Application of end-to-side arterial anastomosis in the transplantation of lobulated free anterolateral thigh flap with a single perforating branch for repair of large soft tissue defects in limbs
10.3760/cma.j.cn114453-20240115-00023
- VernacularTitle:股前外侧单穿支分叶皮瓣联合动脉端侧吻合法修复四肢大面积软组织缺损
- Author:
Haisheng QIU
1
;
Xiao NI
;
Fangzheng YU
Author Information
1. 温州医科大学附属第一医院手外科、周围神经外科，温州 325000
- Keywords:
Surgical flaps;
Anterolateral thigh flap;
Perforator flap;
Lobulated skin flap;
Vascular anastomosis;
Microsurgical technique;
Limbs;
Wound
- From:
Chinese Journal of Plastic Surgery
2024;40(9):970-976
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods:A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022. Before surgery, Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch. Based on the shape and size of the wound, a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella, and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched. The skin flap was transplanted to the recipient site of the limbs, and after reasonable combination, the wound was covered. An oval hole of suitable size was cut on the side of the receiving artery. The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it, while the accompanying veins of the two were still anastomosed end-to-end. The incision was directly sutured in the donor area. Follow up and observation were conducted for the survival status, appearance, color, texture, wound healing, scar condition, and limb function of the skin flap after surgery.Results:A total of 18 patients were included, including 12 males and 6 females, age range: 41-60 years old, with an average of 48.5 years old. There were 8 cases of hands and wrists, 4 cases of forearms, 4 cases of calves, and 2 cases of feet. The wound was large and irregular, or with multiple defects, all accompanied by bone or tendon exposure, with a wound area of 5 cm × 13 cm to 17 cm × 28 cm. The area of the lobulated skin flap harvested during the operation ranged from 3 cm × 9 cm to 24 cm × 10 cm. The combined flap area was 6 cm × 14 cm to 18 cm × 30 cm. All 18 flaps survived successfully, with one case experiencing arterial crisis, which was resolved through arterial re-anastomosis. No significant contracture was observed during the 3 months to 4 years of follow-up, and the appearance of the flaps was satisfactory. The donor sites in all 18 cases healed primarily. Only linear scars remain, with no impact on limb function.Conclusion:The lobulated anterolateral thigh flap with a single perforating branch can not only effectively repair the extensive irregular or multiple defects in limbs, but also facilitate direct primary closure of the donor site and reduce donor site morbidity. Additionally, end-to-side arterial anastomosis can reduce the risk of injury to the recipient’s main vessels, lower the difficulty of vascular anastomosis, and ensure a high flap survival rate.
