Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Lin ¹ , LIU Hongjun ¹ , ZHANG Wenzhong ¹ , SONG Guoxun ¹ , XIA Shicong ² , ZHANG Naichen ¹ ,  GU Jiaxiang ¹ , YUAN Chaoqun ¹

1. Department of Hand and Foot Microsurgery, Clinical Medicine College of Yangzhou University, Subei People’s Hospital of Jiangsu Province, Yangzhou Jiangsu, 225001, P.R.China;
2. Department of Orthopaedics, Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China;

Corresponding?author：

GU Jiaxiang, Email: gjx69@163.com

Keywords：

Anterolateral thigh perforator flap; soft tissue defect; cross-bridge; lower leg; wound repair

DOI：

10.7507/1002-1892.201705022

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg. Methods Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation. Results After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site. Conclusion Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle and lower segments of the leg.

Citation： YANG Lin, LIU Hongjun, ZHANG Wenzhong, SONG Guoxun, XIA Shicong, ZHANG Naichen, GU Jiaxiang, YUAN Chaoqun. Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1240-1244. doi: 10.7507/1002-1892.201705022 Copy

1.	侯春林, 劉小林. 中國顯微外科歷史回顧. 中華顯微外科雜志, 2015, 38(5): 417-419.0.
2.	任義軍, 胡銳, 嚴立, 等. 股前外側組織瓣修復下肢多處皮膚軟組織缺損. 中華顯微外科雜志, 2015, 38(5): 447-450.0.
3.	符健松, 高順紅, 張凈宇, 等. 以腓腸內側血管為受區血管的游離股前外側皮瓣移植修復小腿皮膚軟組織缺損. 中國修復重建外科雜志, 2015, 29(7): 804-806.0.
4.	李海軍, 鄭曉菊, 張忠, 等. 股前外側嵌合皮瓣與 Flow-through 修復四肢環形組織缺損. 中華顯微外科雜志, 2017, 40(1): 97-100.0.
5.	Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg, 1993, 96(9): 488-492.
6.	湯樣華, 曾林如, 黃忠名, 等. 封閉式負壓引流聯合游離股前外側皮瓣修復 Pilon 骨折術后軟組織缺損. 中國修復重建外科雜志, 2012, 26(11): 1407-1408.0.
7.	Marsh DJ, Chana JS. Reconstruction of very large defeets: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Recons Aesthet Surg, 2010, 63(1): 120-125.
8.	隋海明, 叢海波, 翟建國, 等. 大面積股前外側皮瓣的設計與切取: 附 28 例報告. 中華顯微外科雜志, 2014, 37(2): 143-146.0.
9.	朱躍良, 殷作明, 王家祥, 等. 股前外側穿支皮瓣切取技巧分析. 中國修復重建外科雜志, 2017, 31(1): 57-61.0.
10.	齊偉亞, 鄭大偉, 張旭陽, 等. 血運重建后皮瓣修薄法在股前外側皮瓣游離移植中的應用. 中國修復重建外科雜志, 2016, 30(4): 525-527.0.
11.	Venkatramani H, Sabapathy SR, Nayak S. Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle. J Plast Reconstr Aesthet Surg, 2014, 67(1): 93-98.
12.	Louer CR, Garcia RM, Earle SA, et al. Free flap reconstruction of the knee: an outcome study of 34 cases. Ann Plast Surg, 2015, 74(1): 57-63.
13.	徐達傳, 鐘世鎮, 劉牧之, 等. 股前外側部皮瓣的解剖學——一個新的游離皮瓣供區. 臨床應用解剖學雜志, 1984, 23(3): 158.0.
14.	羅力生, 高建華, 陳林峰, 等. 股前外側皮瓣及其游離移植的應用. 第一軍醫大學學報, 1984, 4(4): 1-4.0.
15.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
16.	Valdatta L, Tuinder S, Buoro M, et al. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg, 2002, 49(2): 145-150.
17.	周鵬, 楊新東, 徐象黨, 等. 股前外側區穿支動脈的形態學研究及皮瓣設計. 中華顯微外科雜志, 2007, 30(3): 203-205.0.
18.	王愛國, 邱勇. 股前外側皮瓣遠側肌皮穿支的解剖學研究與臨床應用. 中華骨科雜志, 2011, 31(3): 255-259.0.
19.	Fabio S, Stefania T, Andrea P, et al. Free flap reconstruction of the sole of the foot with or with out sensory nerve coaptation. Plast Reconstr Surg, 2002, 109(7): 2314-2322.
20.	楊何平, 張洪武, 楊書雄, 等. 帶感覺神經與失神經的股前外側穿支皮瓣在頭頸部感覺重建的對比研究. 中華顯微外科雜志, 2016, 39(3): 225-229.0.
21.	Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study. Plast Reconstr Surg, 2014, 133(2): 420-429.
22.	Hughes T, Yu Jonathan TS, Wong KY, et al. " Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap. Int J Surg Case Rep, 2013, 4(5): 453-455.

1. 侯春林, 劉小林. 中國顯微外科歷史回顧. 中華顯微外科雜志, 2015, 38(5): 417-419.0.
2. 任義軍, 胡銳, 嚴立, 等. 股前外側組織瓣修復下肢多處皮膚軟組織缺損. 中華顯微外科雜志, 2015, 38(5): 447-450.0.
3. 符健松, 高順紅, 張凈宇, 等. 以腓腸內側血管為受區血管的游離股前外側皮瓣移植修復小腿皮膚軟組織缺損. 中國修復重建外科雜志, 2015, 29(7): 804-806.0.
4. 李海軍, 鄭曉菊, 張忠, 等. 股前外側嵌合皮瓣與 Flow-through 修復四肢環形組織缺損. 中華顯微外科雜志, 2017, 40(1): 97-100.0.
5. Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg, 1993, 96(9): 488-492.
6. 湯樣華, 曾林如, 黃忠名, 等. 封閉式負壓引流聯合游離股前外側皮瓣修復 Pilon 骨折術后軟組織缺損. 中國修復重建外科雜志, 2012, 26(11): 1407-1408.0.
7. Marsh DJ, Chana JS. Reconstruction of very large defeets: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Recons Aesthet Surg, 2010, 63(1): 120-125.
8. 隋海明, 叢海波, 翟建國, 等. 大面積股前外側皮瓣的設計與切取: 附 28 例報告. 中華顯微外科雜志, 2014, 37(2): 143-146.0.
9. 朱躍良, 殷作明, 王家祥, 等. 股前外側穿支皮瓣切取技巧分析. 中國修復重建外科雜志, 2017, 31(1): 57-61.0.
10. 齊偉亞, 鄭大偉, 張旭陽, 等. 血運重建后皮瓣修薄法在股前外側皮瓣游離移植中的應用. 中國修復重建外科雜志, 2016, 30(4): 525-527.0.
11. Venkatramani H, Sabapathy SR, Nayak S. Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle. J Plast Reconstr Aesthet Surg, 2014, 67(1): 93-98.
12. Louer CR, Garcia RM, Earle SA, et al. Free flap reconstruction of the knee: an outcome study of 34 cases. Ann Plast Surg, 2015, 74(1): 57-63.
13. 徐達傳, 鐘世鎮, 劉牧之, 等. 股前外側部皮瓣的解剖學——一個新的游離皮瓣供區. 臨床應用解剖學雜志, 1984, 23(3): 158.0.
14. 羅力生, 高建華, 陳林峰, 等. 股前外側皮瓣及其游離移植的應用. 第一軍醫大學學報, 1984, 4(4): 1-4.0.
15. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
16. Valdatta L, Tuinder S, Buoro M, et al. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg, 2002, 49(2): 145-150.
17. 周鵬, 楊新東, 徐象黨, 等. 股前外側區穿支動脈的形態學研究及皮瓣設計. 中華顯微外科雜志, 2007, 30(3): 203-205.0.
18. 王愛國, 邱勇. 股前外側皮瓣遠側肌皮穿支的解剖學研究與臨床應用. 中華骨科雜志, 2011, 31(3): 255-259.0.
19. Fabio S, Stefania T, Andrea P, et al. Free flap reconstruction of the sole of the foot with or with out sensory nerve coaptation. Plast Reconstr Surg, 2002, 109(7): 2314-2322.
20. 楊何平, 張洪武, 楊書雄, 等. 帶感覺神經與失神經的股前外側穿支皮瓣在頭頸部感覺重建的對比研究. 中華顯微外科雜志, 2016, 39(3): 225-229.0.
21. Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study. Plast Reconstr Surg, 2014, 133(2): 420-429.
22. Hughes T, Yu Jonathan TS, Wong KY, et al. " Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap. Int J Surg Case Rep, 2013, 4(5): 453-455.

Chinese Journal of Reparative and Reconstructive Surgery

Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content