Comparison of the effects of anterolateral thigh flap with nerve and sural neurovascular flap in repairing soft tissue defect of foot and ankle
10.3760/cma.j.cn114453-20200303-00100
- VernacularTitle:带神经股前外侧皮瓣与腓肠神经营养血管皮瓣修复足踝部软组织缺损效果比较
- Author:
Dong LIU
1
;
Xin ZHOU
;
Changliang OU
;
Guanghui WU
;
Lin LUO
;
Yonggen ZOU
Author Information
1. 西南医科大学附属中医医院显微外科修复重建中心，泸州 646000
- Keywords:
Surgical flap;
Anterolateral thigh flap;
Sural neurocutaneous flap;
Foot;
Microsurgery
- From:
Chinese Journal of Plastic Surgery
2020;36(8):880-886
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of the free anterolateral thigh flap with nerve and the sural neurocutaneous flap on ankle and foot tissue defect, and to provide guidance for clinical selection.Methods:From May 2016 to May 2019, we reviewed and analyzed the data of patients with soft tissue injury of ankle and foot repaired by flap from Microsurgery Repair and Reconstruction Center, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University. According to the surgical method, they were divided into the free anterolateral thigh flap with nerve group and the sural neurocutaneous flap group. The survival rate of the 2 groups of skin flaps were calculated. According to the trial standard for evaluation of upper limb function in Chinese Medical Association Hand Surgery Society, the flaps were rated as excellent, good, and acceptable. And the excellent and good rates were counted. The incidence of regional complications of the 2 groups were counted. SPSS 26.0 software was used for analysis, the measurement data were subjected to t-test, expressed as mean±standard deviation; the categorical variables were subjected to chi-square test or Fisher’s exact probability method, and P<0.05 indicated that the difference was statistically significant. Results:A total of 59 patients with soft tissue defects in the foot and ankle were included. Among them, 21 cases were repaired with free anterolateral thigh flaps with nerve (group A), 12 males and 9 females, with an average age of 42.1 years, and the defect area was 4 cm×6 cm-11 cm ×16 cm, followed up for an average of 12.3 months after surgery; 17 cases of sural neurocutaneous flap repair (group B), 11 males and 6 females, average age 45.3 years, defect area 5 cm×5 cm-10 cm× 14 cm, the average follow-up was 11.3 months. There were no statistically significant differences in age, gender and cause of injury between the two groups ( P<0.05). The area of the flaps in group A and group B were (53.0±12.2) cm 2 and (46.4±9.62) cm 2, respectively. There was no significant difference between the two groups ( t=1.824, P=0.076). The flaps were all survived in both groups. Among them, 2 cases of group A had partial necrosis at the distal end of the flaps and healed after post-treatment; 1 case of group B had vascular crisis after operation, and the flaps survived after exploratory decompression. The first-stage survival rate of skin flaps in group A was 90.5% (19/21), and the first-stage survival rate of skin flaps in group B was 94.1% (16/17). The difference was not statistically significant ( P=1.000). According to the trial standard of upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the skin flaps in group A were excellent in 10 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 81.0% (17/21). In group B, skin flaps were excellent in 3 cases and good in 3 cases. Of the 11 cases, the excellent and good rate was 35.3% (6/17), and the difference was statistically significant ( P=0.007). The flap donor area in group A healed well without related complications. In group B, 2 patients (11.8%) developed scar contracture deformity after the flap donor area, which affected calf function, and the function recovered after the second-stage scar was released. The incidence of complications in the region was not statistically significant ( P=0.193). Conclusions:Both the free anterolateral thigh flap with nerve and the sural neurocutaneous flap can repair the soft tissue defect of foot and ankle with high survival rate. But the sural neurocutaneous flap has a higher good rate than the free anterolateral thigh flap with nerve, and the donor site is affected smaller.
