Objective To introduce the application of the pedicled anterolateral thigh flap transferring for coverage of the oversized skin defect of the hand. Methods The pedicled anterolateral thigh flap was transferred to cover the large skin defects of the hands or the skin defects of theabdomen after the abdominal flap transferred to the hand in 5 male patients aged 16-44 years from April 2002 to August 2005. The injured sites were as follows:4 right hands and 1 left hand, including 2 hands injured by a machine and 3 hands injured by burning.The mechanically injured patients underwent an operation within 6 hours after the injury. The burned patients were reconstructed by the flap transferring 4-7 days after the burn when the decayed tissues could be clearly indentified.The areas of the hand defects were 12.19 cm×18.22 cm.The areas of the pedicled anterolateral thigh flaps were 7.12 cm×16.24 cm. The areas of the abdominal flaps were 13.20 cm×19.23 cm.The pedicles were separated 3 weeks after the repairing operation. Results All the flaps survived well and there was no vascular crisis, with the wound healing of the first intention. The skin defects of the hand were covered completely. Five patients were followed up for 6-12 months. The texture of the flaps was soft and the flaps had a good blood circulation. Of the patients, 3 underwent the finger exclusion and degreasing operation 47 months after operation. All the flaps of the hands had protective sensation, which could meet the requirement of the daily life. Conclusion The pedicled anterolateral thigh flap can provide the large coverage for the skin defects of the hands. The risk of the operation can be greatly decreased by obviation of the vessel anastomosis. It can be an optimal choice for themanagement of the oversized skin defects of the hands.
To introduce a new technique for vascular pedicle elongation in the anterolateral thigh island flap transplantation and evaluate the outcome of this technique in the clinical application. Methods From January 2003 to January 2006, 6 patients (5 males, 1 female; age, 1849 years) were admitted for surgical operation because of the soft tissue defect around the knee joint. The soft tissue defect after the injury was found in 3 patients, the defect after the removal of the softtissue tumor in 1, and the defect after the prosthetic replacement in the knee joint in 2. The soft tissue defects ranged in size of 8 cm×4 cm to 15 cm ×6 cm. When the anterolateral island flap of the thigh underwent the reverse transplantation, the ascending branch of the lateral circumflex femoral artery was used as a nutrient vessel for the flap, and the descending branch of the lateral circumflex femoralartery was separated to the distal part. The main trunk of the lateral circumflex femoral artery was ligated at the point that was proximal to the furcation ofthe ascending and decending branches so that the vessel pedicle of the flap could be lengthened and then the defect was repaired.The flaps ranged in size of 10cm×6 cm to 18 cm×8 cm Results All the flaps were successfullytransferred in the 6 patients. The lengthened pedicle ranged in length from 8 to 12 cm, with an average of 10 cm. There was no vascular crisis after operation. All the transferred flaps survived, with a color and texture similar to those in the recipient site. The postoperative followup for 6-18 months revealed that the motion range of the knees was satisfactory. Conclusion The vascular pedicle elongation technique can enlarge the application scope of the anterolateral thigh island flap and the survival rate of the flap is not influenced by any factor.
Objective To investigate the effect of free anterolateral thigh adipofascial flap in correcting the hemifacial atrophy. Methods From January 1997 to May 2006, 35 patients suffering from hemifacial atrophy were corrected with microvascular anastomotic free anterolateral thigh adipofascial flap and other additional measures according to the symptoms of the deformities. There were 11 males and 24 females, aging 1547 years. The locations were left in 12cases and right in 23 cases. The course of disease was 4 to 28 years. Their hemifacial deformities were fairly severity. Their cheeks were depressed obviously. The X-ray films and threedimensinal CT showed the 28 patients’ skeletons were dysplasia. The size of adipofascial flap ranged from 8 cm×7 cm to 20 cm×11 cm. Donor sites weresutured directly. Results Recipient site wound of all patients healed by first intention. All adipofascial flaps survived. The donor sites healed well and no adiponecrosis occurred. Thirty-five cases were followed up for 6 months to 8 years. The faces of all patients were symmetry, and the satisfactory results were obtained. There were no donor site dysfunction. Conclusion The anterolateral thigh adipofascial flapprovides adequate tissue, easytosurvive, no important artery sacrificed and the donor scar ismore easily hidden. Combining with other auxiliary methods, it can be successfully used to correct the deformity of hemifacial atrophy.
ObjectiveTo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect. MethodsBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft. ResultsAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up. ConclusionThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.
Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
Objective To summarize the cl inical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities. Methods From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsal is pedis in 5 cases, and planta pedis in 4 cases. The defect area ranged from 9 cm × 6 cm to 15 cm × 13 cm. Nine cases compl icated by bone defect and 1 case by radial nerve defect. The time from injury to hospital ization was 1 hourto 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterial ized small saphenous vein in 1 case, nd with fibular or il ium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm × 8 cm to 16 cm × 15 cm. Skin defects at donor site were repaired with spl it thickness skin graft or sutured directly. Results All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or il ium, the bony heal ing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site. Conclusion The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feel ing recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.
Objective To increase the success rate of vaginal reconstruction with pudendal-thigh flap, reduce the chance of hemocirculatory disorder and rel ieve the deformity of greater l ip of pudendum and vaginal orifice. Methods FromJune 1998 to May 2004, 15 patients, 2 males with transsexual ism and 13 females with vaginal absence, aged 23-31 years old (26.2 on average), received vaginal reconstruction. Arterial perforator was detected at 3 cm laterally away from the mid-point between the vaginal orifice and the anus. The flap of 12.0 cm × 5.5 cm was designed at the lateral of the greater l ip of pudendum, with the groin as the axis. After the flap was elevated beneath the deep fascia, the fascial pedicle was partially severed from lateral to medium, keeping the perforator intact into the flap. Then the flap was transferred through the tunnel to the socket. The inner layer and the orifice were formed. Results All flaps survived, and the contour of the vulva was satisfactory. Among the 15 patients, 14 patients’ incisions obtained heal ing by first intention, and only 1 male with transsexual ism was discovered to suffer from rectovaginal fistula at the remote juncture of the two flaps at 7 days after the operation. By taking out all the gauze and cleaning the feces, the fistula healed automatically. All patients were followed up for 6 months-3 years. The reconstructed vagina was about 10 cm deep and 2 fingers wide. One female’s vagina was found pilous at 20 months after the operation, and no special treatment was given. The other patients’ vaginal inner walls were smooth and complete. Two female patients had the experienceof sexual intercourse and felt satisfied after using lubricant. Conclusion The modified pudendal-thigh flap has rel iable blood supply and makes the transferring during vaginal reconstruction more convenient and the contour of the vulva more satisfactory.
Objective To evaluate the effectiveness of anterolateral thigh and groin conjoined flap in emergent repair of ultra-long complex tissue defects in forearm and hand. Methods Between February 2009 and October 2011, 6 patients with complex tissue defect of dorsal forearm and hand were in adminsion. There were 5 male and 1 female with an average age of 38.5 years (range, 32-47 years). Injury reasons included machine injury in 5 cases and traffic accident injury in 1 case. Injury to admission time was from 3 to 16 hours (mean, 6 hours). All case were single limb injury, including right forearm and hand injury in 4 cases and left forearm and hand injury in 2 cases. The wound area was from 36 cm × 9 cm to 48 cm × 12 cm. The type of associated injury included elbow dislocation associated with open injury in 2 cases; fractures of the radial, ulnar, and metacarpal bone in 4 cases; defects of wrist dorsal skin and extensor tendons of fingers and wrist in 5 cases; and defects of ulnar artery and ulnar nerve in 1 case. The anterolateral thigh and groin conjoined free flaps were used to repair defects in the forearm and hand in emergency. The area of flap was from 36 cm × 9 cm to 48 cm × 12 cm. Meanwhile the partial functional reconstruction was performed. The donor site was repaired by skin grafts. Results The anastomotic embolization of vascular pedicle and arteria interossea dorsalis occurred in 1 case, purulent secretion under the flap in 1 case, which were cured after symptomatic treatment; the skin flaps completely survived, and primary healing of the wounds were obtained in the other cases. The donor skin grafts survived in 2 cases, and partial necrosis of the skin graft of lower abdominal occurred in 4 cases, and healed after changing dressing. All of the 6 patients were followed up 3 to 18 months (mean, 10 months). The appearance and texture of the flaps were good. The protective sensation was recovered in 2 cases followed up for more than 14 months; no sensory recovery was observed in the other cases. At last follow-up, according to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 1 case, good in 4 cases, and poor in 1 case, and the excellent and good rate was 83.3%. Conclusion It could get a good short-term effectiveness to use the anterolateral thigh and groin conjoined flap for emergent repair of the ultra-long and complex tissue defects in forearm and hand.
Objective To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture. Methods Between October 2009 and June 2011, 10 cases of Achilles tendon and soft tissue defects were treated. There were 7 males and 3 females, aged from 5 to 60 years (median, 40 years). Injury was caused by spoke in 5 cases, by heavy pound in 3 cases, and by traffic accident in 2 cases. The time between injury and admission was 2-24 hours (mean, 8 hours). The size of wound ranged from 11 cm × 7 cm to 18 cm × 10 cm; the length of Achilles tendon defect was 4-10 cm (mean, 7 cm). Three cases complicated by calcaneal tuberosity defect. After admission, emergency debridement and vacuum sealing drainage were performed for 5-7 days, anterolateral thigh fasciocutaneous flap transplantation of 11 cm × 7 cm to 20 cm × 12 cm was used to repair skin and soft tissue defects, and improved method of ilio-tibial bundle suture was used to reconstruct Achilles tendon. The flap donor site was closed directly or repaired with skin grafting to repair. Results All flaps and the graft skin at donor site survived, healing of wounds by first intention was obtained. All patients were followed up 6-18 months (mean, 10 months). The flap was soft and flexible; the flap had slight encumbrance in 3 cases, and the others had good appearance. At last follow-up, two-point discrimination was 2-4 cm (mean, 3 cm). The patients were able to walk normally. The range of motion (ROM) of affected side was (24.40 ± 2.17)° extension and (44.00 ± 1.94)° flexion, showing no significant difference when compared with ROM of normal side [(25.90 ± 2.33)° and (45.60 ± 1.84)° ] (t=1.591, P=0.129; t=1.735, P=0.100). According to Arner-Lindhoim assessment method for ankle joint function, all the patients obtained excellent results. Conclusion A combination of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defects and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture is beneficial to function recovery of the ankle joint because early function exercises can be done.
Objective To compare the effectiveness of poly ether ether ketone (PEEK) localization marker combined with mixed reality technology versus color doppler ultrasound guidance for the vessel localization of anterolateral thigh perforator flap. Methods A retrospective analysis was conducted on 40 patients with tissue defects after oral cancer resection who underwent repair using the anterolateral thigh perforator flap between January 2022 and June 2023. According to the different intraoperative positioning methods of the anterolateral thigh perforator flap, they were randomly divided into PEEK group [using PEEK localization marker combined with mixed reality technology based on CT angiography (CTA) data] and color ultrasound group (using color ultrasound guidance), with 20 cases in each group. There was no significant difference in gender, age, etiology, and disease duration between the two groups (P>0.05). The number of perforator vessels identified in the two groups of regions of interest was recorded, and compared them with the intraoperative actually detected number to calculate the success identifying rate of perforator vessels; the distance between the perforating point and the actual puncture point was measured, the operation time of the two groups of flaps was recorded. ResultsIn the PEEK group, 32 perforator vessels were identified, 34 were detected by intraoperative exploration, and the success identifying rate was 94.1% (32/34); in the color ultrasound group, 29 perforator vessels were identified, 33 were detected by intraoperative exploration, and the success identifying rate was 87.8% (29/33); there was a significant difference in the success identifying rate between the two groups (P<0.05). The distance between the perforating point and the actual puncture point and the operation time in PEEK group were significantly shorter than those in color ultrasound group (P<0.05). Patients in both groups were followed up 6-30 months, with a median of 17 months; there was no significant difference in follow-up time between the two groups (P>0.05). In the PEEK group, there was 1 case of flap necrosis at the distal edge and delayed healing after trimming and dressing change. In the color ultrasound group, there was 1 case of flap necrosis at 7 days after operation and pectoralis major myocutaneous flap was selected for repair after removal of the necrotic flap. In the rest, the flap survived and the incision healed by first intention. Donor site infection occurred in 1 case in PEEK group and healed after anti-inflammatory treatment. The maxillofacial appearance of the two groups was good, the flap was not obviously bloated, and the patients were satisfied with the repair effect. Conclusion Compared with the traditional color ultrasound guidance, the PEEK localization marker combined with mixed reality technology based on CTA data in vessel localization of anterolateral thigh perforator flap has higher success identifying rate and positioning accuracy, and the flap production time is shorter, which has high clinical application value.