anatomical characteristics,such as relative constant position of vascular pedicle,adequate pedicle length,large diameter of blood vessels,accompanied by sensory nerves,concealed donor site without any important structure,large amount of soft tissue available and so on.Up to now,it has been widely used in various medical fields.The anterolateral thigh flap can be designed as regional flaps and free flaps.As regional flaps,they can repair tissue defects in the lower abdomen,perineum,and iliolumbar region,while they are mainly used as free flaps to repair defects in head and neck.With the deepening of research,scholars have found that the anatomy of anterolateral femoral flaps is variable.Not only are the perforating branches of the anterolateral femoral flaps divided into septal perforators and musculocutaneous perforators,but also the vascular pedicles are not entirely derived from the descending branches of the lateral circumflex femoral arteiy.Now,articles revealing the variation of vascular anatomy have been extensively published,while articles addressing the difference of bilateral anterolateral thigh flap in the same body is rare.In addition,in cases involving bone defect,this flap is usually abandoned because it cannot meet the need of hard tissue reconstruction.Based on the anatomical variation of the blood vessels in the anterolateral thigh,this study compares the anatomy of bilateral anterolateral thigh flap of the same body,and tries to fabricate the anterolateral thigh osteomyocutaneous flaps with the adjacent bone tissue in order to provide a new choice for the reconstruction of hard tissue defects in oral and maxillofacial area.The research mainly includes the following three aspects:1.Anatomical comparison of bilateral anterolateral thigh flap of the same body.Objective:To study the anatomic variation of bilateral anterolateral thigh(ALT)flap,serving as an anatomical basis for the necessity of preoperative selection of donor thigh.Methods:10 fresh cadavers(20 cases)were recruited for the fabrication of bilateral ALT flap.The nutrient perforating branches of each flap were found out and then traced reversely to the vascular pedicle.the type and number of perforating branches was recorded,the length and diameter of the perforator and vascular pedicle was measured.Statistic data was expressed as meanąSD.Results:3 cadavers were found that the bilateral ALT flap were nourished by both septocutaneous and musculocutaneous perforators,while the other 7 cadavers were found not feeded by the exactly same perforator in types bilaterally.Only 4/10 of the cadavers were noticed sharing the same number of perforator bilaterally,while the remnant 60%not.All the septocutaneous perforators pass through the intermuscular septum between the vastus lateralis and rectus femoris muscle,and all the musculocutaneous perforators penetrate vertically or obliquely into the vastus lateralis.Perforators derived solely from descending branch of LCFA were observed in 14 cases.The other 6 cases,2 of which from 1 cadaver bilaterally and 4 of which from 4 cadavers unilaterally,saw that both oblique branch and descending branch of LCFA gave off perforators into the flap.The length and diameter of each main perforator and vascular pedicle in 10 cadavers bilaterally were not different significantly(P>0.05).Conclusions:Nutritive perforating branch of bilateral ALT flap differed in type?number?course and pedicle sourse,which has direct effects on the difficulty of flap fabrication and the duration of operation.Preoperative selection of donor thigh is helpful for safe and rapid preparation of anterolateral thigh flap.2.Anatomical study of anterolateral thigh osteomyocutaneous free flap with femur graft.Objective:To study the anatomy of anterolateral thigh-vastus intermedius-femur complex free flap,laying an anatomical foundation for the feasibility of fabricating anterolateral thigh osteomyocutaneous free flap with femur graft to repair soft and hard tissue defects in maxillofacial region.Methods:Another six fresh cadaveric specimens were recruited for the fabrication of vastus intermedius-femur flaps after the harvest of bilateral ALT flap.The nutrient vessels of the femur flaps were recorded,and the diameter and circumference of the femoral middle shaft and thickness of femur cortex were measured.Results:The nutrient vessel of the ALT-vastus intermedius-femur flap is a constant branch,named vestus intermedius branch,originating from the descending branchor the transverse branch of lateral circumflex femoral artery,which accounts for 75%?25%respectively.The underlying femur recieves nutrition from the capillary network between the overlying periosteum and vastus intermedius muscle.The diameter and circumference of the femoral middle shaft were measured at 25.62-30.02mm and 78.82-92.42mm,respectively.The thickness of the femur cortex was 5.24-7.04mm.Conclusions:The ALT-femur osteomyocutaneous free flap can not only provide enough soft tissue for the reconstruction of maxillofacial region but also offer adequate amount of bone graft for the repairment of hard tissue defect.3.Model design of anterolateral thigh osteomyocutaneous free flap with femur graft repairing the defects after lateral skull base tumor resection.Objective:To explore the feasibility of anterolateral thigh osteomyocutaneous free flap with femur graft for repairing soft and hard tissue defects after lateral skull base surgery by using the aforementioned anterolateral thigh osteomyocutaneous flap to repair the defect model as we designed after lateral skull base surgery.Methods:The skull model of soft and hard tissue defect caused by lateral skull base tumor resection was made.Then the ALTO from the second part of study was used to repair the soft and hard tissue defect in the model to restore the facial contour and the integrity of the affected mandibular ramus.Results:The anterolateral thigh osteomyocutaneous flap with abundant soft tissue can fully fill the soft tissue defect of the model and restore its contour and fullness.The attached femur graft can restore the height of the ipsilateral mandible ramus.Conclusion:The anterolateral thigh osteomyocutaneous flap provides a new choice for repairing tissue defects caused by lateral skull base tumors resection. |
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