Clinical application of anterolateral thigh polyfoliate perforator flap for vascular pedicle protection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Hai , DENG Chengliang ,  WEI Zairong , JIN Wenhu , NIE Kaiyu , TANG Xiujun , WANG Dali , CHANG Shusen , LI Shujun

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000, P.R.China;

Corresponding?author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

Anterolateral thigh perforator flap; polyfoliate flap; extremities soft tissue defect

DOI：

10.7507/1002-1892.201703048

Video：

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Objective To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect. Methods Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case. Wounds located in lower extremity in 16 cases, complicated with calcaneal or metatarsal, phalangeal fractures in 4 cases, Achilles tendon departure in 1 case, toe long extensor tendon and flexor digitorum longus tendon exposed in 8 cases. The wound area ranged from 8 cm×5 cm to 18 cm×12 cm. According to wound size, anterolateral thigh perforators were detected by conventional ultrasound Doppler (2-5 perforators). The irregular wounds were decomposed into multiple parts and the leaf number (2-4 leaves) of polyfoliate flap depended on the part number of the wound. The flap area ranged from 9 cm×6 cm to 20 cm×14 cm, and the largest area of single leaf was 24 cm×6 cm. The vascular pedicle length ranged from 7 cm to 12 cm. The foliate flap area with protecting pedicle ranged from 5 cm×3 cm to 7 cm×5 cm. Results All the flaps survived, and no vascular crisis occurred. All the patients were followed up 2-28 months (mean, 9 months). Sinus occurred in 1 case of calcaneal fracture after flap repair, and the sinus was healed after 3 months by conventional dressing. All the flaps were thin and had a good texture. Healing of soft tissue was found in 5 patients with fracture. The wrist and ankle plantar flexion and dorsiflexion function of recipient site were normal in all patients. Conclusion It is safe and reliable to repair the extremities soft tissue defect with anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. And it is one of the ways to reduce the vascular crisis of the anterolateral thigh free perforator flap.

Citation： LI Hai, DENG Chengliang, WEI Zairong, JIN Wenhu, NIE Kaiyu, TANG Xiujun, WANG Dali, CHANG Shusen, LI Shujun. Clinical application of anterolateral thigh polyfoliate perforator flap for vascular pedicle protection. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1245-1249. doi: 10.7507/1002-1892.201703048 Copy

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4.	施海峰, 芮永軍, 陸征峰, 等. 血管吻合術后晚期突發危象的處理. 中華手外科雜志, 2015, 31(6): 448-450.0.
5.	王劍利, 趙剛, 王五洲, 等. 游離皮瓣移植 1270 例回顧性研究. 中華顯微外科雜志, 2012, 35(3): 189-193.0.
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8.	段維軼, 徐中飛, 劉法昱, 等. 游離組織瓣修復口腔頜面-頭頸部缺損 244 例. 中華顯微外科雜志, 2014, 37(5): 444-448.0.
9.	李學淵, 王揚劍, 章偉文, 等. 端側吻合與端端吻合法在游離穿支皮瓣修復手部軟組織缺損病例中的對比研究. 中華顯微外科雜志, 2016, 39(1): 8-11.0.
10.	Pohlenz P, Klatt J, Schon G, et al. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg, 2012, 41(6): 739-743.
11.	熊勝, 巨積輝, 金光哲, 等. 吻合血管術后 55 例血管危象探查體會. 中華手外科雜志, 2011, 27(5): 284-286.0.
12.	袁灼輝, 趙軍, 王鵬程, 等. 靜脈皮瓣移植術后血管危象的原因及處理. 實用手外科雜志, 2015, 29(2): 184-185.0.
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14.	方偉, 郭曙光, 陳翠菊, 等. 下肢再灌注損傷并發骨筋膜室綜合征的治療. 中華普通外科雜志, 2005, 20(8): 535-536.0.
15.	郭建興. 腘血管損傷致小腿骨筋膜室綜合征的治療體會. 實用骨科雜志, 2014, 20(8): 763-764.0.
16.	劉會仁, 曹磊, 王立新, 等. 組織移植修復肢體嚴重損傷發生血管危象的原因分析. 中華顯微外科雜志, 2010, 33(2): 161-162.0.
17.	張世民, 唐茂林, 章偉文, 等. 中國穿支皮瓣的名詞術語與臨床應用原則共識 (暫定稿). 中華顯微外科雜志, 2012, 35(2): 89-92.0.
18.	胡銳, 任義軍, 嚴立, 等. 股前外側皮瓣聯合髂脛束移植修復小兒足踝部軟組織缺損. 中華顯微外科雜志, 2014, 37(5): 457-460.0.
19.	譚琪, 劉光軍, 王謙, 等. 分葉式股前外側穿支皮瓣修復四肢復雜性皮膚軟組織缺損. 中華創傷雜志, 2014, 30(8): 793-794.0.
20.	郭翱, 尤靈建, 李俊, 等. 股前外側皮瓣聯合股直肌肌腱瓣移植修復前臂軟組織伴肌腱缺損. 中華手外科雜志, 2011, 27(2): 92-93.0.
21.	陳潔, 蔣燦華, 李寧, 等. 靜脈改形聯合微血管吻合器在頭頸部缺損重建口徑不等血管吻合中的應用. 中華顯微外科雜志, 2015, 38(6): 546-549.0.
22.	常樹森, 魏在榮. 穿支皮瓣術前影像學導航技術的研究進展. 中國臨床解剖學雜志, 2016, 34(5): 596-598.0.
23.	Taylor GI, Coflett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg, 2011, 127(4): 1447-1459.
24.	吳攀峰, 唐舉玉, 李康華, 等. 旋股外側動脈降支分葉穿支皮瓣臨床應用 16 例. 中華顯微外科雜志, 2015, 38(6): 526-529.0.

1. 徐達傳, 鐘世鎮, 劉牧之, 等. 股前外側部皮瓣的解剖學一個新的游離皮瓣供區. 臨床應用解剖學雜志, 1984, 2(3): 158-160.0.
2. 季衛平, 李浩, 黃穎寶, 等. 股部皮穿支的數字化解剖學研究. 中華整形外科雜志, 2012, 28(2): 96-100.0.
3. 顧立強, 朱慶棠, 汪華僑, 等. 顯微外科血管吻合新技術專題座談會專家意見. 中華顯微外科雜志, 2014, 37(2): 105.0.
4. 施海峰, 芮永軍, 陸征峰, 等. 血管吻合術后晚期突發危象的處理. 中華手外科雜志, 2015, 31(6): 448-450.0.
5. 王劍利, 趙剛, 王五洲, 等. 游離皮瓣移植 1270 例回顧性研究. 中華顯微外科雜志, 2012, 35(3): 189-193.0.
6. 陳元莊, 黃遠翹, 莫華貴. 微血管吻合器在游離皮瓣移植術中的應用. 中華顯微外科雜志, 2014, 37(2): 167-169.0.
7. 侯書健, 程國良, 方光榮, 等. 拇指及手指再造手術血管危象 164 例臨床分析. 中華顯微外科雜志, 2005, 28(2): 130-132.0.
8. 段維軼, 徐中飛, 劉法昱, 等. 游離組織瓣修復口腔頜面-頭頸部缺損 244 例. 中華顯微外科雜志, 2014, 37(5): 444-448.0.
9. 李學淵, 王揚劍, 章偉文, 等. 端側吻合與端端吻合法在游離穿支皮瓣修復手部軟組織缺損病例中的對比研究. 中華顯微外科雜志, 2016, 39(1): 8-11.0.
10. Pohlenz P, Klatt J, Schon G, et al. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg, 2012, 41(6): 739-743.
11. 熊勝, 巨積輝, 金光哲, 等. 吻合血管術后 55 例血管危象探查體會. 中華手外科雜志, 2011, 27(5): 284-286.0.
12. 袁灼輝, 趙軍, 王鵬程, 等. 靜脈皮瓣移植術后血管危象的原因及處理. 實用手外科雜志, 2015, 29(2): 184-185.0.
13. 王澍寰, 韋加寧, 田光磊, 等. 手外科學. 北京: 人民衛生出版社, 1999: 80-81.0.
14. 方偉, 郭曙光, 陳翠菊, 等. 下肢再灌注損傷并發骨筋膜室綜合征的治療. 中華普通外科雜志, 2005, 20(8): 535-536.0.
15. 郭建興. 腘血管損傷致小腿骨筋膜室綜合征的治療體會. 實用骨科雜志, 2014, 20(8): 763-764.0.
16. 劉會仁, 曹磊, 王立新, 等. 組織移植修復肢體嚴重損傷發生血管危象的原因分析. 中華顯微外科雜志, 2010, 33(2): 161-162.0.
17. 張世民, 唐茂林, 章偉文, 等. 中國穿支皮瓣的名詞術語與臨床應用原則共識 (暫定稿). 中華顯微外科雜志, 2012, 35(2): 89-92.0.
18. 胡銳, 任義軍, 嚴立, 等. 股前外側皮瓣聯合髂脛束移植修復小兒足踝部軟組織缺損. 中華顯微外科雜志, 2014, 37(5): 457-460.0.
19. 譚琪, 劉光軍, 王謙, 等. 分葉式股前外側穿支皮瓣修復四肢復雜性皮膚軟組織缺損. 中華創傷雜志, 2014, 30(8): 793-794.0.
20. 郭翱, 尤靈建, 李俊, 等. 股前外側皮瓣聯合股直肌肌腱瓣移植修復前臂軟組織伴肌腱缺損. 中華手外科雜志, 2011, 27(2): 92-93.0.
21. 陳潔, 蔣燦華, 李寧, 等. 靜脈改形聯合微血管吻合器在頭頸部缺損重建口徑不等血管吻合中的應用. 中華顯微外科雜志, 2015, 38(6): 546-549.0.
22. 常樹森, 魏在榮. 穿支皮瓣術前影像學導航技術的研究進展. 中國臨床解剖學雜志, 2016, 34(5): 596-598.0.
23. Taylor GI, Coflett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg, 2011, 127(4): 1447-1459.
24. 吳攀峰, 唐舉玉, 李康華, 等. 旋股外側動脈降支分葉穿支皮瓣臨床應用 16 例. 中華顯微外科雜志, 2015, 38(6): 526-529.0.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of anterolateral thigh polyfoliate perforator flap for vascular pedicle protection

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