Clinical application of anterolateral thigh perforator flap pedicled with oblique branch in intramuscular of lateral circumflex femoral artery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Lin ^1,2 , LIU Zhijin ^1,2 , CHENG Junnan ^1,2 , GAO Qinfeng ^1,2 , YANG Chengpeng ^1,2 , LIU Shengzhe ^1,2 , ZHANG Tao ^1,2 , SUN Fengwen ^1,2 , HUANG Yongtao ^1,2 ,  JU Jihui ^1,2

1. Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215104, P. R. China;
2. Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China;

Corresponding?author：

JU Jihui, Email: jjh2006@263.net

Keywords：

Perforator flap; anterolateral thigh perforator flap; lateral circumflex femoral artery; oblique branch

DOI：

10.7507/1002-1892.202207012

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Objective To explore the characteristics and clinical application of the anterolateral thigh flap pedicled with the oblique branch in the intramuscular of lateral circumflex femoral artery. Methods The clinical data of 25 patients with skin and soft tissue defects of extremities admitted between December 2020 and April 2021 were retrospectively analyzed, including 16 males and 9 females, aged 14-75 years, with the median age of 43 years. The defect site included 13 cases of hand, 2 cases of forearm, 2 cases of calf, and 8 cases of foot and ankle. The wound area ranged from 6 cm×4 cm to 35 cm×22 cm. Twenty-four patients with trauma were admitted to hospital immediately after injury, and 1 patient with diabetic foot infection was transferred to the hospital after ineffective treatment in other hospital. Flap surgery was performed from 0 to 56 days (median, 22 days) after admission. A total of 26 thigh flaps were harvested in 25 patients, with unilateral flaps in size of 7 cm×5 cm to 40 cm×10 cm. The type, caliber, and location of the perforating branch were recorded during the operation, and the anatomical characteristics of the oblique branch of the intramuscular trunk were mainly observed. The flap harvesting time was recorded; the flap survival and wound healing time were observed; at last follow-up, XIAO Feipeng et al. flap comprehensive efficacy evaluation table was used to evaluate the effectiveness of flap repair from three aspects of donor site, recipient site, and subjective satisfaction of doctors and patients. Results After the oblique branch in intramuscular of lateral circumflex femoral artery was sent out, it ran 2-3 cm obliquely laterally and inferiorly in the intermuscular septum and then entered the vastus lateralis muscle, and sent out perforating branches to nourish the skin. A total of 61 perforating branches were marked in 26 thighs of 25 patients before operation, and 70 perforating branches were found during operation, including 9 transverse branches, 29 descending branches, and 32 oblique branches, all of the oblique branches were musculocutaneous perforators. All 25 patients were followed up 6-10 months, with an average of 8 months. The time of unilateral thigh flap harvesting ranged from 13 to 90 minutes, with an average of 48 minutes. One patient with diabetes developed disturbance of blood supply and complete necrosis of the flap at 1 month after operation, and then the flap was repaired with skin graft; 1 case developed arterial crisis after operation, which survived after timely exploration; and the rest of the flaps survived smoothly. The wound healing time of the recipient site ranged from 10 to 44 days, with an average of 19 days, and the donor site of the thigh healed by first intention. At last follow-up, the color and texture of the flap was good and the sensation recovered to S₁-S₂. Only linear scar was left in the donor site, no scar contracture, pain, and other discomfort occurred, and no other serious complications occurred. Evaluated by flap comprehensive efficacy evaluation table, the score was 74-93, with an average of 88, of which 10 cases were excellent, 13 cases were good, and 2 cases were fair, with an excellent and good rate of 92%. Conclusion The intramuscular trunk oblique branch is not uncommon, and its trunk course and perforators distribution are regular. To improve the understanding of this type of oblique branch and adopt appropriate methods during operation can improve the success rate of skin flap extraction.

Citation： YANG Lin, LIU Zhijin, CHENG Junnan, GAO Qinfeng, YANG Chengpeng, LIU Shengzhe, ZHANG Tao, SUN Fengwen, HUANG Yongtao, JU Jihui. Clinical application of anterolateral thigh perforator flap pedicled with oblique branch in intramuscular of lateral circumflex femoral artery. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(12): 1512-1518. doi: 10.7507/1002-1892.202207012 Copy

1.	芮永軍. 股前外側皮瓣在中國的研究進展. 中華顯微外科雜志, 2020, 43(4): 313-325.
2.	Lim S, Atwi N, Long S, et al. Variations in the anterolateral thigh flap’s vascular anatomy in African Americans. J Reconstr Microsurg, 2018, 34(4): 300-306.
3.	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.
4.	臧夢青, 朱珊, 陳博, 等. 旋股外側動脈斜支在帶蒂股前外側皮瓣中的應用. 中華整形外科雜志, 2019, 35(10): 995-999.
5.	柳志錦, 巨積輝, 程俊楠, 等. 以旋股外側動脈斜支為源動脈的股前外側雙葉穿支皮瓣修復四肢創面. 中華顯微外科雜志, 2021, 44(2): 152-156.
6.	肖飛鵬, 柳志錦, 劉勝哲, 等. 綜合評價量表在股前外側皮瓣修復術后療效評價中的應用. 中國美容整形外科雜志, 2021, 32(6): 348-351.
7.	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.
8.	吳攀峰, 唐舉玉, 卿黎明, 等. 數字化技術輔助旋股外側動脈降支分葉穿支皮瓣重建足跟軟組織缺損. 中華顯微外科雜志, 2022, 45(1): 33-37.
9.	Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
10.	胡浩良, 陳宏, 李苗鐘, 等. CT血管造影輔助下以旋股外側動脈斜支血管為蒂的游離股前外側穿支皮瓣修復四肢軟組織缺損. 中華創傷雜志, 2021, 37(9): 780-785.
11.	胡濤濤, 常樹森, 魏在榮, 等. 改良三縱五橫法在股前外側穿支皮瓣修復術前穿支定位中的應用研究. 中國修復重建外科雜志, 2021, 35(8): 1027-1032.
12.	Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.
13.	Maruccia M, Orfaniotis G, Ciudad P, et al. Application of extended bi-pedicle anterolateral thigh free flaps for reconstruction of large defects: A case series. Microsurgery, 2018, 38(1): 26-33.
14.	柳志錦, 巨積輝, 劉勝哲, 等. 股前外側區雙葉穿支皮瓣的血供方式及臨床應用. 中華骨科雜志, 2021, 41(4): 211-218.
15.	Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: its expanding role in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 235-248.
16.	柳志錦, 巨積輝, 周榮, 等. 股外側區雙葉嵌合穿支皮瓣修復伴嚴重感染的肢體創面. 中華整形外科雜志, 2021, 37(5): 541-546.
17.	常樹森, 何春念, 金文虎. 股前外側皮瓣的供區并發癥. 中華顯微外科雜志, 2018, 41(1): 101-104.
18.	張敬良. 努力追求創面修復的 “泳褲供區” 理念. 中華顯微外科雜志, 2020, 43(1): 3-4.
19.	卿黎明, 賀繼強, 唐舉玉, 等. 旋股外側動脈降支穿支皮瓣供區直接閉合的可靠切取寬度及其影響因素分析. 中華顯微外科雜志, 2017, 40(2): 114-117.
20.	Zapata-Ospina A, Chen J, Tee R, et al. Harvesting the anterolateral thigh flap with non-sizable perforators. J Plast Reconstr Aesthet Surg, 2021, 74(5): 1022-1030.
21.	王丹瑩, 劉元波, 陳威威, 等. CT血管造影預估近端蒂股前外側皮瓣血管蒂長度的臨床應用研究. 中國修復重建外科雜志, 2022, 36(3): 322-328.

1. 芮永軍. 股前外側皮瓣在中國的研究進展. 中華顯微外科雜志, 2020, 43(4): 313-325.
2. Lim S, Atwi N, Long S, et al. Variations in the anterolateral thigh flap’s vascular anatomy in African Americans. J Reconstr Microsurg, 2018, 34(4): 300-306.
3. 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.
4. 臧夢青, 朱珊, 陳博, 等. 旋股外側動脈斜支在帶蒂股前外側皮瓣中的應用. 中華整形外科雜志, 2019, 35(10): 995-999.
5. 柳志錦, 巨積輝, 程俊楠, 等. 以旋股外側動脈斜支為源動脈的股前外側雙葉穿支皮瓣修復四肢創面. 中華顯微外科雜志, 2021, 44(2): 152-156.
6. 肖飛鵬, 柳志錦, 劉勝哲, 等. 綜合評價量表在股前外側皮瓣修復術后療效評價中的應用. 中國美容整形外科雜志, 2021, 32(6): 348-351.
7. 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.
8. 吳攀峰, 唐舉玉, 卿黎明, 等. 數字化技術輔助旋股外側動脈降支分葉穿支皮瓣重建足跟軟組織缺損. 中華顯微外科雜志, 2022, 45(1): 33-37.
9. Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
10. 胡浩良, 陳宏, 李苗鐘, 等. CT血管造影輔助下以旋股外側動脈斜支血管為蒂的游離股前外側穿支皮瓣修復四肢軟組織缺損. 中華創傷雜志, 2021, 37(9): 780-785.
11. 胡濤濤, 常樹森, 魏在榮, 等. 改良三縱五橫法在股前外側穿支皮瓣修復術前穿支定位中的應用研究. 中國修復重建外科雜志, 2021, 35(8): 1027-1032.
12. Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.
13. Maruccia M, Orfaniotis G, Ciudad P, et al. Application of extended bi-pedicle anterolateral thigh free flaps for reconstruction of large defects: A case series. Microsurgery, 2018, 38(1): 26-33.
14. 柳志錦, 巨積輝, 劉勝哲, 等. 股前外側區雙葉穿支皮瓣的血供方式及臨床應用. 中華骨科雜志, 2021, 41(4): 211-218.
15. Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: its expanding role in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 235-248.
16. 柳志錦, 巨積輝, 周榮, 等. 股外側區雙葉嵌合穿支皮瓣修復伴嚴重感染的肢體創面. 中華整形外科雜志, 2021, 37(5): 541-546.
17. 常樹森, 何春念, 金文虎. 股前外側皮瓣的供區并發癥. 中華顯微外科雜志, 2018, 41(1): 101-104.
18. 張敬良. 努力追求創面修復的 “泳褲供區” 理念. 中華顯微外科雜志, 2020, 43(1): 3-4.
19. 卿黎明, 賀繼強, 唐舉玉, 等. 旋股外側動脈降支穿支皮瓣供區直接閉合的可靠切取寬度及其影響因素分析. 中華顯微外科雜志, 2017, 40(2): 114-117.
20. Zapata-Ospina A, Chen J, Tee R, et al. Harvesting the anterolateral thigh flap with non-sizable perforators. J Plast Reconstr Aesthet Surg, 2021, 74(5): 1022-1030.
21. 王丹瑩, 劉元波, 陳威威, 等. CT血管造影預估近端蒂股前外側皮瓣血管蒂長度的臨床應用研究. 中國修復重建外科雜志, 2022, 36(3): 322-328.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of anterolateral thigh perforator flap pedicled with oblique branch in intramuscular of lateral circumflex femoral artery

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