The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lin , ZHOU Xin , HUANG Yu , HUANG Bo , LIU Anming ,  ZOU Yonggen

Department of Burn and Plastic Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

ZOU Yonggen, Email: yonggenzou1975@163.com

Keywords：

Anterolateral thigh perforator flap; combined transplantation; circumferential defect; degloving injury

DOI：

10.7507/1002-1892.202108002

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of the combination of the anterolateral thigh perforator (ALTP) flap and other flaps for repairing the extreme circumferential defects on the limb. Methods Between October 2016 and June 2019, 9 patients with the extreme circumferential defects on the limb were admitted, which resulted by degloving injury, including 8 males and 1 female with a median age of 42 years (range, 32-65 years). The etiology involved twist injury in 5 cases, traffic accident in 2 cases, and high voltage electric injury in 2 cases. The location of the defects was left forearm in 2 cases, right forearm in 3, left foot in 3, and right foot in 1. The injected wound bed followed by the exposure of bone, joint, tendon, and blood vessel. The dimension of defects was 25 cm×20 cm to 40 cm×28 cm. The period between the injury and admission was 1-12 hours (mean, 5 hours). All contaminated wounds were taken thorough and radical debridement and covered by the vacuum sealing drainage device during the emergency operation. The ALTP flap and the other one flap were tailored according to the dimension of the wound when the wound surface became granulating, including the thoracodorsal artery perforator (TAP) flap in 3 cases, superficial inferior epigastric artery perforator flap in 3 cases, superficial circumflex iliac artery perforator flap in 3 cases. And the donor site was primary closure. Results After operation, all the flaps survived except 1 case of partial necrosis at the edge of TAP flap and healed after secondary skin grafting, and the wounds in the donor and recipient areas healed by first intention. All patients were followed up 14-24 months (mean, 16 months). The shape of the flap was satisfactory and the texture was soft. There was no abnormal hair growth and obvious pigmentation during the follow-up. Only linear scar was left in the donor area, there was no complication such as abdominal wall hernia, and the activity of hip and knee was not affected. The functional reconstruction of upper limb and ankle was satisfactory, and the disabilities of the arm, shoulder, and hand (DASH) score was excellent in 4 cases and good in 1 case; the American Orthopaedic Foot and Ankle Association (AOFAS) score was excellent in 3 cases and good in 1 case. Conclusion ALTP flap combined with different flaps can reconstruct the circumferential extreme defects after limb damage in one-stage, which can achieve limb salvage to the greatest extent.

Citation： TANG Lin, ZHOU Xin, HUANG Yu, HUANG Bo, LIU Anming, ZOU Yonggen. The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1609-1614. doi: 10.7507/1002-1892.202108002 Copy

1.	Hakim S, Ahmed K, El-Menyar A, et al. Patterns and management of degloving injuries: a single national level 1 trauma center experience. World J Emerg Surg, 2016, 11: 35. doi: 10.1186/s13017-016-0093-2.
2.	Zhou X, You P, Huang S, et al. Resection and reconstruction of a giant primitive neuroectodermal tumour of the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap: a case report. BMC Surg, 2021, 21(1): 90. doi: 10.1186/s12893-021-01095-5.
3.	Hung SY, Loh CYY, Chen HC. Supercharging extra-large anterolateral thigh flaps for single-stage resurfacing of massive burn defects over upper extremity elbow joints. J Burn Care Res, 2018, 39(5): 831-834.
4.	Weise H, Naros A, Blumenstock G, et al. Donor site morbidity of the anterolateral thigh flap. J Craniomaxillofac Surg, 2017, 45(12): 2105-2108.
5.	Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg, 2013, 41(1): 15-21.
6.	Pachón Suárez JE, Sadigh PL, Shih HS, et al. Achieving direct closure of the anterolateral thigh flap donor site-an algorithmic approach. Plast Reconstr Surg Glob Open, 2014, 2(10): e232. doi: 10.1097/GOX.0000000000000205.
7.	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.
8.	贺继强, 唐举玉, 卿黎明, 等. 动脉插管造影CTA与普通CTA显影股前外侧穿支的比较研究. 中国临床解剖学杂志, 2017, 35(5): 508-512.
9.	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.
10.	Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
11.	Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
12.	施权, 魏在荣. 旋髂浅动脉穿支皮瓣的应用进展. 中华显微外科杂志, 2018, 41(5): 插 5-1, 5-2.
13.	王晓敏, 张凯, 马士崟, 等. 腹壁浅动脉皮瓣的应用解剖研究. 中国修复重建外科杂志, 2010, 24(11): 1357-1360.
14.	Mahajan AL, Van Waes C, D’Arpa S, et al. Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients. J Plast Reconstr Aesthet Surg, 2016, 69(7): 920-927.
15.	Harii K, Iwaya T, Kawaguchi N. Combination myocutaneous flap and microvascular free flap. Plast Reconstr Surg, 1981, 68(5): 700-711.
16.	刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损. 中国修复重建外科杂志, 2021, 35(7): 886-890.
17.	周鑫, 宋达疆, 邹永根. 游离胸背动脉穿支皮瓣联合旋髂浅动脉穿支皮瓣移植修复下肢大面积环周软组织缺损一例. 中国修复重建外科杂志, 2021, 35(3): 399-400.
18.	Qing L, Li X, Wu P, et al. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1909-1916.
19.	周征兵, 唐举玉, 吴攀峰, 等. 双侧旋股外侧动脉降支穿支皮瓣组合移植修复下肢大面积软组织缺损. 中华显微外科杂志, 2020, 43(6): 535-539.
20.	Ou Q, Wu P, Zhou Z, et al. Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation. Injury, 2021, 52(6): 1356-1362.

1. Hakim S, Ahmed K, El-Menyar A, et al. Patterns and management of degloving injuries: a single national level 1 trauma center experience. World J Emerg Surg, 2016, 11: 35. doi: 10.1186/s13017-016-0093-2.
2. Zhou X, You P, Huang S, et al. Resection and reconstruction of a giant primitive neuroectodermal tumour of the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap: a case report. BMC Surg, 2021, 21(1): 90. doi: 10.1186/s12893-021-01095-5.
3. Hung SY, Loh CYY, Chen HC. Supercharging extra-large anterolateral thigh flaps for single-stage resurfacing of massive burn defects over upper extremity elbow joints. J Burn Care Res, 2018, 39(5): 831-834.
4. Weise H, Naros A, Blumenstock G, et al. Donor site morbidity of the anterolateral thigh flap. J Craniomaxillofac Surg, 2017, 45(12): 2105-2108.
5. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg, 2013, 41(1): 15-21.
6. Pachón Suárez JE, Sadigh PL, Shih HS, et al. Achieving direct closure of the anterolateral thigh flap donor site-an algorithmic approach. Plast Reconstr Surg Glob Open, 2014, 2(10): e232. doi: 10.1097/GOX.0000000000000205.
7. 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.
8. 贺继强, 唐举玉, 卿黎明, 等. 动脉插管造影CTA与普通CTA显影股前外侧穿支的比较研究. 中国临床解剖学杂志, 2017, 35(5): 508-512.
9. 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.
10. Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
11. Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
12. 施权, 魏在荣. 旋髂浅动脉穿支皮瓣的应用进展. 中华显微外科杂志, 2018, 41(5): 插 5-1, 5-2.
13. 王晓敏, 张凯, 马士崟, 等. 腹壁浅动脉皮瓣的应用解剖研究. 中国修复重建外科杂志, 2010, 24(11): 1357-1360.
14. Mahajan AL, Van Waes C, D’Arpa S, et al. Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients. J Plast Reconstr Aesthet Surg, 2016, 69(7): 920-927.
15. Harii K, Iwaya T, Kawaguchi N. Combination myocutaneous flap and microvascular free flap. Plast Reconstr Surg, 1981, 68(5): 700-711.
16. 刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损. 中国修复重建外科杂志, 2021, 35(7): 886-890.
17. 周鑫, 宋达疆, 邹永根. 游离胸背动脉穿支皮瓣联合旋髂浅动脉穿支皮瓣移植修复下肢大面积环周软组织缺损一例. 中国修复重建外科杂志, 2021, 35(3): 399-400.
18. Qing L, Li X, Wu P, et al. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1909-1916.
19. 周征兵, 唐举玉, 吴攀峰, 等. 双侧旋股外侧动脉降支穿支皮瓣组合移植修复下肢大面积软组织缺损. 中华显微外科杂志, 2020, 43(6): 535-539.
20. Ou Q, Wu P, Zhou Z, et al. Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation. Injury, 2021, 52(6): 1356-1362.

Chinese Journal of Reparative and Reconstructive Surgery

The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content