Application of perforators positioning technique in anterolateral thigh perforator sub lobe flap transplantation for reconstructing soft tissue defects of forearm or hand
10.3760/cma.j.issn.1001-8050.2018.10.006
- VernacularTitle:穿支定位技术辅助股前外侧分叶穿支皮瓣移植修复前臂及手部大面积软组织缺损
- Author:
Yongqiang KANG
1
;
Yongwei WU
;
Yunhong MA
;
Jun LIU
;
Tong YANG
;
Jun GU
;
Taotao HUI
;
Peng XU
;
Fang LIN
;
Yongjun RUI
Author Information
1. 214062 江苏省无锡市,无锡市第九人民医院,无锡市骨科医院创伤骨科
- Keywords:
Soft tissue injuries;
Surgical flaps;
Surgery,computed tomography;
Anterolateral thigh flap
- From:
Chinese Journal of Trauma
2018;34(10):886-891
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the clinical efficacy of perforators positioning technique in anterolateral thigh perforator sub lobe flap transplantation for reconstructing soft tissue defects of forearm or hand.Methods A retrospective case series study was performed to analyze 24 patients with forearm and hand soft tissue defects admitted from January 2013 to August 2017.There were 18 males and six females,aged 31-68 years (mean,52.3 years).The wound defect areas ranged from 11 cm × 10 cm to 18 cm× 14 cm.The anterolateral thigh sub lobe perforator flaps were used for repair.CT angiography (CTA) combined with color Doppler ultrasound (CDS) was used to determine the perforator position before operation.After the appropriate thigh side was selected according to the perforator position and the wound area,the lobed flaps were designed to ensure all the flaps for the stage I suture after the length was converted into width.All patients obtained stage Ⅱ repair,and the repair time was 5-29 days,with an average of 13 days.The accuracy of perforation positioning was observed during operation (the error was not more than 1 cm for accurate positioning).The flap survival and complications were recorded within 2 weeks after operation.Follow-up was performed using the seven indicators of flap function to evaluate the efficacy.Results The positioning accuracy rate was 99％.One case was seen necrosis about 2 cm at the proximal end of flap.Two cases had arterial crisis after flap operation and survived after active exploration.In two nonunion cases because of wound infection around the flap,one case was healed after dressing change,and another case was healed after debridement.The donor site of the flap obtained stage Ⅰ direct suture,and one case was seen obvious scar hyperplasia at the donor site.Flaps were made thinner in two patients with hand defects at the later stage.All 24 patients were followed up for 7-33 months,with an average of 18.3 months.According to the seven indexes of the flap function,the results were excellent in seven cases,good in 13,fair in three,and poor in onee,with an excellent and good rate of 83％.The flaps appeared soft with good color at the last follow-up.Conclusions In the treatment of soft tissue defects of forearm or hand using anterolateral thigh flap,conversion from length to width and direct suture of donor site can cover the wound well and reduce complications.Perforators positioning technique can facilitate precise preoperative planning and intraoperative accurate cutting.
