Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Lin ¹ , LIU Hongjun ¹ , ZHANG Wenzhong ¹ , SONG Guoxun ¹ , XIA Shicong ² , ZHANG Naichen ¹ ,  GU Jiaxiang ¹ , YUAN Chaoqun ¹

1. Department of Hand and Foot Microsurgery, Clinical Medicine College of Yangzhou University, Subei People’s Hospital of Jiangsu Province, Yangzhou Jiangsu, 225001, P.R.China;
2. Department of Orthopaedics, Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China;

Corresponding author：

GU Jiaxiang, Email: gjx69@163.com

Keywords：

Anterolateral thigh perforator flap; soft tissue defect; cross-bridge; lower leg; wound repair

DOI：

10.7507/1002-1892.201705022

Video：

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Objective To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg. Methods Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation. Results After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site. Conclusion Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle and lower segments of the leg.

Citation： YANG Lin, LIU Hongjun, ZHANG Wenzhong, SONG Guoxun, XIA Shicong, ZHANG Naichen, GU Jiaxiang, YUAN Chaoqun. Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1240-1244. doi: 10.7507/1002-1892.201705022 Copy

1.	侯春林, 刘小林. 中国显微外科历史回顾. 中华显微外科杂志, 2015, 38(5): 417-419.0.
2.	任义军, 胡锐, 严立, 等. 股前外侧组织瓣修复下肢多处皮肤软组织缺损. 中华显微外科杂志, 2015, 38(5): 447-450.0.
3.	符健松, 高顺红, 张净宇, 等. 以腓肠内侧血管为受区血管的游离股前外侧皮瓣移植修复小腿皮肤软组织缺损. 中国修复重建外科杂志, 2015, 29(7): 804-806.0.
4.	李海军, 郑晓菊, 张忠, 等. 股前外侧嵌合皮瓣与 Flow-through 修复四肢环形组织缺损. 中华显微外科杂志, 2017, 40(1): 97-100.0.
5.	Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg, 1993, 96(9): 488-492.
6.	汤样华, 曾林如, 黄忠名, 等. 封闭式负压引流联合游离股前外侧皮瓣修复 Pilon 骨折术后软组织缺损. 中国修复重建外科杂志, 2012, 26(11): 1407-1408.0.
7.	Marsh DJ, Chana JS. Reconstruction of very large defeets: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Recons Aesthet Surg, 2010, 63(1): 120-125.
8.	隋海明, 丛海波, 翟建国, 等. 大面积股前外侧皮瓣的设计与切取: 附 28 例报告. 中华显微外科杂志, 2014, 37(2): 143-146.0.
9.	朱跃良, 殷作明, 王家祥, 等. 股前外侧穿支皮瓣切取技巧分析. 中国修复重建外科杂志, 2017, 31(1): 57-61.0.
10.	齐伟亚, 郑大伟, 张旭阳, 等. 血运重建后皮瓣修薄法在股前外侧皮瓣游离移植中的应用. 中国修复重建外科杂志, 2016, 30(4): 525-527.0.
11.	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.
12.	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.
13.	徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学——一个新的游离皮瓣供区. 临床应用解剖学杂志, 1984, 23(3): 158.0.
14.	罗力生, 高建华, 陈林峰, 等. 股前外侧皮瓣及其游离移植的应用. 第一军医大学学报, 1984, 4(4): 1-4.0.
15.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
16.	Valdatta L, Tuinder S, Buoro M, et al. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg, 2002, 49(2): 145-150.
17.	周鹏, 杨新东, 徐象党, 等. 股前外侧区穿支动脉的形态学研究及皮瓣设计. 中华显微外科杂志, 2007, 30(3): 203-205.0.
18.	王爱国, 邱勇. 股前外侧皮瓣远侧肌皮穿支的解剖学研究与临床应用. 中华骨科杂志, 2011, 31(3): 255-259.0.
19.	Fabio S, Stefania T, Andrea P, et al. Free flap reconstruction of the sole of the foot with or with out sensory nerve coaptation. Plast Reconstr Surg, 2002, 109(7): 2314-2322.
20.	杨何平, 张洪武, 杨书雄, 等. 带感觉神经与失神经的股前外侧穿支皮瓣在头颈部感觉重建的对比研究. 中华显微外科杂志, 2016, 39(3): 225-229.0.
21.	Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study. Plast Reconstr Surg, 2014, 133(2): 420-429.
22.	Hughes T, Yu Jonathan TS, Wong KY, et al. " Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap. Int J Surg Case Rep, 2013, 4(5): 453-455.

1. 侯春林, 刘小林. 中国显微外科历史回顾. 中华显微外科杂志, 2015, 38(5): 417-419.0.
2. 任义军, 胡锐, 严立, 等. 股前外侧组织瓣修复下肢多处皮肤软组织缺损. 中华显微外科杂志, 2015, 38(5): 447-450.0.
3. 符健松, 高顺红, 张净宇, 等. 以腓肠内侧血管为受区血管的游离股前外侧皮瓣移植修复小腿皮肤软组织缺损. 中国修复重建外科杂志, 2015, 29(7): 804-806.0.
4. 李海军, 郑晓菊, 张忠, 等. 股前外侧嵌合皮瓣与 Flow-through 修复四肢环形组织缺损. 中华显微外科杂志, 2017, 40(1): 97-100.0.
5. Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg, 1993, 96(9): 488-492.
6. 汤样华, 曾林如, 黄忠名, 等. 封闭式负压引流联合游离股前外侧皮瓣修复 Pilon 骨折术后软组织缺损. 中国修复重建外科杂志, 2012, 26(11): 1407-1408.0.
7. Marsh DJ, Chana JS. Reconstruction of very large defeets: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Recons Aesthet Surg, 2010, 63(1): 120-125.
8. 隋海明, 丛海波, 翟建国, 等. 大面积股前外侧皮瓣的设计与切取: 附 28 例报告. 中华显微外科杂志, 2014, 37(2): 143-146.0.
9. 朱跃良, 殷作明, 王家祥, 等. 股前外侧穿支皮瓣切取技巧分析. 中国修复重建外科杂志, 2017, 31(1): 57-61.0.
10. 齐伟亚, 郑大伟, 张旭阳, 等. 血运重建后皮瓣修薄法在股前外侧皮瓣游离移植中的应用. 中国修复重建外科杂志, 2016, 30(4): 525-527.0.
11. 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.
12. 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.
13. 徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学——一个新的游离皮瓣供区. 临床应用解剖学杂志, 1984, 23(3): 158.0.
14. 罗力生, 高建华, 陈林峰, 等. 股前外侧皮瓣及其游离移植的应用. 第一军医大学学报, 1984, 4(4): 1-4.0.
15. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
16. Valdatta L, Tuinder S, Buoro M, et al. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg, 2002, 49(2): 145-150.
17. 周鹏, 杨新东, 徐象党, 等. 股前外侧区穿支动脉的形态学研究及皮瓣设计. 中华显微外科杂志, 2007, 30(3): 203-205.0.
18. 王爱国, 邱勇. 股前外侧皮瓣远侧肌皮穿支的解剖学研究与临床应用. 中华骨科杂志, 2011, 31(3): 255-259.0.
19. Fabio S, Stefania T, Andrea P, et al. Free flap reconstruction of the sole of the foot with or with out sensory nerve coaptation. Plast Reconstr Surg, 2002, 109(7): 2314-2322.
20. 杨何平, 张洪武, 杨书雄, 等. 带感觉神经与失神经的股前外侧穿支皮瓣在头颈部感觉重建的对比研究. 中华显微外科杂志, 2016, 39(3): 225-229.0.
21. Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study. Plast Reconstr Surg, 2014, 133(2): 420-429.
22. Hughes T, Yu Jonathan TS, Wong KY, et al. " Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap. Int J Surg Case Rep, 2013, 4(5): 453-455.

Chinese Journal of Reparative and Reconstructive Surgery

Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg

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