ANTEROLATERAL THIGH FLAP PEDICLED WITH MEDIAL SURAL VESSELS AS RECIPIENT VESSELS IN RECONSTRUCTION OF LEG SKIN AND SOFT TISSUE DEFECTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FUJiansong ,  GAOShunhong , ZHANGJingyu , ZHANGWenlong , ZHANGYunpeng , NIYulong

No. 2 Department of Hand Surgery, the Second Hospital of Tangshan (North China University of Science and Technology Affiliated Orthopedic Hospital), Tangshan Hebei, 063000, P. R. China;

Corresponding author：

GAOShunhong, Email: gshdj@126.com

Keywords：

Medial sural vessel; Anterolateral thigh flap; Free flap; Leg skin defect

DOI：

10.7507/1002-1892.20150174

Video：

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Objective To discuss the effectiveness of free anterolateral thigh flap pedicled with medial sural vessels for treatment of leg skin and soft tissue defects. Methods Between July 2008 and January 2014, 32 cases of serious skin and soft tissue defects in the leg were repaired by using free anterolateral thigh flap pedicled with medial sural artery and vein. Of them, there were 22 males and 10 females, aged 23 to 50 years (mean, 36.5 years). Defects were caused by traffic accidents injury in 9 cases, crash injury of heavy object in 15 cases, and machine twist injury in 8 cases. The left side was involved in 10 cases and the right side in 22 cases. The mean interval of injury and admission was 2.5 hours (range, 1-4 hours). The location was the upper, middle, and lower one third of the anterior tibia in 15 cases, 10 cases, and 7 cases respectively. The area of defect ranged from 10 cm×5 cm to 23 cm×9 cm. After debridement and vaccum sealing drainage treatment, the anterolateral thigh flap ranging from 12 cm×7 cm to 25 cm×11 cm pedicled with the medial sural vessels was used to repair the wound. The donor site was sutured directly or repaired with the skingrafts. Results All flaps and skingrafts survived after operation, and primary healing of wound was obtained. After 6-23 months (mean, 14.5 months) follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. The sensation of the flaps were recovered to S₂~S₃₊ according to the Britain's Medical Research Council criteria at 6 months after operation. No obvious scar contracture was observed at donor site. Conclusion The medial sural artery has the advantages of constant anatomical position, large diameter, rich blood flow, and a long artery pedicle, so the medial sural vessels is an ideal choice as recipient vessels for the reconstruction of leg skin and soft tissue defect.

Citation： FUJiansong, GAOShunhong, ZHANGJingyu, ZHANGWenlong, ZHANGYunpeng, NIYulong. ANTEROLATERAL THIGH FLAP PEDICLED WITH MEDIAL SURAL VESSELS AS RECIPIENT VESSELS IN RECONSTRUCTION OF LEG SKIN AND SOFT TISSUE DEFECTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 804-806. doi: 10.7507/1002-1892.20150174 Copy

1.	农明善,陈凯宁,杨幸,等.逆行股前外侧皮瓣移位修复胫骨外露创面.中国修复重建外科杂志,2012,26(3):316-318.
2.	Innocenti M,Cardin-Langlois E,Menichini G,et al.Gastrocnaemius-propeller extended miocutanous flap:a new chimaeric flap for soft tissue reconstruction of the knee.J Plast Reconstr Aesthet Surgery,2014,67(2):244-251.
3.	Krishnamoorthy VP,Inja DB,Roy AC.Knee extensor loss and proximal tibial soft tissue defect managed successfully with simultaneous medial gastrocnemius flap,saphenous fasciocutaneous flap and medial hemisoleus flap:a case report.J Med Case Rep,2013,7:76-81.
4.	Elghamry AH.The medial gastrocnemius muscle with an achilles tendon sheath extension flap as a versatile myo-tendon sheath flap for coverage of the upper two-thirds of the tibia and pre-tibial area:a preliminary report.J Plast Reconstr Aesthet Surg,2014,67(2):252-256.
5.	5王鲁云,郭林.小腿内侧逆行皮支皮瓣交腿应用的体会.中国骨与关节损伤杂志,2015,30(2):184-187.
6.	徐永清,李主一,李军,等.逆行供血的胸脐皮瓣游离移植修复胫骨外露创面.中国修复重建外科杂志,2000,14(6):352-354.
7.	Kang MJ,Chung CH,Chang YJ,et al.Reconstruction of the lower extremity using free flaps.Arch Plast Surg,2013,40(5):575-583.
8.	Gottlieb LJ,Krieger LM.From the reconstructive ladder to the reconstructive elevator.Plast Reconstr Surg,1994,93(7):1503-1504.
9.	Rao AL,Kanagal DV.Free flap:Important tool for lower extremity reconstruction.Journal of Evolution of Medical and Dental Sciences,2014,53(3):12234-12240.
10.	Lin CH,Mardini S,Lin YT,et al.Sixty-five clinical cases of free tissue transfer using long arteriovenous fistulas or vein grafts.J Trauma,2004,56(5):1107-1117.
11.	Parrett BM,Pribaz JJ.Lower extremity reconstruction.Rev Med Clin Condes,2010,21(1):66-75.
12.	Venkatramani H,Sabapathy SR,Nayak S.Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle.J Plast Reconstr Aesthet Surg,2014,67(1):93-98.
13.	Louer CR,Garcia RM,Earle SA,et al.Free flap reconstruction of the knee:an outcome study of 34 cases.Ann Plast Surg,2015,74(1):57-63.
14.	Parsa FD,Spira M.Evaluation of anastomotic techniques in the experimental transfer of free skin flaps.Plast Reconstr Surg,1979,63(5):696-699.
15.	Johnson PE,Harris GD,Nagle DJ,et al.The sural artery and vein as recipient vessels in free flap reconstruction about the knee.J Reconstr Microsurg,1987,3(3):233-241.
16.	He Y,Jin SF,Zhang CP,et al.Medial sural artery perforator flap aided by preoperative computed tomography angiography mapping for tongue reconstruction.Int J Oral Maxillofac Surg,2014,43(9):1064-1068.
17.	符健松,高顺红.膝周血管在下肢修复中的应用进展.中国矫形外科杂志,2015,23(8):705-708.
18.	Beumer JD,Karoo R,Caplash Y,et al.The medial sural artery as recipient vessel and the impact on the medial gastrocnemius.Ann Plastic Surg,2011,67(4):382-386.

1. 农明善,陈凯宁,杨幸,等.逆行股前外侧皮瓣移位修复胫骨外露创面.中国修复重建外科杂志,2012,26(3):316-318.
2. Innocenti M,Cardin-Langlois E,Menichini G,et al.Gastrocnaemius-propeller extended miocutanous flap:a new chimaeric flap for soft tissue reconstruction of the knee.J Plast Reconstr Aesthet Surgery,2014,67(2):244-251.
3. Krishnamoorthy VP,Inja DB,Roy AC.Knee extensor loss and proximal tibial soft tissue defect managed successfully with simultaneous medial gastrocnemius flap,saphenous fasciocutaneous flap and medial hemisoleus flap:a case report.J Med Case Rep,2013,7:76-81.
4. Elghamry AH.The medial gastrocnemius muscle with an achilles tendon sheath extension flap as a versatile myo-tendon sheath flap for coverage of the upper two-thirds of the tibia and pre-tibial area:a preliminary report.J Plast Reconstr Aesthet Surg,2014,67(2):252-256.
5. 5王鲁云,郭林.小腿内侧逆行皮支皮瓣交腿应用的体会.中国骨与关节损伤杂志,2015,30(2):184-187.
6. 徐永清,李主一,李军,等.逆行供血的胸脐皮瓣游离移植修复胫骨外露创面.中国修复重建外科杂志,2000,14(6):352-354.
7. Kang MJ,Chung CH,Chang YJ,et al.Reconstruction of the lower extremity using free flaps.Arch Plast Surg,2013,40(5):575-583.
8. Gottlieb LJ,Krieger LM.From the reconstructive ladder to the reconstructive elevator.Plast Reconstr Surg,1994,93(7):1503-1504.
9. Rao AL,Kanagal DV.Free flap:Important tool for lower extremity reconstruction.Journal of Evolution of Medical and Dental Sciences,2014,53(3):12234-12240.
10. Lin CH,Mardini S,Lin YT,et al.Sixty-five clinical cases of free tissue transfer using long arteriovenous fistulas or vein grafts.J Trauma,2004,56(5):1107-1117.
11. Parrett BM,Pribaz JJ.Lower extremity reconstruction.Rev Med Clin Condes,2010,21(1):66-75.
12. Venkatramani H,Sabapathy SR,Nayak S.Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle.J Plast Reconstr Aesthet Surg,2014,67(1):93-98.
13. Louer CR,Garcia RM,Earle SA,et al.Free flap reconstruction of the knee:an outcome study of 34 cases.Ann Plast Surg,2015,74(1):57-63.
14. Parsa FD,Spira M.Evaluation of anastomotic techniques in the experimental transfer of free skin flaps.Plast Reconstr Surg,1979,63(5):696-699.
15. Johnson PE,Harris GD,Nagle DJ,et al.The sural artery and vein as recipient vessels in free flap reconstruction about the knee.J Reconstr Microsurg,1987,3(3):233-241.
16. He Y,Jin SF,Zhang CP,et al.Medial sural artery perforator flap aided by preoperative computed tomography angiography mapping for tongue reconstruction.Int J Oral Maxillofac Surg,2014,43(9):1064-1068.
17. 符健松,高顺红.膝周血管在下肢修复中的应用进展.中国矫形外科杂志,2015,23(8):705-708.
18. Beumer JD,Karoo R,Caplash Y,et al.The medial sural artery as recipient vessel and the impact on the medial gastrocnemius.Ann Plastic Surg,2011,67(4):382-386.

Chinese Journal of Reparative and Reconstructive Surgery

ANTEROLATERAL THIGH FLAP PEDICLED WITH MEDIAL SURAL VESSELS AS RECIPIENT VESSELS IN RECONSTRUCTION OF LEG SKIN AND SOFT TISSUE DEFECTS

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