Application of multiple-perforator extra-large anterolateral thigh flap for repairing of circular wound of foot and ankle
10.3760/cma.j.cn114453-20200309-00130
- VernacularTitle:多穿支超长股前外侧皮瓣修复足踝部环形创面
- Author:
Rong ZHOU
1
;
Jihui JU
;
Zhijin LIU
;
Shengzhe LIU
;
Liping GUO
;
Yuefei LIU
;
Changqing HU
;
Liang YANG
Author Information
1. 苏州大学附属瑞华医院足踝外科 215104
- Keywords:
Perforator flap;
Foot injuries;
Ankle injuries;
Microsurgery;
Circular wound
- From:
Chinese Journal of Plastic Surgery
2021;37(11):1244-1250
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of multiple-perforator extra-large anterolateral thigh flap (ALT) for repairing the circular wound of foot and ankle.Methods:Data of 13 cases with the circular wound of foot and ankle repaired by foot and ankle surgery in Ruihua Affiliated Hospital of Soochow University from October 2011 to June 2018 were retrospectively analyzed. The perforator was located by color Doppler ultrasound before the operation, and the flap was designed according to the size of the wound. Both the perforator vessel and lateral femoral cutaneous nerve entering the flap should be carefully protected. When all perforating branches in the flap come from the same vascular trunk, two or more perforating branches are carried to cover the wound directly; when the branches come from the different trunks, the turbocharging technique was used to ensure that there are two or more perforators to nourish the flap. All the donor areas were closed primarily. The sensory of flaps were elevated by the British Medical Research Council (BMRC) sensory function assessment standard, and the motor function was elevated by the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function scoring system.Results:A total of 13 patients were enrolled in this study, including 8 males and 5 females.The age ranged from 21 to 65 years, with an average of 39 years. The wound area was 21.0 cm×6.0 cm to 35.0 cm×18.0 cm with exposure of bone and tendon. 12 cases were repaired with multiple-perforator extra-large anterolateral thigh flap ( ALT) harvested from one thigh, and 1 case was repaired with the combined bilateral ALT flap due to the huge wound. The size of flap was 21.0 cm × 7.0 cm to 35.0 cm×10.0 cm. During the procedure, 14 flaps were successfully harvested, 9 flaps were supplied by two perforators, 4 by three perforators, and 1 by four skin perforators. Each flap had an average of 2.4 perforators. Among them, there were 5 flaps with the common source perforators while the other 9 flaps whose perforators came from different sources. All flaps in this group finally survived. One flap suffered the venous crisis 24 hours after the operation and survived after removing the thrombus and re-anastomosing the vessel again. The stitches were removed 2 to 3 weeks after operation when the wound had healed. All wounds in the donor area healed primarily. 9 flaps underwent flap thinning and plastic surgery 6 to 10 months after the operation. Follow-up for 6 to 18 months showed the color and texture of the flap was close to the recipient area, and the sensation of the flap elevated by BMRC sensory function assessment standard was S2-S3. According to the AOFAS ankle and hindfoot scoring system, the function of the recipient area was 72-98 points, with an average of 92 points. Only linear scars were left in the donor area.Conclusions:Because of the advantages of rich blood supply, strong anti-infection ability, and less damage to the donor area, it is an ideal method to repair the circular wound of the foot and ankle with multiple-perforator extra-large anterolateral thigh flap.
