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 explore the application effect of rotating skin flap in the repair of skin and soft tissue defects in the perineum.Methods:A retrospective analysis was conducted on the data of 9 patients with perineal soft tissue defects treated in the Department of the First Affiliated Hospital, Wenzhou Medical University from January 2022 to March 2024. Among them, 8 cases were soft tissue defects after extensive resection of Paget′s disease in the perineum, and 1 case was soft tissue defects after treatment of severe urethral stricture. The defect area ranged from 4 cm×1.5 cm to 30 cm×35 cm, and all wounds were repaired with rotating skin flaps, For patients with excessive area, rotating skin flaps were used to cover important areas, combined with autologous skin and artificial skin to cover the remaining wounds. Patients with urethral stricture were treated with free oral mucosal reconstruction of the urethra combined with rotational skin flap coverage. The donor site was directly sutured or autologous skin was transplanted.Results:After surgery, the recipient skin flaps of 9 patients survived and the donor area healed. After a follow-up of 9-15 months, the skin flap survived well, with skin color approaching normal, and the donor site wound healed well. Eight patients with Paget′s disease did not show any recurrence, among which one patient with extensive wound expansion had good recovery of the perineal skin flap coverage area, and small-scale chronic ulcers appeared in the skin graft area. The skin flap of the patient with urethral stricture had recovered well, and the shape of the penis was good, without any urethral stricture, urinary fistula, sinus tract, etc.Conclusions:The rotational skin flap has a clear therapeutic effect on perineal soft tissue defects and is suitable for repairing perineal skin and soft tissue defects.