Clinical application of Flow-through chimeric anterolateral thigh perforator flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TANG Juyu ¹ , DU Wei ^1,2 , QING Liming ¹ , WU Panfeng ¹ , ZHOU Zhengbing ¹ , YU Fang ¹ , PANG Xiaoyang ¹ , ZENG Lei ¹ , PAN Ding ¹ , XIAO Yongbing ¹ , LIU Rui ¹

1. Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China;
2. Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China;

Corresponding author：

TANG Juyu, Email: tangjuyu@csu.edu.cn

Keywords：

Anterolateral thigh perforator flap; Flow-through; chimeric flap; extremity; wound repair

DOI：

10.7507/1002-1892.201802039

Video：

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Objective To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities. Methods Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients’ mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly. Results All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction. Conclusion The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.

Citation： TANG Juyu, DU Wei, QING Liming, WU Panfeng, ZHOU Zhengbing, YU Fang, PANG Xiaoyang, ZENG Lei, PAN Ding, XIAO Yongbing, LIU Rui. Clinical application of Flow-through chimeric anterolateral thigh perforator flap. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 1052-1055. doi: 10.7507/1002-1892.201802039 Copy

1.	Qing L, Wu P, Liang J, et al. Use of flow-through anterolateral thigh perforator flaps in reconstruction of complex extremity defects. J Reconstr Microsurgery, 2015, 31(8): 571-578.
2.	唐举玉, 周征兵, 吴攀峰, 等. 显微削薄穿支皮瓣技术在臃肿皮瓣二期削薄中的应用. 中华显微外科杂志, 2016, 39(1): 4-7.
3.	Zheng X, Zheng C, Wang B, et al. Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap. Int J Surg, 2016, 26: 25-31.
4.	李倩, 肖海涛, 岑瑛, 等. 选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损. 中国修复重建外科杂志, 2018, 32(3): 350-353.
5.	唐举玉. 特殊形式穿支皮瓣的临床应用教程. 中华显微外科杂志, 2013, 36(2): 201-205.
6.	Tang L, Pafitanis G, Yang P, et al. Combined multi-lobed flaps: A series of 39 extensive hand and multi-digit injuries one-staged reconstructions using modified designs of ALT, DPA and chimeric linking flaps. Injury, 2017, 48(7): 1527-1535.
7.	Arikawa M, Miyamoto S, Fujiki M, et al. Comparison of donor site drainage duration and seroma rate between latissimus dorsi musculocutaneous flaps and thoracodorsal artery perforator flaps. Ann Plast Surg, 2017, 79(2): 183-185.
8.	Debelmas A, Camuzard O, Aguilar P, et al. Reliability of color doppler ultrasound imaging for the assessment of anterolateral thigh flap perforators: a prospective study of 30 perforators. Plast Reconstr Surg, 2018, 141(3): 762-766.
9.	Kim JT, Kim SW, Youn S, et al. What is the ideal free flap for soft tissue reconstruction? A ten-year experience of microsurgical reconstruction using 334 latissimus dorsi flaps from a universal donor site. Ann Plast Surg, 2015, 75(1): 49-54.
10.	Tang J, Fang T, Song D, et al. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery, 2013, 33(8): 612-619.
11.	唐举玉, 章伟文, 张世民, 等. 中国特殊形式穿支皮瓣的名词术语与定义专家共识. 中华显微外科杂志, 2013, 36(2): 113-114.
12.	唐举玉, 吴攀峰, 俞芳, 等. 特殊类型穿支皮瓣在创伤骨科的临床应用. 中华创伤杂志, 2014, 30(11): 1085-1088.
13.	李成东, 陈国成, 颜世猛. Flow-through 股前外侧游离皮瓣修复下肢组织缺损的临床效果. 包头医学院学报, 2018, 34(3): 79-80.
14.	Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
15.	Hsiao YC, Yang JY, Chang CJ, et al. Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity. Burns, 2013, 39(3): 515-521.
16.	Miyamoto S, Fujiki M, Nakatani F, et al. Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery. Microsurgery, 2015, 35(6): 485-488.
17.	戚剑, 朱庆棠, 王东, 等. Flow-through 股前外侧游离皮瓣急诊修复上肢大面积软组织和主干血管缺损. 广东医学, 2015, 36 (15): 2293-2294.
18.	Henn D, Abouarab MH, Hirche C, et al. Sequential chimeric medial femoral condyle and anterolateral thigh flow-through flaps for one-stage reconstructions of composite bone and soft tissue defects: Report of three cases. Microsurgery, 2017, 37(7): 824-830.
19.	Aggarwal A, Singh H, Mahendru S, et al. A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect. Indian J Plast Surg, 2016, 49(1): 35-41.

1. Qing L, Wu P, Liang J, et al. Use of flow-through anterolateral thigh perforator flaps in reconstruction of complex extremity defects. J Reconstr Microsurgery, 2015, 31(8): 571-578.
2. 唐举玉, 周征兵, 吴攀峰, 等. 显微削薄穿支皮瓣技术在臃肿皮瓣二期削薄中的应用. 中华显微外科杂志, 2016, 39(1): 4-7.
3. Zheng X, Zheng C, Wang B, et al. Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap. Int J Surg, 2016, 26: 25-31.
4. 李倩, 肖海涛, 岑瑛, 等. 选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损. 中国修复重建外科杂志, 2018, 32(3): 350-353.
5. 唐举玉. 特殊形式穿支皮瓣的临床应用教程. 中华显微外科杂志, 2013, 36(2): 201-205.
6. Tang L, Pafitanis G, Yang P, et al. Combined multi-lobed flaps: A series of 39 extensive hand and multi-digit injuries one-staged reconstructions using modified designs of ALT, DPA and chimeric linking flaps. Injury, 2017, 48(7): 1527-1535.
7. Arikawa M, Miyamoto S, Fujiki M, et al. Comparison of donor site drainage duration and seroma rate between latissimus dorsi musculocutaneous flaps and thoracodorsal artery perforator flaps. Ann Plast Surg, 2017, 79(2): 183-185.
8. Debelmas A, Camuzard O, Aguilar P, et al. Reliability of color doppler ultrasound imaging for the assessment of anterolateral thigh flap perforators: a prospective study of 30 perforators. Plast Reconstr Surg, 2018, 141(3): 762-766.
9. Kim JT, Kim SW, Youn S, et al. What is the ideal free flap for soft tissue reconstruction? A ten-year experience of microsurgical reconstruction using 334 latissimus dorsi flaps from a universal donor site. Ann Plast Surg, 2015, 75(1): 49-54.
10. Tang J, Fang T, Song D, et al. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery, 2013, 33(8): 612-619.
11. 唐举玉, 章伟文, 张世民, 等. 中国特殊形式穿支皮瓣的名词术语与定义专家共识. 中华显微外科杂志, 2013, 36(2): 113-114.
12. 唐举玉, 吴攀峰, 俞芳, 等. 特殊类型穿支皮瓣在创伤骨科的临床应用. 中华创伤杂志, 2014, 30(11): 1085-1088.
13. 李成东, 陈国成, 颜世猛. Flow-through 股前外侧游离皮瓣修复下肢组织缺损的临床效果. 包头医学院学报, 2018, 34(3): 79-80.
14. Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
15. Hsiao YC, Yang JY, Chang CJ, et al. Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity. Burns, 2013, 39(3): 515-521.
16. Miyamoto S, Fujiki M, Nakatani F, et al. Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery. Microsurgery, 2015, 35(6): 485-488.
17. 戚剑, 朱庆棠, 王东, 等. Flow-through 股前外侧游离皮瓣急诊修复上肢大面积软组织和主干血管缺损. 广东医学, 2015, 36 (15): 2293-2294.
18. Henn D, Abouarab MH, Hirche C, et al. Sequential chimeric medial femoral condyle and anterolateral thigh flow-through flaps for one-stage reconstructions of composite bone and soft tissue defects: Report of three cases. Microsurgery, 2017, 37(7): 824-830.
19. Aggarwal A, Singh H, Mahendru S, et al. A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect. Indian J Plast Surg, 2016, 49(1): 35-41.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of Flow-through chimeric anterolateral thigh perforator flap

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