Objective:To investigate the blood supply pattern and characteristics of bilobate anterolateral thigh flaps, and to summarize the clinical experience.Methods:Date of 102 cases of limb wounds repaired by bilateral anterolateral thigh perforator flaps from March 2014 to July 2019 were retrospectively analyzed. There were 80 males and 22 females with an average age of 40.7 years (range, 9-66 years). All of the patients suffered from limb trauma with complex tissue defects, among which 29 cases had two adjacent and discontinuous wound surfaces on the same limb, and the area ranged from 5 cm×5 cm to 30 cm×18 cm, while the other 73 cases remained a single wound with the area ranged from 12 cm×11 cm to 27 cm×15 cm. Ultrasonic Doppler was used to locate the perforating branches. According to different patterns of blood supply, flaps of different types were designed and applied respectively. For those who with perforating branches of common trunk type or fascial type, the wound surface can be covered by the flap directly; for those who with perforating branches of double trunks type or mixed type, the turbocharging technique was performed after dissection of the pedicles of the flap, while the wound was repaired by reconnection. All the donor sites were sutured directly.Results:Total of 105 bilobed flaps were designed in 102 patients, including 43 flaps of common trunk type, 30 flaps of double trunks type, 24 flaps of fascial type and 8 flaps of mixed type. The single harvested flap area ranged from 6 cm×5 cm to 20 cm×9 cm. One patient's one piece of the bilobed flap repairing two wounds suffered an arterial crisis at 17 h after surgery. The surgery confirmed there was an intractable arterial spasm and the crisis was relieved after a vein trans-plantation. Then about 4 cm×3 cm superficial necrosis appeared in the most distal part of the flap and healed in secondary after dressing changes. Two cases with single wounds suffered from a vein crisis at 48 h after operation. After removing the suture and blood letting, the flaps survived a week later. The average healing time was 19 days (range, 8-83 days). All the thigh donor sites healed by first stage. All the cases were followed-up for an average period of 16 month (range, 6-70 months). The latest follow-up showed that the flaps were of good color and texture, and the sensation of the flaps recovered partially. According to the British Medical Research Council sensory rating scale: 21 cases were grade S2 and 81 cases were grade S3. According to the revascularization assessments of digital replantation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 91 cases, good in 11 cases, with excellent and good rate of 100%. Linear scars were left in most donor sites and the VAS scores were all zero. 5 cases had a large scar area which the width was more than 3 cm, but there was no scar contracture or pain. 9 cases had an abnormal sensation in the donor area in the early stage and recovered gradually 3 months later without any movement disorder.Conclusion:The use of the bilobed anterolateral femoral perforator flap with different blood supply patterns to repair the wounds of extremities could overcome the lack or deficiency of blood supply caused by perforators with different sources. To clarify the blood supply types is conducive to the flap cutting and leaf splitting during the operation, which greatly improves the survival rate of the flap.

Objective:To explore the clinical effect of bilobate anterolateral thigh flaps with turbocharging technique in repairing limb wounds.Methods:A retrospective case series study was conducted to analyze the clinical data of 29 patients with complex wounds of limbs admitted to Ruihua Hospital Affiliated to Soochow University from March 2014 to July 2019. There were 26 males and 3 females, aged 22-60 years [(41.9±11.1)years]. A total of 24 patients had single-wounds with the dimension of 12 cm×10 cm to 38 cm×27 cm, and 5 patients had two adjacent and discontinuous wounds with the area from 7 cm×4 cm to 13 cm×9 cm. The bilobate anterolateral thigh flaps with turbocharging technique were used. All the donor sites were directly sutured by primary closure. Routine treatment was given after operation. The origin artery of perforators, time of flap harvesting and operation time were recorded. The survival of the flap, healing of the donor area, long-term shape of the flap and donor area, sensory recovery and complications were observed.Results:All patients were followed up for 6-64 months [(19.0±12.7)months]. A total of 30 bilobed flaps were designed for the 29 patients. The time of flap harvesting ranged from 25 to 60 minutes [(46.6±20.2)minutes]. The operation time was 4-11 hours [(6.4±1.8)hours]. All flaps survived except one piece of a bilobed flap suffered from a vein crisis, which healed well after conservative treatment. These wounds' healing time ranged from 11 to 53 days [(18.5±9.9)days], and all the donor sites healed by first intention. Four patients underwent skin flap thinning operation 4 to 8 months later due to the bloated appearance of flaps. Acceptable cosmetic outcomes, soft and elastic skin, and sensation recovery were achieved at the final follow-up. All patients 'donor area left linear scars. One patient had large scar area, but there was no scar contracture and pain. Two patients had an abnormal sensation in the incision area in the early stage and recovered gradually 3 months later without any other serious complications.Conclusions:Repair of limb wounds with bilobed anterolateral thigh flaps with turbocharged technique can overcome the limitation that the bilobed flap can not be designed if the perforators do not share the same trunk and expand the application scope of the bilobed flaps. The design of bilobate flaps reduces the width of the donor site, which can effectively avoid the complications of the donor site.

Objective:To explore the feasibility and clinical effect of repairing the wound of limbs with severe infection by the bilateral chimeric perforator flaps in the anterolateral femoral area.Methods:From December 2015 to October 2018, 12 cases of limb wounds with severe infection were repaired by the lateral femoral bilateral chimeric perforator flaps in the Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, including five cases of traffic accident, four cases of machine strangulation and three cases of other injuries. There were eight males and four females, aged from 25 to 48 years old, with an average age of 40-year-old. All the wounds were complicated with the exposure of bone, tendon, or internal fixation and had different degrees of infection, 10 cases were of soft tissue infection, and two cases were of osteomyelitis. The wounds were outlined by sample cloth. A total of nine cases had single-wounds with the dimension of 12 cm × 11 cm to 26 cm × 11 cm, and these bilobed chimeric flaps were designed by dividing the sample cloth into two parts from the center and changing the width to the length. Three cases had two adjacent and discontinuous wounds in just one limb with an area from 6 cm × 4 cm to 14 cm × 6 cm, and the bilobed flaps were designed according to the size and the shape of these wounds. Six cases were reconstructed with the bilateral chimeric flaps of which the branches originate from one artery, three with flaps of different original arteries, two with fascia skin flaps, and one with a flap of mixed blood supply. The lateral thigh muscle or tensor fascia muscle carried in the flap was used to fill the cavity or sinus, and the donor area was sutured directly. The flap survival, wound healing, and donor area recovery were observed after the operation.Results:All the flaps survived without vascular crisis. The flap size ranged from 24 cm × 6 cm to 32 cm × 7 cm in nine cases of the single wound, and 7 cm × 5 cm to 14 cm× 7 cm in three cases with two wounds. The volume of muscle resection ranged from 4 cm × 3 cm × 2 cm to 11 cm× 6 cm × 4 cm. The average time of wound healing was 27 days (range from 12 to 83 days). All the donor areas of the thigh healed primarily. Follow-up time was 7 to 32 months, showing good color and texture. The sensation of the flaps recovered partially. Linear scars were left in all donor sites, except that one case suffereda large scar with no contracture or pain. One patient had an abnormal sensation in the incision area early but recovered gradually after two months without other serious complications. During the follow-up period, two cases of osteomyelitis showed no sinus, skin nonunion, and wound abscess. One case underwent a bone flap operation due to the bone defect one year later, and the defect healed well.Conclusions:Anterolateral femoral bilateral chimeric perforator flaps could be designed flexibly according to the conditions of the recipient area. By carrying the muscle with an abundant blood supply, the infection can be effectively controlled, and the damage to the donor area can be reduced.

Objective:To explore the feasibility and clinical effect of repairing the wound of limbs with severe infection by the bilateral chimeric perforator flaps in the anterolateral femoral area.Methods:From December 2015 to October 2018, 12 cases of limb wounds with severe infection were repaired by the lateral femoral bilateral chimeric perforator flaps in the Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, including five cases of traffic accident, four cases of machine strangulation and three cases of other injuries. There were eight males and four females, aged from 25 to 48 years old, with an average age of 40-year-old. All the wounds were complicated with the exposure of bone, tendon, or internal fixation and had different degrees of infection, 10 cases were of soft tissue infection, and two cases were of osteomyelitis. The wounds were outlined by sample cloth. A total of nine cases had single-wounds with the dimension of 12 cm × 11 cm to 26 cm × 11 cm, and these bilobed chimeric flaps were designed by dividing the sample cloth into two parts from the center and changing the width to the length. Three cases had two adjacent and discontinuous wounds in just one limb with an area from 6 cm × 4 cm to 14 cm × 6 cm, and the bilobed flaps were designed according to the size and the shape of these wounds. Six cases were reconstructed with the bilateral chimeric flaps of which the branches originate from one artery, three with flaps of different original arteries, two with fascia skin flaps, and one with a flap of mixed blood supply. The lateral thigh muscle or tensor fascia muscle carried in the flap was used to fill the cavity or sinus, and the donor area was sutured directly. The flap survival, wound healing, and donor area recovery were observed after the operation.Results:All the flaps survived without vascular crisis. The flap size ranged from 24 cm × 6 cm to 32 cm × 7 cm in nine cases of the single wound, and 7 cm × 5 cm to 14 cm× 7 cm in three cases with two wounds. The volume of muscle resection ranged from 4 cm × 3 cm × 2 cm to 11 cm× 6 cm × 4 cm. The average time of wound healing was 27 days (range from 12 to 83 days). All the donor areas of the thigh healed primarily. Follow-up time was 7 to 32 months, showing good color and texture. The sensation of the flaps recovered partially. Linear scars were left in all donor sites, except that one case suffereda large scar with no contracture or pain. One patient had an abnormal sensation in the incision area early but recovered gradually after two months without other serious complications. During the follow-up period, two cases of osteomyelitis showed no sinus, skin nonunion, and wound abscess. One case underwent a bone flap operation due to the bone defect one year later, and the defect healed well.Conclusions:Anterolateral femoral bilateral chimeric perforator flaps could be designed flexibly according to the conditions of the recipient area. By carrying the muscle with an abundant blood supply, the infection can be effectively controlled, and the damage to the donor area can be reduced.

Objective To observe the changes of memory function in patients with mild traumatic brain injury(mTBI),and to explore the correlation between functional connection(FC)changes and montreal cognitive assessment(MoCA)scale scores in the mTBI cohort.Methods Thirty-nine patients with acute mTBI and 39 healthy controls were prospectively collected.All subjects underwent rs-fMRI scans,and FC values were calculated in both groups.Results Compared with healthy controls,the FC of the left posterior cingulate cortex,the left cuneus and the right calcarine fissure were enhanced.The FC of the left orbital superior frontal gyrus with the right superior temporal gyrus and the right postcentral gyrus was enhanced,and the FC of the right parahippocampal gyrus with the right medial and lateral cingulate gyrus,right thalamus and right caudate nucleus was weakened.Correlation analysis showed that there was no significant correlation between MoCA scale score and FC based on DMN network nodes.Conclusion The DMN network was damaged in patients with acute mTBI,and the memory function was impaired.In addition,no correlation was found between FC abnormalities and MoCA scale scores in this study