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Objective:To investigate the therapeutic effect of Flow-through anterolateral thigh perforator flap (ALTPF) or medial sural artery perforator flap (MSAPF) in repair of Gustilo III C wound of foot.Methods:From July 2015 to June 2021, 8 patients with Gustilo III C wound of foot were treated in the Department of Foot and Ankle Surgery of Wuxi No.9 People’s Hospital. The patients were 7 males and 1 female, aged 25-62 years old, and (45.88±12.96) years old in average. Flow-through ALTPF or Flow-through MSAPF were used to repair the defect according to the size of the wound and the length and diameter of the defect vascular. Among the patients, 6 were repaired with free Flow-through ALTPF, and 2 with free Flow-through MSAPF. The size of flap was 9 cm×5 cm-22 cm×8 cm with (115.00±46.16) cm 2 in average, and the vascular bridging was 6-12 cm in length, with (8.75±2.50) cm in average. All patients received outpatient follow-up. The appearance of the flap, blood supply of affected limb, healing of fracture and dislocation and the recovery of limb function were recorded. Maryland score was used to evaluate functional recovery. Results:The flaps survived uneventfully in all 8 patients, and the wounds in donor site healed primarily. All patients were followed-up for 6-22 months with (12.25±5.39 ) months in average. At the last follow-up, all the flaps had satisfactory contour in soft texture and blood supply without occlusion in the bridging vessels. The fractures and dislocation were healed, and the appearance and function of the foot recovered satisfactorily. The Maryland score showed excellent in 3 patients, good in 4 patients and fair in 1 patient.Conclusion:Flow-through ALTPF or MSAPF can selectively used to reconstruct the Gustilo III C wound of foot in one stage. The functional recovery of the affected limb was satisfactory and the clinical effect was good.
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Objective To investigate the clinical effects of irrigation sequential Flow-through type anterolat eral thigh chimeric myocutaneous flap in the treatment of chronic tibial osteomyelitis.Methods From January,2012 to December,2017,trench grooved sequential Flow-through anterolateral femoral chimeric flaps were u sed to treat chronic tibial osteomyelitis.On the basis of sensitive antibiotics,bone grooving and VSD grooved sequential Flow-through anterolateral thigh chimeric flaps were used to fill the bone cavity and cover the wound.The patients received the follow-up care in outpatient office and telephone regularly after hospital discharge.Results Among the 18 cases in this group,2 cases were positive and 16 cases were negative in secondary bacteriological detection.The flaps and donor sites survived in one stage.Fifteen cases healed in one stage,and extravasate occurred in 3 cases after operation.After dressing change,the wounds healed in 25 days,32 days and 43 days after flap operation,respectively.All the patients were followed-up for 12 to 30 months,with an average of 25 months.Local low toxicity infection symptom occurred again in 1 case with delayed healing 6 months after operation.After 1 week of antibiotic treatment,the symptom subsided.After 1 more week of antibiotic use,the patient was discharged from hospital.And followed-up for 1 year,no recurrence occurred.During the follow-up period,no recurrence of infection and no fracture occurred after primary fracture healing in other 17 cases.One year after the second operation,there was no obvi ous stenosis in the bridged vessels examined by Doppler ultrasonography and the blood flow velocity was the same as that of the contralateral limbs.Conclusion The application of irrigation and sequential Flow-through type anterolateral thigh chimeric myocutaneous flap for treatment of chronic tibial osteomyelitis can achieve good therapeutic effect and is worth popularizing.
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Objective To explore the clinical application and effect of Flow-through anterolateral thigh flap transfer combined with bone transport technique for repairing the segamental mutilating injury in lower extremity.Methods From June,2010 to June,2016,Flow-through anterolateral thigh flap transfer combined with Ilizarov technique were applied to repair the segamental mutilating injury in lower extremity in 10 cases.Of the 10 cases,there were 8 males and 2 females (their ages ranged from 26 to 55,36 on average).Four caused by road accident,4 caused by crush injury,2 cases caused by squeeze injury.First stage,Flow-through anterolateral thigh flap transfer were applied to revascularize the lower limb and repair the soft tissue defect in emergency.Second stage,bone transfort with external fixator were applied to repair bone defect in second stage.The area of the flap ranged from 12.0 cm×15.5 cm to 20.0 cm×25.0 cm.The repair of bone defect ranged from 4.0 cm to 10.0 cm.Time interval between two stages ranged from 2 to 4 months,3 months on average.Followed-up method was regular outpatientcare after discharge.The main contents include:the presence of red swollen with pus,the condition of infection in the pin,if the fixed pin was loosening,and adjust the speed of bone transport according to the mineralization of new bone.Results All cases were successfully repaired in 10 cases.Ten cases were followed-up with a mean followed-up time of 42 months.All flaps survived,in with 6 cases were healed in first stage,4 case were healed in second stage (healing time ranged from 14 to 30 days),and bone transfort time ranged from 6 to 16 months.The docking site union occurred in 6 cases and were healed by use of bone debridement,bone graft and compression.Deformity in foot and ankle occurred during the bone transport in 2 cases and were cured by draft therapy with adding ring fixator.The functions of donor sites were not found malfunctional.Conclusion Flow-through anterolateral thigh flap transfer combined with bone transport have high success rate of limb salvage,good quality of os teogenesis,and satisfactory function recovery.It is an optimal method to repair the segamental mutilating injury of the lower extremity.
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Objective To evaluate the clinical value of MDCTA (Multi-detector computed tomographic angiography) in reconstruction of the soft tissue defect of the limbs combined with the main vascular defects by using Flow-through anterolateral thigh flap.Methods From September,2013 to May,2016,12 cases of limb soft tissue with main vascular defects were examined by MDCTA.The length of vascular defect was measured.The length of bridging vessel needed to design a Flow-through anterolateral thigh flap was measured.The points of anterolateral thigh flap perforator were positioned.The relationship between the perforation and the trunk vascular pedicle was defined.The outcomes were evaluated based on Berton scores for upper extremities and John-Wruh scores for lower extremities.Results The length of the main vascular defects,the positions of flap perforators and the configuration of vascular pedicles were successfully imaged through MDCTA.The length of the main vascular defects were 5-12 cm,which was consistent with the intraoperative findings.The length of bridging vessel for the defects were 7-14 cm,which was enough for the vascular defects.There were not vessel grafts.Twenty perforators were imaged by MDCTA preoperatively,and 22 perforators were found during the operations,which means 2 perforators were not imaged.All flaps survived completely.All patients were followed-up from 6 to 21 months (average,11 months).According to the Berton scores for upper extremities and John-Wruh scores for lower extremities,the excellent/good were 6 in 8 cases and 4 in 4 cases,respectively.Conclusion MDCTA can be used to evaluate the pedicle conditions of the free Flow-through anterolateral thigh flap for the reconstructions.It is worthy to be popularized in clinical application.
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Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.