Objective:To summarize and discuss the clinical effect of different forms of anterolateral femoral perforator flap in the repair of acute lower extremity lesions based on the theory of damage control orthopaedics (DCO).Methods:The clinical data of 33 patients with acute destructive wounds in the lower limbs admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2022 were retrospectively analyzed. Under the guidance of the DCO theory, the combined injuries were treated through multidisciplinary consultation, and at the same time, first-stage debridement, bone stent restoration, limb blood transport reconstruction, nerve tendon repair and temporary vacuum sealing drainage (VSD) dressing were applied. After the systemic condition was stabilized, the wound was repaired with anterolateral femoral perforator flaps of different forms. The defect area was 8.0 cm×5.0 cm-35.0 cm×25.0 cm, and the donor flap area was closed in one stage in all cases.Results:30 cases of skin flap survived completely after operation, 2 cases had distal partial necrosis, wound healing after dressing change, 1 case had delayed complete necrosis. The follow-up time was 9-25(14.7±5.3)months. 2 patients were treated with the second stage of repair surgery due to the bloated flap. The rest were satisfied with the shape of the reconstructed flap and the donor flap area, and the ankle joint function score was good.Conclusions:DCO theory combined with anterolateral femoral perforator flap is a safe and effective way to repair the mutilated wounds of lower limbs.

Objective:To summarize and discuss the clinical effect of different forms of anterolateral femoral perforator flap in the repair of acute lower extremity lesions based on the theory of damage control orthopaedics (DCO).Methods:The clinical data of 33 patients with acute destructive wounds in the lower limbs admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2022 were retrospectively analyzed. Under the guidance of the DCO theory, the combined injuries were treated through multidisciplinary consultation, and at the same time, first-stage debridement, bone stent restoration, limb blood transport reconstruction, nerve tendon repair and temporary vacuum sealing drainage (VSD) dressing were applied. After the systemic condition was stabilized, the wound was repaired with anterolateral femoral perforator flaps of different forms. The defect area was 8.0 cm×5.0 cm-35.0 cm×25.0 cm, and the donor flap area was closed in one stage in all cases.Results:30 cases of skin flap survived completely after operation, 2 cases had distal partial necrosis, wound healing after dressing change, 1 case had delayed complete necrosis. The follow-up time was 9-25(14.7±5.3)months. 2 patients were treated with the second stage of repair surgery due to the bloated flap. The rest were satisfied with the shape of the reconstructed flap and the donor flap area, and the ankle joint function score was good.Conclusions:DCO theory combined with anterolateral femoral perforator flap is a safe and effective way to repair the mutilated wounds of lower limbs.

Objective:To evaluate the clinical results of using the free polyfoliate anterolateral thigh perforator flaps based on a single perforator in repair large soft tissue defects in extremities.Methods:Between March, 2014 and April, 2019, 9 patients with large soft tissue defects in extremities were repaired with the free polyfoliate anterolateral thigh perforator flaps based on a single perforator. One of the patients were repaired with bilateral free polyfoliate anterolateral thigh perforator flaps. Six defects on hand and wrist, 1 on forearm, 1 on shank and 1 on foot. The sizes of soft tissue defect ranged 5 cm×19 cm-17 cm×24 cm. All the wounds of donor site were closed primarily.Results:Seven flaps survived without vascular incidence. One flap developed artery crisis after surgery with the bilateral free polyfoliate anterolateral thigh perforator flaps. After emergency re-anastomosing, the flap survived successfully. Necrosis on one-leaf occurred in one flap, which was finally repaired by skin graft. The clinical results were satisfactory after 3-48 months of followed-up. The scars of the donor site were not obvious.Conclusion:The free polyfoliate anterolateral thigh perforator flaps can be designed with only one perforator. The flap can be changed into a variety of shapes based on the combination of the polyfoliate flaps in order to repair a large soft tissue defects in extremity. The polyfoliate flap has advantages of less donor site injury with a high survival rate.