Effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Feiyu , Jiasharete·Jielile , LIU Kai , LIU Yanshi , FAN Chenchen ,  Aihemaitijiang·Yusufu

Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P.R.China;

Corresponding author：

Aihemaitijiang·Yusufu, Email: ahmatjang@163.com

Keywords：

Hand injury; vascular injury; anterolateral thigh flap; free flap; wound repair

DOI：

10.7507/1002-1892.202103049

Video：

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Objective To evaluate the effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury.Methods Between February 2016 and March 2020, 14 patients with hand twist trauma combined with forearm main vascular injury were admitted. There were 10 males and 4 females. The mean age was 36.3 years (range, 22-53 years). There were 5 cases with left hand and 9 cases with right hand. The degloving injury of hand was rated as type ⅢA in 2 cases, type ⅢB in 9 cases, and type Ⅳ in 3 cases. The size of soft tissue defects range from 8.0 cm×4.5 cm to 13.5 cm×8.0 cm. Of all patients, 11 cases were ulnar artery injury and 3 cases were radial artery injury. Time from injury to operation was 2-16 hours (mean, 7.1 hours). The free anterolateral thigh flaps with the size of 10.0 cm×5.5 cm to 15.0 cm×9.5 cm were used to repair the soft tissue defects with the “T” shape anastomosis of blood vessel in 8 cases or direct anastomosis of blood vessel in 6 cases. The donor sites were directly sutured in 9 cases and repaired with free skin graft in 5 cases.Results All patients were followed up 6-12 months (mean, 10.5 months). The vascular crisis occurred in 1 case and the flap survived with symptomatic treatment after operation. Other flaps survived and the wounds healed by first intention. All donor sites healed by first intention and the skin grafts survived. Three cases underwent the fat-free trimming at 4-5 months after operation. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the hand function was evaluated as excellent in 4 cases, good in 7 cases, and fair in 3 cases, with an excellent and good rate of 78.6% at last follow-up.Conclusion Because the diameter of the descending branch of the lateral femoral circumflex artery is similar to that of the ulnar artery and radial artery, the use of free anterolateral thigh flap can not only repair the wound and obtain a good hand shape, but also repair blood vessels and promote recovery of hand function.

Citation： CAI Feiyu, Jiasharete·Jielile, LIU Kai, LIU Yanshi, FAN Chenchen, Aihemaitijiang·Yusufu. Effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 1033-1037. doi: 10.7507/1002-1892.202103049 Copy

1.	杜全红, 毕卫伟, 仲崇华, 等. 游离足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损的远期随访. 中华显微外科杂志, 2020, 43(4): 357-360.
2.	旷玲玉, 周望高, 贺海燕, 等. 自制固定托装置在腹部皮瓣修复术后护理中的应用. 中国实用护理杂志, 2021, 37(10): 780-785.
3.	邢培朋, 郭海娜, 狄海萍, 等. 游离股前外侧皮瓣联合动脉血管重建修复腕部高压电烧伤创面的临床效果. 中华烧伤杂志, 2020, 36(6): 419-425.
4.	Bali ZU, Ozkan B, Parspancı A, et al. Reconstruction of lower lip defects with free super-thin anterolateral thigh flap. Microsurgery, 2021, 41(3): 216-222.
5.	Abdelrahman M, McGarry K, Alsharkawy K, et al. A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery. J Plast Reconstr Aesthet Surg, 2021, 74(5): 1013-1021.
6.	Gu S, Fu H, Huang Y, et al. Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers. J Int Med Res, 2021, 49(2): 300060521991032. doi: 10.1177/0300060521991032.
7.	唐俊华, 金国栋, 曾永文, 等. Flow-through 尺动脉腕上支穿支皮瓣在伴指掌侧固有动脉缺损创面中的应用. 中华显微外科杂志, 2021, 44(1): 77-79.
8.	洪建军, 高伟阳, 李志杰, 等. 手部套脱伤的分型和治疗. 中华手外科杂志, 2006, 22(4): 221-223.
9.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-136.
10.	Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
11.	侯毅, 顾立强. 显微血管吻合技术的现状与展望. 中华显微外科杂志, 2014, 37(2): 201-204.
12.	王东, 郑灿镔, 王洪刚, 等. 微血管吻合器在口径不等血管吻合中的应用. 中华显微外科杂志, 2014, 37(2): 106-109.
13.	Yan ZX, Zhou YJ, Zhao YX, et al. Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures. Circ J, 2010, 74(4): 686-692.
14.	罗新锦, 王巍, 王跃堂, 等. 冠状动脉旁路移植术中旋股外动脉降支的获取与运用. 中华外科杂志, 2017, 55(11): 834-837.
15.	陈胜华, 徐达传, 周小兵, 等. 以旋股外侧动脉降支为蒂分叶股前外侧肌皮瓣设计的解剖学研究. 中国临床解剖学杂志, 2010, 28(3): 237-241.
16.	Roberts JM, Carr LW, Haley CT, et al. Venous flaps for revascularization and soft-tissue coverage in traumatic hand injuries: a systematic review of the literature. J Reconstr Microsurg, 2020, 36(2): 104-109.
17.	刘铭波, 胡伟, 梁勇, 等. 带掌长肌腱的动脉化 Flow-through 静脉皮瓣修复指背侧复合组织缺损. 中华显微外科杂志, 2021, 44(1): 11-15.
18.	刘长松, 朱熙铭, 徐强, 等. 穿支皮瓣与腹部带蒂皮瓣治疗手外伤皮肤软组织缺损疗效比较. 中华全科医学, 2020, 18(10): 1671-1674.
19.	江吉勇, 兰荣玉, 邹芬, 等. 削薄股前外侧穿支皮瓣修复手部术后瘢痕挛缩畸形 12 例. 中华显微外科杂志, 2020, 43(5): 446-449.

1. 杜全红, 毕卫伟, 仲崇华, 等. 游离足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损的远期随访. 中华显微外科杂志, 2020, 43(4): 357-360.
2. 旷玲玉, 周望高, 贺海燕, 等. 自制固定托装置在腹部皮瓣修复术后护理中的应用. 中国实用护理杂志, 2021, 37(10): 780-785.
3. 邢培朋, 郭海娜, 狄海萍, 等. 游离股前外侧皮瓣联合动脉血管重建修复腕部高压电烧伤创面的临床效果. 中华烧伤杂志, 2020, 36(6): 419-425.
4. Bali ZU, Ozkan B, Parspancı A, et al. Reconstruction of lower lip defects with free super-thin anterolateral thigh flap. Microsurgery, 2021, 41(3): 216-222.
5. Abdelrahman M, McGarry K, Alsharkawy K, et al. A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery. J Plast Reconstr Aesthet Surg, 2021, 74(5): 1013-1021.
6. Gu S, Fu H, Huang Y, et al. Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers. J Int Med Res, 2021, 49(2): 300060521991032. doi: 10.1177/0300060521991032.
7. 唐俊华, 金国栋, 曾永文, 等. Flow-through 尺动脉腕上支穿支皮瓣在伴指掌侧固有动脉缺损创面中的应用. 中华显微外科杂志, 2021, 44(1): 77-79.
8. 洪建军, 高伟阳, 李志杰, 等. 手部套脱伤的分型和治疗. 中华手外科杂志, 2006, 22(4): 221-223.
9. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-136.
10. Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
11. 侯毅, 顾立强. 显微血管吻合技术的现状与展望. 中华显微外科杂志, 2014, 37(2): 201-204.
12. 王东, 郑灿镔, 王洪刚, 等. 微血管吻合器在口径不等血管吻合中的应用. 中华显微外科杂志, 2014, 37(2): 106-109.
13. Yan ZX, Zhou YJ, Zhao YX, et al. Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures. Circ J, 2010, 74(4): 686-692.
14. 罗新锦, 王巍, 王跃堂, 等. 冠状动脉旁路移植术中旋股外动脉降支的获取与运用. 中华外科杂志, 2017, 55(11): 834-837.
15. 陈胜华, 徐达传, 周小兵, 等. 以旋股外侧动脉降支为蒂分叶股前外侧肌皮瓣设计的解剖学研究. 中国临床解剖学杂志, 2010, 28(3): 237-241.
16. Roberts JM, Carr LW, Haley CT, et al. Venous flaps for revascularization and soft-tissue coverage in traumatic hand injuries: a systematic review of the literature. J Reconstr Microsurg, 2020, 36(2): 104-109.
17. 刘铭波, 胡伟, 梁勇, 等. 带掌长肌腱的动脉化 Flow-through 静脉皮瓣修复指背侧复合组织缺损. 中华显微外科杂志, 2021, 44(1): 11-15.
18. 刘长松, 朱熙铭, 徐强, 等. 穿支皮瓣与腹部带蒂皮瓣治疗手外伤皮肤软组织缺损疗效比较. 中华全科医学, 2020, 18(10): 1671-1674.
19. 江吉勇, 兰荣玉, 邹芬, 等. 削薄股前外侧穿支皮瓣修复手部术后瘢痕挛缩畸形 12 例. 中华显微外科杂志, 2020, 43(5): 446-449.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury

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