Application of anterolateral thigh flow-through flaps for simultaneous repair of soft tissue and main vascular defects of extremities

Abstract

Objective To summarize the operative method and clinical efficacy of anterolateral thigh flow-through flap for simultaneous repair of soft tissue and main vascular defects of extremities. Methods From April 2009 to May 2017, 7 patients with soft tissue defects and main vessel defects were treated with anterolateral thigh flow-through flaps. The anterolateral thigh flow-through flaps were used to cover the skin and soft tissue defects of limbs, and the descending branch of the lateral circumflex femoral artery was bridged with the defective main artery to reconstruct the blood circulation. The skin and soft tissue defects ranged from 5.0 cm×4.5 cm to 21.0 cm×11.0 cm. The trunk vascular defects ranged from 2.5 to 11.0 cm. The area of skin flaps ranged from 6.5 cm×5.5 cm to 23.0 cm×12.0 cm. For those with major nerve or muscle or tendon defect or dead space, sural nerve or lateral femoral muscle or rectus femoris muscle tendon flaps were transplanted to repair the defect. Results The perforator vessels were accidentally injured in the process of free flap in one case, and anastomosis was performed immediately. The vascular crisis occurred in one case and was relieved after surgical exploration. The remaining flaps and limbs survived smoothly. The postoperative follow-up ranged from 6 to 36 months, with an average of 12 months. One patient suffered from mild atrophy of the distal limb half a year after operation, but there was no significant functional impact. The follow-up for 1 or 2 years showed no aggravation. The rest of the limbs recovered their basic shape and flexion and extension function. The appearance and texture of the skin flaps were good, and the sensation of protection was restored. The donor site had no functional effect except linear scar or pigmentation. According to the Berton criteria, the upper limb function was evaluated as excellent in 2 cases, good in 1 case and fair in 2 cases. According to the Maryland criteria of the American foot and ankle surgery association, the lower limb function was evaluated as excellent in 1 case and good in 1 case. Conclusion The anterolateral thigh flow-through flap can be used to repair the soft tissue and main vessel defect of the extremity simultaneously. It can bridge and reconstruct the main vessel of the extremity while repairing the wound or composite tissue defect of the extremity. The operation that should be performed by stages or at the expense of multiple donor sites should be performed by one donor site at a time. It shortens the course of disease, gains time for the recovery of extremity function, and reduces the pain of patients and the economic burden of families. It's worth promoting. Key words: Extremities; Microsurgery; Flow-through; Anterolateral thigh flap; Transplantation repair