Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONG Lin , HE Liang , YIN Dong , JIN Zhe , NIU Yang , WANG Zifu , HUANG Jun , ZHOU Tao , ZHOU Ding ,  ZHOU Hongxiang

The Microscopic Repair and Reconstruction Department of Hand and Foot, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P. R. China;

Corresponding author：

ZHOU Hongxiang, Email: zhouhx8888@163.com

Keywords：

Anterolateral thigh flap; calf; soft tissue defect; bridge flap; vascular bridge

DOI：

10.7507/1002-1892.202201093

Video：

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Objective To explore the effectiveness of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in repairing complex calf soft tissue defects. Methods The clinical data of 11 patients with complex calf soft tissue defects between April 2018 and October 2021 were retrospectively analyzed, including 9 males and 2 females, aged 11-60 years, with a median age of 39 years. There were 8 cases of calf soft tissue defect caused by traffic accident, and 3 cases of calf skin infection caused by chronic osteomyelitis. The skin and soft tissue defects ranged from 10 cm×8 cm to 35 cm×10 cm after thorough debridement and accompanied with bone and tendon exposure. There was only one main vessel in calf of 9 cases and no blood vessel that could be anastomosed with the flap vessel could be found in the recipient site of 2 cases. The anterolateral thigh skin flap (the flap size ranged from 12 cm×10 cm to 37 cm×12 cm) was taken to repair the soft tissue defect. The donor site of the flap was treated with direct suture (8 cases) or partial suture followed by skin grafting (3 cases), and the vascular bridge was wrapped with medium-thickness skin graft. Results The flaps of 11 patients survived completely without necrosis, infection, and vascular crisis. The blood supply of the vascular bridge was unobstructed and the pulse was good. The color of the medium-thickness skin graft were ruddy. All 11 patients were followed up 2-40 months, with an average of 19.4 months. The flaps healed well with the surrounding tissues without obvious exudation and color difference. The flaps had normal color and temperature, good blood supply, and soft texture. The shape of the flap and calf contour were satisfactory and the function of the limb recovered well. The donor area of thigh flap healed by first intention without obvious scar formation. The donor area of skin healed well with a longitudinal oblong scar only and the appearance was satisfactory. Conclusion The anterolateral thigh bridge flap transplantation with free skin wrapping vascular bridge is an effective method for the treatment of complex calf soft tissue defects.

Citation： ZHONG Lin, HE Liang, YIN Dong, JIN Zhe, NIU Yang, WANG Zifu, HUANG Jun, ZHOU Tao, ZHOU Ding, ZHOU Hongxiang. Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 619-624. doi: 10.7507/1002-1892.202201093 Copy

1.	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.
2.	Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg, 2004, 114(6): 1457-1466.
3.	刘军, 芮永军, 吴永伟, 等. 创伤性胫骨骨髓炎并软组织及骨缺损的分期治疗. 中国矫形外科杂志, 2018, 26(4): 378-381.
4.	Arslan H, Demiröz A. Comparison of subacute and delayed free flap reconstruction in the treatment of open lower extremity fractures. Ulus Travma Acil Cerrahi Derg, 2019, 25(2): 188-192.
5.	王强, 巨积辉, 刘杰, 等. Flow-through股前外侧穿支皮瓣在断肢再植创面修复中的应用. 中华显微外科杂志, 2020, 43(6): 540-543.
6.	李海, 肖顺娥, 邓呈亮, 等. 游离分叶穿支皮瓣修复四肢复杂创面. 中国修复重建外科杂志, 2022, 36(1): 98-101.
7.	翟瑞华, 刘春娟, 王燕燕, 等. 健侧小腿内侧皮瓣桥接游离胸脐皮瓣修复下肢大面积软组织缺损. 中华整形外科杂志, 2018, 34(7): 538-541.
8.	金文虎, 张子阳, 吴祥奎, 等. 改良桥式交叉游离皮瓣修复小腿软组织缺损. 中华创伤杂志, 2021, 37(10): 900-905.
9.	张功林, 章鸣, 丁法明, 等. 桥式游离皮瓣移植血管蒂采用植皮包裹的方法介绍. 中华创伤骨科杂志, 2008, 10(12): 1200.
10.	周望高, 张振伟, 余少校, 等. 带肌瓣的旋股外侧动脉降支穿支皮瓣修复合并死腔的小腿软组织缺损. 中国美容整形外科杂志, 2021, 32(7): 411-414.
11.	He J, Qing L, Wu P, et al. Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow-through anterolateral thigh perforator flap transfer. Microsurgery, 2021, 41(6): 533-542.
12.	Manrique OJ, Bishop SN, Ciudad P, et al. Lower extremity limb salvage with cross leg pedicle flap, cross leg free flap, and cross leg vascular cable bridge flap. J Reconstr Microsurg, 2018, 34(7): 522-529.
13.	Knobloch K, Herold C, Vogt PM. Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity. Oper Orthop Traumatol, 2012, 24(2): 122-130.
14.	赵鹏, 刘晓春, 牟勇, 等. 股前外侧皮瓣联合阔筋膜移植修复大段跟腱及皮肤缺损. 中国修复重建外科杂志, 2020, 34(12): 1585-1589.
15.	张功林, 章鸣, 郭翱, 等. 桥式交叉 “T” 形血管吻合游离背阔肌皮瓣移植修复小腿软组织缺损. 中华骨科杂志, 2008, 28(5): 364-368.
16.	Salmon PJ, Gunson TH, Ong S, et al. Bridge flap repair of the lower limb: A hybrid alternative to the keystone. Australas J Dermatol, 2019, 60(3): 224-227.
17.	于仲嘉, 曾炳芳, 何鹤皋. 桥式交叉吻合血管游离组织移植. 中华骨科杂志, 1994, 14(6): 332-335, C2.
18.	周洪翔, 李钟苗, 李俊杰, 等. 桥式皮瓣结合Ilizarov技术治疗小腿GustiloⅢ-B、C型损伤. 中国矫形外科杂志, 2017, 25(4): 317-320.
19.	孙萍, 张功林, 师富贵, 等. 交腿桥式游离背阔肌肌皮瓣改进与临床应用. 中华临床医师杂志 (电子版), 2021, 15(5): 360-364.
20.	Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: Its expanding role in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 235-248.
21.	Cherubino M, Stocco C, Ronga M, et al. Comparisons of fascio-cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery, 2020, 40(4): 452-459.

1. 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.
2. Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg, 2004, 114(6): 1457-1466.
3. 刘军, 芮永军, 吴永伟, 等. 创伤性胫骨骨髓炎并软组织及骨缺损的分期治疗. 中国矫形外科杂志, 2018, 26(4): 378-381.
4. Arslan H, Demiröz A. Comparison of subacute and delayed free flap reconstruction in the treatment of open lower extremity fractures. Ulus Travma Acil Cerrahi Derg, 2019, 25(2): 188-192.
5. 王强, 巨积辉, 刘杰, 等. Flow-through股前外侧穿支皮瓣在断肢再植创面修复中的应用. 中华显微外科杂志, 2020, 43(6): 540-543.
6. 李海, 肖顺娥, 邓呈亮, 等. 游离分叶穿支皮瓣修复四肢复杂创面. 中国修复重建外科杂志, 2022, 36(1): 98-101.
7. 翟瑞华, 刘春娟, 王燕燕, 等. 健侧小腿内侧皮瓣桥接游离胸脐皮瓣修复下肢大面积软组织缺损. 中华整形外科杂志, 2018, 34(7): 538-541.
8. 金文虎, 张子阳, 吴祥奎, 等. 改良桥式交叉游离皮瓣修复小腿软组织缺损. 中华创伤杂志, 2021, 37(10): 900-905.
9. 张功林, 章鸣, 丁法明, 等. 桥式游离皮瓣移植血管蒂采用植皮包裹的方法介绍. 中华创伤骨科杂志, 2008, 10(12): 1200.
10. 周望高, 张振伟, 余少校, 等. 带肌瓣的旋股外侧动脉降支穿支皮瓣修复合并死腔的小腿软组织缺损. 中国美容整形外科杂志, 2021, 32(7): 411-414.
11. He J, Qing L, Wu P, et al. Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow-through anterolateral thigh perforator flap transfer. Microsurgery, 2021, 41(6): 533-542.
12. Manrique OJ, Bishop SN, Ciudad P, et al. Lower extremity limb salvage with cross leg pedicle flap, cross leg free flap, and cross leg vascular cable bridge flap. J Reconstr Microsurg, 2018, 34(7): 522-529.
13. Knobloch K, Herold C, Vogt PM. Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity. Oper Orthop Traumatol, 2012, 24(2): 122-130.
14. 赵鹏, 刘晓春, 牟勇, 等. 股前外侧皮瓣联合阔筋膜移植修复大段跟腱及皮肤缺损. 中国修复重建外科杂志, 2020, 34(12): 1585-1589.
15. 张功林, 章鸣, 郭翱, 等. 桥式交叉 “T” 形血管吻合游离背阔肌皮瓣移植修复小腿软组织缺损. 中华骨科杂志, 2008, 28(5): 364-368.
16. Salmon PJ, Gunson TH, Ong S, et al. Bridge flap repair of the lower limb: A hybrid alternative to the keystone. Australas J Dermatol, 2019, 60(3): 224-227.
17. 于仲嘉, 曾炳芳, 何鹤皋. 桥式交叉吻合血管游离组织移植. 中华骨科杂志, 1994, 14(6): 332-335, C2.
18. 周洪翔, 李钟苗, 李俊杰, 等. 桥式皮瓣结合Ilizarov技术治疗小腿GustiloⅢ-B、C型损伤. 中国矫形外科杂志, 2017, 25(4): 317-320.
19. 孙萍, 张功林, 师富贵, 等. 交腿桥式游离背阔肌肌皮瓣改进与临床应用. 中华临床医师杂志 (电子版), 2021, 15(5): 360-364.
20. Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: Its expanding role in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 235-248.
21. Cherubino M, Stocco C, Ronga M, et al. Comparisons of fascio-cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery, 2020, 40(4): 452-459.

Chinese Journal of Reparative and Reconstructive Surgery

Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects

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