Effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Feiyu , Jiasharete·Jielile , LIU Kai , LIU Yanshi , FAN Chenchen ,  Aihemaitijiang·Yusufu

Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P.R.China;

Corresponding?author：

Aihemaitijiang·Yusufu, Email: ahmatjang@163.com

Keywords：

Hand injury; vascular injury; anterolateral thigh flap; free flap; wound repair

DOI：

10.7507/1002-1892.202103049

Video：

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Objective To evaluate the effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury.Methods Between February 2016 and March 2020, 14 patients with hand twist trauma combined with forearm main vascular injury were admitted. There were 10 males and 4 females. The mean age was 36.3 years (range, 22-53 years). There were 5 cases with left hand and 9 cases with right hand. The degloving injury of hand was rated as type ⅢA in 2 cases, type ⅢB in 9 cases, and type Ⅳ in 3 cases. The size of soft tissue defects range from 8.0 cm×4.5 cm to 13.5 cm×8.0 cm. Of all patients, 11 cases were ulnar artery injury and 3 cases were radial artery injury. Time from injury to operation was 2-16 hours (mean, 7.1 hours). The free anterolateral thigh flaps with the size of 10.0 cm×5.5 cm to 15.0 cm×9.5 cm were used to repair the soft tissue defects with the “T” shape anastomosis of blood vessel in 8 cases or direct anastomosis of blood vessel in 6 cases. The donor sites were directly sutured in 9 cases and repaired with free skin graft in 5 cases.Results All patients were followed up 6-12 months (mean, 10.5 months). The vascular crisis occurred in 1 case and the flap survived with symptomatic treatment after operation. Other flaps survived and the wounds healed by first intention. All donor sites healed by first intention and the skin grafts survived. Three cases underwent the fat-free trimming at 4-5 months after operation. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the hand function was evaluated as excellent in 4 cases, good in 7 cases, and fair in 3 cases, with an excellent and good rate of 78.6% at last follow-up.Conclusion Because the diameter of the descending branch of the lateral femoral circumflex artery is similar to that of the ulnar artery and radial artery, the use of free anterolateral thigh flap can not only repair the wound and obtain a good hand shape, but also repair blood vessels and promote recovery of hand function.

Citation： CAI Feiyu, Jiasharete·Jielile, LIU Kai, LIU Yanshi, FAN Chenchen, Aihemaitijiang·Yusufu. Effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 1033-1037. doi: 10.7507/1002-1892.202103049 Copy

1.	杜全紅, 畢衛偉, 仲崇華, 等. 游離足底內側動脈穿支皮瓣修復手指掌側軟組織缺損的遠期隨訪. 中華顯微外科雜志, 2020, 43(4): 357-360.
2.	曠玲玉, 周望高, 賀海燕, 等. 自制固定托裝置在腹部皮瓣修復術后護理中的應用. 中國實用護理雜志, 2021, 37(10): 780-785.
3.	邢培朋, 郭海娜, 狄海萍, 等. 游離股前外側皮瓣聯合動脈血管重建修復腕部高壓電燒傷創面的臨床效果. 中華燒傷雜志, 2020, 36(6): 419-425.
4.	Bali ZU, Ozkan B, Parspanc? A, et al. Reconstruction of lower lip defects with free super-thin anterolateral thigh flap. Microsurgery, 2021, 41(3): 216-222.
5.	Abdelrahman M, McGarry K, Alsharkawy K, et al. A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery. J Plast Reconstr Aesthet Surg, 2021, 74(5): 1013-1021.
6.	Gu S, Fu H, Huang Y, et al. Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers. J Int Med Res, 2021, 49(2): 300060521991032. doi: 10.1177/0300060521991032.
7.	唐俊華, 金國棟, 曾永文, 等. Flow-through 尺動脈腕上支穿支皮瓣在伴指掌側固有動脈缺損創面中的應用. 中華顯微外科雜志, 2021, 44(1): 77-79.
8.	洪建軍, 高偉陽, 李志杰, 等. 手部套脫傷的分型和治療. 中華手外科雜志, 2006, 22(4): 221-223.
9.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-136.
10.	Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
11.	侯毅, 顧立強. 顯微血管吻合技術的現狀與展望. 中華顯微外科雜志, 2014, 37(2): 201-204.
12.	王東, 鄭燦鑌, 王洪剛, 等. 微血管吻合器在口徑不等血管吻合中的應用. 中華顯微外科雜志, 2014, 37(2): 106-109.
13.	Yan ZX, Zhou YJ, Zhao YX, et al. Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures. Circ J, 2010, 74(4): 686-692.
14.	羅新錦, 王巍, 王躍堂, 等. 冠狀動脈旁路移植術中旋股外動脈降支的獲取與運用. 中華外科雜志, 2017, 55(11): 834-837.
15.	陳勝華, 徐達傳, 周小兵, 等. 以旋股外側動脈降支為蒂分葉股前外側肌皮瓣設計的解剖學研究. 中國臨床解剖學雜志, 2010, 28(3): 237-241.
16.	Roberts JM, Carr LW, Haley CT, et al. Venous flaps for revascularization and soft-tissue coverage in traumatic hand injuries: a systematic review of the literature. J Reconstr Microsurg, 2020, 36(2): 104-109.
17.	劉銘波, 胡偉, 梁勇, 等. 帶掌長肌腱的動脈化 Flow-through 靜脈皮瓣修復指背側復合組織缺損. 中華顯微外科雜志, 2021, 44(1): 11-15.
18.	劉長松, 朱熙銘, 徐強, 等. 穿支皮瓣與腹部帶蒂皮瓣治療手外傷皮膚軟組織缺損療效比較. 中華全科醫學, 2020, 18(10): 1671-1674.
19.	江吉勇, 蘭榮玉, 鄒芬, 等. 削薄股前外側穿支皮瓣修復手部術后瘢痕攣縮畸形 12 例. 中華顯微外科雜志, 2020, 43(5): 446-449.

1. 杜全紅, 畢衛偉, 仲崇華, 等. 游離足底內側動脈穿支皮瓣修復手指掌側軟組織缺損的遠期隨訪. 中華顯微外科雜志, 2020, 43(4): 357-360.
2. 曠玲玉, 周望高, 賀海燕, 等. 自制固定托裝置在腹部皮瓣修復術后護理中的應用. 中國實用護理雜志, 2021, 37(10): 780-785.
3. 邢培朋, 郭海娜, 狄海萍, 等. 游離股前外側皮瓣聯合動脈血管重建修復腕部高壓電燒傷創面的臨床效果. 中華燒傷雜志, 2020, 36(6): 419-425.
4. Bali ZU, Ozkan B, Parspanc? A, et al. Reconstruction of lower lip defects with free super-thin anterolateral thigh flap. Microsurgery, 2021, 41(3): 216-222.
5. Abdelrahman M, McGarry K, Alsharkawy K, et al. A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery. J Plast Reconstr Aesthet Surg, 2021, 74(5): 1013-1021.
6. Gu S, Fu H, Huang Y, et al. Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers. J Int Med Res, 2021, 49(2): 300060521991032. doi: 10.1177/0300060521991032.
7. 唐俊華, 金國棟, 曾永文, 等. Flow-through 尺動脈腕上支穿支皮瓣在伴指掌側固有動脈缺損創面中的應用. 中華顯微外科雜志, 2021, 44(1): 77-79.
8. 洪建軍, 高偉陽, 李志杰, 等. 手部套脫傷的分型和治療. 中華手外科雜志, 2006, 22(4): 221-223.
9. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-136.
10. Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
11. 侯毅, 顧立強. 顯微血管吻合技術的現狀與展望. 中華顯微外科雜志, 2014, 37(2): 201-204.
12. 王東, 鄭燦鑌, 王洪剛, 等. 微血管吻合器在口徑不等血管吻合中的應用. 中華顯微外科雜志, 2014, 37(2): 106-109.
13. Yan ZX, Zhou YJ, Zhao YX, et al. Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures. Circ J, 2010, 74(4): 686-692.
14. 羅新錦, 王巍, 王躍堂, 等. 冠狀動脈旁路移植術中旋股外動脈降支的獲取與運用. 中華外科雜志, 2017, 55(11): 834-837.
15. 陳勝華, 徐達傳, 周小兵, 等. 以旋股外側動脈降支為蒂分葉股前外側肌皮瓣設計的解剖學研究. 中國臨床解剖學雜志, 2010, 28(3): 237-241.
16. Roberts JM, Carr LW, Haley CT, et al. Venous flaps for revascularization and soft-tissue coverage in traumatic hand injuries: a systematic review of the literature. J Reconstr Microsurg, 2020, 36(2): 104-109.
17. 劉銘波, 胡偉, 梁勇, 等. 帶掌長肌腱的動脈化 Flow-through 靜脈皮瓣修復指背側復合組織缺損. 中華顯微外科雜志, 2021, 44(1): 11-15.
18. 劉長松, 朱熙銘, 徐強, 等. 穿支皮瓣與腹部帶蒂皮瓣治療手外傷皮膚軟組織缺損療效比較. 中華全科醫學, 2020, 18(10): 1671-1674.
19. 江吉勇, 蘭榮玉, 鄒芬, 等. 削薄股前外側穿支皮瓣修復手部術后瘢痕攣縮畸形 12 例. 中華顯微外科雜志, 2020, 43(5): 446-449.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury

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