[Clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities]

Abstract

Objective: To investigate clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities. Methods: A retrospective observational study was conducted. From October 2018 to June 2021, Suzhou Ruihua Orthopedic Hospital admitted 12 patients (11 males and 1 female, aged 24-64 years) who met the inclusion criteria, and did not have the lateral circumflex femoral artery during anterolateral thigh flap resection, or changed to medial femoral perforator as a source of blood supply due to small perforator to repair the wound with flap transplantation. The wounds were on the upper limbs in 7 cases and on the lower limbs in 5 cases. The wound area after debridement was 8.0 cm×5.0 cm-24.0 cm×6.5 cm, and the applied flap area was 9 cm×6 cm-25 cm×7 cm. During transplantation, the perforating branch or source artery of the flap was anastomosed end to end with the vascular pedicle of the recipient area. Subcutaneous beauty suture was performed on all the donor wounds. After operation, the survival of the flap and vascular crisis were observed; and the wound healing at the donor site was observed. During follow-up, the texture of the flap and complications at the donor site were observed. At the last follow-up, the effect of flap repair was evaluated by using the modified self-made comprehensive efficacy rating table. Results: After operation, all the flaps of patients survived without vascular crisis; the wounds in the donor site healed smoothly. During follow-up of 6 to 26 months, the flaps had good texture; only linear scars remained in the donor area without scar contracture, pain or other discomfort. At the last follow-up, the total score of flap repair effect of 12 patients was 75-95, with an average of 87, of which 5 cases were rated as excellent, 6 cases as good, and 1 case as fair, and the proportion of excellent and good patients was 11/12. Conclusions: The application of anterolateral thigh flap with blood supply from the medial femoral perforator to repair wounds on extremities is an alternative method for the vascular variations such as no descending branch, oblique branch, or small perforator of the lateral circumflex femoral artery during the resection of the anterolateral thigh flap. This operation has the advantages of simple operation, small trauma, and others, which effectively ensures the smooth operation.

图 1

切开股前外侧区皮瓣时观察到的内侧穿支（黄色箭头所示） The medial perforator observed during incision of anterolateral thigh flap

图 2

采用以股内侧穿支为血供来源的股前外侧区皮瓣修复例1患者的交通事故伤致左小腿创面的疗效。2A.术前左小腿远端创面清创后即刻；2B.于右大腿设计皮瓣；2C.显示皮瓣内侧来源的2条穿支情况, 该2条穿支均较粗大；2D.皮瓣游离切取后即刻；2E、2F.分别为皮瓣移植术后22个月, 受区和供区创面情况, 受区皮瓣存活良好, 供区创面仅遗留线性瘢痕 Effects of the anterolateral thigh flap with medial femoral perforator as blood supply to repair the left leg wound caused by traffic accident in patient 1

图 3

采用以股内侧穿支为血供来源的股前外侧区皮瓣修复例2患者的压伤致右手创面的疗效。3A.术前右手掌皮肤坏死情况；3B.右手掌清创后即刻；3C.左大腿上的皮瓣设计；3D.皮瓣内侧穿支来源的情况, 该穿支较粗大；3E、3F.分别皮瓣术后6个月随访时右手正面、侧面观, 皮瓣外观稍显臃肿 The effects of anterolateral thigh flap with medial femoral perforator as blood supply to repair the right hand wound caused by crush injury in patient 2