带蒂股前外侧皮瓣阴茎再造术的临床应用  

The pedicled anterolateral thigh flap for penile reconstruction

作　　者：杨喆[1] 李养群[1] 唐勇[1] 赵穆欣[1] 陈文[1] 马宁[1] 王维新[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院整形二科,北京100144

出　　处：《中华整形外科杂志》2015年第6期406-410,共5页Chinese Journal of Plastic Surgery

摘　　要：目的 介绍股前外侧皮瓣带蒂转移再造阴茎的手术方法,探讨其临床应用效果及可行性.方法 2011年5月至2014年5月,对12例阴茎缺损的患者,应用股前外侧皮瓣带蒂转移进行阴茎再造术,皮瓣面积为11 cm＆#215;11 cm-12 cm＆#215;15 cm.8例患者以＂管中管＂的形式在皮瓣中央设计皮瓣再造尿道,4例应用阴囊中隔瓣再造尿道.一期进行尿道吻接者4例,于阴茎再造6个月后进行二期尿道吻接者8例.结果 12例皮瓣完全成活10例,皮瓣血运不良致再造阴茎全部坏死1例,术后皮瓣部分坏死继发感染1例,上述2例均采用对侧股前外侧皮瓣带蒂转移完成阴茎再造.术后获随访10例,时间为1-4年,平均1.5年,9例患者对再造阴茎外形满意,其中4例已婚者自述能够完成性生活;8例患者排尿功能正常,2例患者发生再造尿道皮肤瘘,于术后6-12个月行局部皮瓣转移尿瘘修补术.结论 应用旋股外侧动脉降支为蒂的股前外侧皮瓣带蒂转移进行阴茎再造,方法相对简单,无需吻合血管,血运可靠,形态满意,供区隐蔽.Objective To introduce the application of pedicled anterolateral thigh （ALT） flap for total penile reconstruction and to investigate its feasibility and effect.Methods From May 2011 to May 2015,12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap.Of them, the median age was 35 years old （range, 20-57 years）.The size of the flaps ranged from 11 cmx 11 cm to 12 cm x15 cm.8 patients underwent urethra reconstruction with tube-in-tube flaps and other 4 patients with scrotal septal flaps.In this series, we performed one-stage urethral anastomosis in 4 cases and second-stage urethral anastomosis 6 months after the phalloplasty in 8 cases.Results An acceptable reconstructed phallus was achieved in 10 patients.These flaps were primarily healed with satisfactory functional and cosmetic results.The reconstructed penis was completely necrosis because of the flap failure in one case.The distal half of the phallus was lost due to infection in one case.Both of them were treated with pedicled ALT flap from the other side.Reliable results were achieved.At a median follow-up of 1.5 year （range 1 to 4 years） , 9 patients （90%） were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse.8 patients had normal urinate function.Fistula was developed in 2 patients （20%） which was treated with delayed repair at 6-12 months with local scrotal flaps.Conclusions The pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra.It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.

关 键 词：股前外侧皮瓣 阴茎再造术 带蒂皮瓣 

分 类 号：R699.8[医药卫生—泌尿科学]