Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf soft tissue defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHOU Hongxiang ¹ , ZHONG Lin ¹ , HE Liang ¹ , HUANG Jun ¹ , ZHOU Tao ¹ , ZHOU Ding ¹ , WANG Zifu ¹ , YIN Dong ¹ , JIN Zhe ¹ , NIU Yang ¹ , ZHOU Yuyang ²

1. Microscopic Repair and Reconstruction and Foot and Ankle Ward, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P. R. China;
2. Anqing Medical College, Anqing Anhui, 246052, P. R. China;

Corresponding?author：

ZHOU Hongxiang, Email: zhouhx8888@163.com

Keywords：

Bridge flap; anterolateral thigh flap; Flow-through technique; complex calf soft tissue defect

DOI：

10.7507/1002-1892.202212073

Video：

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Objective To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects. Methods The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation (P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society’s functional evaluation standard for replantation of amputated limbs. Weber’s quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups. Results No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group (P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) (χ²=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation (P>0.05). Conclusion Flow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.

Citation： ZHOU Hongxiang, ZHONG Lin, HE Liang, HUANG Jun, ZHOU Tao, ZHOU Ding, WANG Zifu, YIN Dong, JIN Zhe, NIU Yang, ZHOU Yuyang. Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf soft tissue defects. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 482-487. doi: 10.7507/1002-1892.202212073 Copy

1.	Alexander Leijdesdorff HA, van Dijck JT, Krijnen P, et al. Accidents involving a motorized mobility scooter: a growing problem. Ned Tijdschr Geneeskd, 2014, 158: A7858.
2.	王強, 巨積輝, 劉杰, 等. Flow-through股前外側穿支皮瓣在斷肢再植創面修復中的應用. 中華顯微外科雜志, 2020, 43(6): 540-543.
3.	Gülaydin A, Sarierler M. Treatment of long bone fractures in calves with Ilizarov external fixator. Vet Comp Orthop Traumatol, 2018, 31(5): 364-372.
4.	Radtke C, Meyer-Marcotty M. Reconstruction of soft tissue defects of the lower extremities. Unfallchirurg, 2021, 124(10): 782-788.
5.	Ciofu RN, Zamfirescu DG, Popescu SA, et al. Reverse sural flap for ankle and heel soft tissues reconstruction. J Med Life, 2017, 10(1): 94-98.
6.	王爽, 舒衡生, 石博文, 等. Ilizarov技術結合腓腸神經或隱神經營養血管皮瓣治療足踝部軟組織缺損伴創傷后馬蹄足畸形. 中華骨科雜志, 2019, 39(5): 305-312.
7.	Kim JH, Yoo H, Eun S. Reconstruction of extensive soft tissue defects of lower extremity with the extended anterolateral thigh flap. Int J Low Extrem Wounds, 2022, 21(4): 601-608.
8.	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.
9.	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.
10.	于仲嘉, 曾炳芳, 何鶴皋. 橋式交叉吻合血管游離組織移植. 中華骨科雜志, 1994, 14(6): 332-335, C2.
11.	Taskin B, Bender R, Sch?ller S, et al. Soft tissue reconstruction of the lower extremity with cross-leg flap as a salvage procedure. Handchir Mikrochir Plast Chir, 2021, 53(4): 383-385.
12.	Zhou HX, He L, Yin D, et al. Modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure for complex lower extremity reconstruction. J Orthop Surg Res, 2022, 17(1): 262. doi: 10.1186/s13018-022-03155-9.
13.	金文虎, 張子陽, 吳祥奎, 等. 改良橋式交叉游離皮瓣修復小腿軟組織缺損. 中華創傷雜志, 2021, 37(10): 900-905.
14.	Bali ZU, Karatan B, Tuluy Y, et al. Preserving the blood flow of the recipient artery in cross-leg free flap procedure for lower extremity reconstruction. Int J Low Extrem Wounds, 2020, 19(3): 255-261.
15.	周洪翔, 何亮, 尹東, 等. 橋式交叉 “Y” 形血管吻合ALTF移植修復小腿復雜軟組織缺損33例. 中華顯微外科雜志, 2020, 19(3): 255-261.
16.	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): 130-135.
17.	Cavit A, Civan O, ?zcanl? H. Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries. Acta Orthop Traumatol Turc, 2021, 55(4): 332-337.
18.	Zhang C, Liu Y, Yuan S, et al. Cross-cultural adaptation and validation of the simplified chinese version of the lower extremity functional scale. Biomed Res Int, 2020, 2020: 1421429. doi: 10.1155/2020/1421429.
19.	周征兵, 唐舉玉, 吳攀峰, 等. 雙側旋股外側動脈降支穿支皮瓣組合移植修復下肢大面積軟組織缺損. 中華顯微外科雜志, 2020, 43(6): 535-539.
20.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
21.	Jia YC, Chen HH, Kang QL, et al. Combined anterolateral thigh and anteromedial thigh flap for extensive extremity reconstruction: vascular anatomy and clinical application. J Reconstr Microsurg, 2015, 31(9): 674-680.
22.	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.
23.	Püschmann H, Rahmanzadeh R, Gorkisch K. Restorative surgery on the lower leg using muscular shifting grafts-anatomical and clinical aspects. Aktuelle Traumatol, 1980, 10(5): 281-285.
24.	鐘林, 何亮, 尹東, 等. 游離植皮包裹血管橋的股前外側橋式皮瓣在復雜小腿軟組織缺損中的應用. 中國修復重建外科雜志, 2022, 36(5): 619-624.
25.	柳志錦, 程俊楠, 楊林, 等. 股前外側區組合穿支皮瓣在嚴重創傷肢體保肢治療中的應用效果. 中華外科雜志, 2022, 60(5): 486-489.

1. Alexander Leijdesdorff HA, van Dijck JT, Krijnen P, et al. Accidents involving a motorized mobility scooter: a growing problem. Ned Tijdschr Geneeskd, 2014, 158: A7858.
2. 王強, 巨積輝, 劉杰, 等. Flow-through股前外側穿支皮瓣在斷肢再植創面修復中的應用. 中華顯微外科雜志, 2020, 43(6): 540-543.
3. Gülaydin A, Sarierler M. Treatment of long bone fractures in calves with Ilizarov external fixator. Vet Comp Orthop Traumatol, 2018, 31(5): 364-372.
4. Radtke C, Meyer-Marcotty M. Reconstruction of soft tissue defects of the lower extremities. Unfallchirurg, 2021, 124(10): 782-788.
5. Ciofu RN, Zamfirescu DG, Popescu SA, et al. Reverse sural flap for ankle and heel soft tissues reconstruction. J Med Life, 2017, 10(1): 94-98.
6. 王爽, 舒衡生, 石博文, 等. Ilizarov技術結合腓腸神經或隱神經營養血管皮瓣治療足踝部軟組織缺損伴創傷后馬蹄足畸形. 中華骨科雜志, 2019, 39(5): 305-312.
7. Kim JH, Yoo H, Eun S. Reconstruction of extensive soft tissue defects of lower extremity with the extended anterolateral thigh flap. Int J Low Extrem Wounds, 2022, 21(4): 601-608.
8. 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.
9. 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.
10. 于仲嘉, 曾炳芳, 何鶴皋. 橋式交叉吻合血管游離組織移植. 中華骨科雜志, 1994, 14(6): 332-335, C2.
11. Taskin B, Bender R, Sch?ller S, et al. Soft tissue reconstruction of the lower extremity with cross-leg flap as a salvage procedure. Handchir Mikrochir Plast Chir, 2021, 53(4): 383-385.
12. Zhou HX, He L, Yin D, et al. Modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure for complex lower extremity reconstruction. J Orthop Surg Res, 2022, 17(1): 262. doi: 10.1186/s13018-022-03155-9.
13. 金文虎, 張子陽, 吳祥奎, 等. 改良橋式交叉游離皮瓣修復小腿軟組織缺損. 中華創傷雜志, 2021, 37(10): 900-905.
14. Bali ZU, Karatan B, Tuluy Y, et al. Preserving the blood flow of the recipient artery in cross-leg free flap procedure for lower extremity reconstruction. Int J Low Extrem Wounds, 2020, 19(3): 255-261.
15. 周洪翔, 何亮, 尹東, 等. 橋式交叉 “Y” 形血管吻合ALTF移植修復小腿復雜軟組織缺損33例. 中華顯微外科雜志, 2020, 19(3): 255-261.
16. 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): 130-135.
17. Cavit A, Civan O, ?zcanl? H. Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries. Acta Orthop Traumatol Turc, 2021, 55(4): 332-337.
18. Zhang C, Liu Y, Yuan S, et al. Cross-cultural adaptation and validation of the simplified chinese version of the lower extremity functional scale. Biomed Res Int, 2020, 2020: 1421429. doi: 10.1155/2020/1421429.
19. 周征兵, 唐舉玉, 吳攀峰, 等. 雙側旋股外側動脈降支穿支皮瓣組合移植修復下肢大面積軟組織缺損. 中華顯微外科雜志, 2020, 43(6): 535-539.
20. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
21. Jia YC, Chen HH, Kang QL, et al. Combined anterolateral thigh and anteromedial thigh flap for extensive extremity reconstruction: vascular anatomy and clinical application. J Reconstr Microsurg, 2015, 31(9): 674-680.
22. 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.
23. Püschmann H, Rahmanzadeh R, Gorkisch K. Restorative surgery on the lower leg using muscular shifting grafts-anatomical and clinical aspects. Aktuelle Traumatol, 1980, 10(5): 281-285.
24. 鐘林, 何亮, 尹東, 等. 游離植皮包裹血管橋的股前外側橋式皮瓣在復雜小腿軟組織缺損中的應用. 中國修復重建外科雜志, 2022, 36(5): 619-624.
25. 柳志錦, 程俊楠, 楊林, 等. 股前外側區組合穿支皮瓣在嚴重創傷肢體保肢治療中的應用效果. 中華外科雜志, 2022, 60(5): 486-489.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf soft tissue defects

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