Application of Zunyi’s Suture Method for donor site of anterolateral thigh flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHANG Shusen , MO Xiaojin ,  WEI Zairong , LI Hai , ZHOU Jian , SHI Chenshuo , DENG Chengliang , NIE Kaiyu , WU Bihua , WANG Dali

Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China;

Corresponding author：

WEI Zairong, Email: zairongwei@163.com

Keywords：

Anterolateral thigh flap; Zunyi’s Suture Method; donor site; scar; tension

DOI：

10.7507/1002-1892.202008101

Video：

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Objective To investigate the effectiveness of multiple tension reduction suture of in-situ return needle vertical mattress suture and in-situ return needle horizontal mattress suture combination with intradermal intermittent continuous suture (denominated as Zunyi’s Suture Method) on suturing the donor site of the anterolateral thigh flap. Methods Between January 2019 and December 2019, 62 patients were treated with anterolateral thigh flaps to repair wounds. There were 46 males and 16 females, aged 9-67 years (mean, 31 years). The size of anterolateral thigh flap ranged from 6 cm×5 cm to 25 cm×7 cm. The donor site of the flap was sutured directly by the Zunyi’s Suture Method. The skin on both sides of the incision was advanced to the middle, and the wound edge was attached and in a state of negative tension. The intradermal suture line was removed at 7 days after operation. The complications and scars at donor site were observed during follow-up. The Vancouver Scar Scale was used to assess the appearance of scars and the width of scars were measured at 6 months after operation.Results The flaps survived smoothly, and the wounds healed by first intention. The incisions at donor sites healed by first intention at 2 to 3 weeks after operation. All patients were followed up 7-16 months, with an average of 10.7 months. There was no ischemic necrosis of the donor site or skin threading. There was pigmentation of the needle back point in the early stage, and the pigmentation completely disappeared after 3 to 6 months without scar hyperplasia. At 6 months after operation, liner scars were achieved in all the patients with an average Vancouver Scar Scale score of 2.5 (range, 1.0-3.5) and an average width of 2.4 mm (range, 0.8-9.1 mm). Conclusion The suture of the donor site of the anterolateral thigh flap with Zunyi’s Suture Method can effectively reduce the tension on wound edges and scar hyperplasia.

Citation： CHANG Shusen, MO Xiaojin, WEI Zairong, LI Hai, ZHOU Jian, SHI Chenshuo, DENG Chengliang, NIE Kaiyu, WU Bihua, WANG Dali. Application of Zunyi’s Suture Method for donor site of anterolateral thigh flap. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 477-482. doi: 10.7507/1002-1892.202008101 Copy

1.	刘宗辉, 舒茂国, 胡翔宇. 整形外科皮肤缝合技术的特点及应用. 中国美容医学, 2017, 26(7): 136-139.
2.	Krishnan R, Macneil SD, Malvankar-Mehta MS. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis. BMJ Open, 2016, 6(1): e009257. doi: 10.1136/bmjopen-2015-009257.
3.	常树森, 何春念, 金文虎, 等. 股前外侧皮瓣的供区并发症. 中华显微外科杂志, 2018, 41(1): 101-104.
4.	Barnes LA, Marshall CD, Leavitt T, et al. Mechanical forces in cutaneous wound healing: emerging therapies to minimize scar formation. Adv Wound Care (New Rochelle), 2018, 7(2): 47-56.
5.	Xu J, Yang E, Yu NZ, et al. Radiation therapy in keloids treatment: history, strategy, effectiveness, and complication. Chin Med J (Engl), 2017, 130(14): 1715-1721.
6.	吕营, 安美文, 侯春胜. 沿不同缝合方向皮肤应力的有限元分析. 中国组织工程研究, 2017, 21(4): 609-614.
7.	Yang DJ, Venkatarajan S, Orengo I. Closure pearls for defects under tension. Dermatol Surg, 2010, 36(10): 1598-1600.
8.	Radonich MA, Bisaccia E, Scarborough D. Management of large surgical defects of the forehead and scalp by imbrication of deep tissues. Dermatol Surg, 2002, 28(6): 524-526.
9.	Yag-Howard C. Novel approach to decreasing tension when approximating wound edges in advancement flaps: the ImPli stitch. Dermatol Surg, 2012, 38(4): 661-663.
10.	Breuninger H. Double butterfly suture for high tension: a broadly anchored, horizontal, buried interrupted suture. Dermatol Surg, 2000, 26(3): 215-218.
11.	芮永军, 张雁, 施海峰, 等. 穿支定位技术在预防股前外侧皮瓣供区并发症中的应用. 中华显微外科杂志, 2016, 39(6): 529-533.
12.	常树森, 何春念, 金文虎, 等. 股前外侧穿支分叶皮瓣修复肢体复杂创面的疗效. 中华创伤杂志, 2017, 33(6): 544-547.
13.	常树森, 杨敏萍, 魏在荣, 等. 旋股外侧动脉降支穿支皮瓣嵌合股外侧肌肌瓣修复下肢两处较远创面. 中华创伤杂志, 2016, 32(8): 741-744.
14.	常树森, 金文虎, 魏在荣, 等. 股前外侧皮瓣术前设计优化及临床应用. 中华显微外科杂志, 2017, 40(2): 118-122.
15.	Boca R, Kuo YR, Hsieh CH, et al. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg, 2010, 126(5): 1558-1562.
16.	Tsuge T, Aoki M, Akaishi S, et al. Geometric modeling and a retrospective cohort study on the usefulness of fascial tensile reductions in severe keloid surgery. Surgery, 2020, 167(2): 504-509.
17.	Agha R, Ogawa R, Pietramaggiori G, et al. A review of the role of mechanical forces in cutaneous wound healing. J Surg Res, 2011, 171(2): 700-708.
18.	Zitelli JA, Moy RL. Buried vertical mattress suture. J Dermatol Surg Oncol, 1989, 15(1): 17-19.
19.	Ogawa R, Akaishi S, Huang C, et al. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch, 2011, 78(2): 68-76.
20.	Meng F, Andrea S, Cheng S, et al. Modified subcutaneous buried horizontal mattress suture compared with vertical buried mattress suture. Ann Plast Surg, 2017, 79(2): 197-202.
21.	Kantor J. The percutaneous set-back dermal suture. J Am Acad Dermatol, 2015, 72(2): e61-62.
22.	Maher IA, Bingham J, Mellette R. A running modification of the percutaneous buried vertical mattress. Dermatol Surg, 2012, 38(9): 1560-1562.
23.	唐举玉, 贺继强, 吴攀峰, 等. 股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用. 中华显微外科杂志, 2020, 43(4): 326-330.
24.	陈立彬, 陈亚红, 高振, 等. 皮肤伤口减张器抑制切口瘢痕作用的临床观察. 组织工程与重建外科杂志, 2015, 11(5): 316-319.

1. 刘宗辉, 舒茂国, 胡翔宇. 整形外科皮肤缝合技术的特点及应用. 中国美容医学, 2017, 26(7): 136-139.
2. Krishnan R, Macneil SD, Malvankar-Mehta MS. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis. BMJ Open, 2016, 6(1): e009257. doi: 10.1136/bmjopen-2015-009257.
3. 常树森, 何春念, 金文虎, 等. 股前外侧皮瓣的供区并发症. 中华显微外科杂志, 2018, 41(1): 101-104.
4. Barnes LA, Marshall CD, Leavitt T, et al. Mechanical forces in cutaneous wound healing: emerging therapies to minimize scar formation. Adv Wound Care (New Rochelle), 2018, 7(2): 47-56.
5. Xu J, Yang E, Yu NZ, et al. Radiation therapy in keloids treatment: history, strategy, effectiveness, and complication. Chin Med J (Engl), 2017, 130(14): 1715-1721.
6. 吕营, 安美文, 侯春胜. 沿不同缝合方向皮肤应力的有限元分析. 中国组织工程研究, 2017, 21(4): 609-614.
7. Yang DJ, Venkatarajan S, Orengo I. Closure pearls for defects under tension. Dermatol Surg, 2010, 36(10): 1598-1600.
8. Radonich MA, Bisaccia E, Scarborough D. Management of large surgical defects of the forehead and scalp by imbrication of deep tissues. Dermatol Surg, 2002, 28(6): 524-526.
9. Yag-Howard C. Novel approach to decreasing tension when approximating wound edges in advancement flaps: the ImPli stitch. Dermatol Surg, 2012, 38(4): 661-663.
10. Breuninger H. Double butterfly suture for high tension: a broadly anchored, horizontal, buried interrupted suture. Dermatol Surg, 2000, 26(3): 215-218.
11. 芮永军, 张雁, 施海峰, 等. 穿支定位技术在预防股前外侧皮瓣供区并发症中的应用. 中华显微外科杂志, 2016, 39(6): 529-533.
12. 常树森, 何春念, 金文虎, 等. 股前外侧穿支分叶皮瓣修复肢体复杂创面的疗效. 中华创伤杂志, 2017, 33(6): 544-547.
13. 常树森, 杨敏萍, 魏在荣, 等. 旋股外侧动脉降支穿支皮瓣嵌合股外侧肌肌瓣修复下肢两处较远创面. 中华创伤杂志, 2016, 32(8): 741-744.
14. 常树森, 金文虎, 魏在荣, 等. 股前外侧皮瓣术前设计优化及临床应用. 中华显微外科杂志, 2017, 40(2): 118-122.
15. Boca R, Kuo YR, Hsieh CH, et al. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg, 2010, 126(5): 1558-1562.
16. Tsuge T, Aoki M, Akaishi S, et al. Geometric modeling and a retrospective cohort study on the usefulness of fascial tensile reductions in severe keloid surgery. Surgery, 2020, 167(2): 504-509.
17. Agha R, Ogawa R, Pietramaggiori G, et al. A review of the role of mechanical forces in cutaneous wound healing. J Surg Res, 2011, 171(2): 700-708.
18. Zitelli JA, Moy RL. Buried vertical mattress suture. J Dermatol Surg Oncol, 1989, 15(1): 17-19.
19. Ogawa R, Akaishi S, Huang C, et al. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch, 2011, 78(2): 68-76.
20. Meng F, Andrea S, Cheng S, et al. Modified subcutaneous buried horizontal mattress suture compared with vertical buried mattress suture. Ann Plast Surg, 2017, 79(2): 197-202.
21. Kantor J. The percutaneous set-back dermal suture. J Am Acad Dermatol, 2015, 72(2): e61-62.
22. Maher IA, Bingham J, Mellette R. A running modification of the percutaneous buried vertical mattress. Dermatol Surg, 2012, 38(9): 1560-1562.
23. 唐举玉, 贺继强, 吴攀峰, 等. 股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用. 中华显微外科杂志, 2020, 43(4): 326-330.
24. 陈立彬, 陈亚红, 高振, 等. 皮肤伤口减张器抑制切口瘢痕作用的临床观察. 组织工程与重建外科杂志, 2015, 11(5): 316-319.

Chinese Journal of Reparative and Reconstructive Surgery

Application of Zunyi’s Suture Method for donor site of anterolateral thigh flap

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