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Efficacy of anteriorlateral thigh myocutaneous flap combined with sequential fibular flap for repairing complex tissue defects of the foot / 中华创伤杂志
Chinese Journal of Trauma ; (12): 773-779, 2021.
Article in Chinese | WPRIM | ID: wpr-909937
ABSTRACT

Objective:

To investigate the clinical effect of the anterolateral thigh myocutaneous flap combined with sequential fibular flap to repair complex tissue defects of the foot.

Methods:

A retrospective case series study was conducted to analyze the clinical data of 6 patients with complex tissue defects of the foot admitted to Ruihua Hospital of Soochow University from March 2017 to March 2019. There were 5 males and 1 femalesaged 33-54 years[(41.4±10.2)years]. The area of the skin and soft tissue defects of the foot was from 12 cm×7 cm to 19 cm×9 cm. First metatarsal defect occurred in 3 patients,4-5th metatarsal defects in 2,and 4-5th metatarsal combined with lateral cuneiform and cuboid defects in 1. The length of bone defects was 6-14 cm,and partial extensor tendon defects were found in all patients. The anterolateral thigh myocutaneous flap was used to cover the wound in the first stage,and the sequential fibula flap was used to repair the complex bone defects. The myocutaneous flap survivalwound healing,fibular bone flap healing and donor site recovery were detected. The appearance and sensory recovery of myocutaneous flap and related complications were observed at the last follow-up. The foot function was evaluated by the Maryland foot function score before operation,at postoperative 1 month,at postoperative 6 months and at the last follow-up.

Results:

All patients were followed up for 9-33 months[(17.8±5.2)months]. All musculocutaneous flaps survived at postoperative 2 weeks. One patient sustained sinus tract formation due to partial necrosis of the residual metatarsal bone,which healed 3 weeks after re-debridement,while the wounds of other patients healed smoothly. The surgical incision healed two weeks after fibular flap surgery,with no signs of local infection. A small amount of callus formed between the transplanted fibula and the fractured end of the bone in the recipient area was observed 6 weeks after the fibular flap operation. Primary bone healing was found in all patients,with the fibular flap healing time of 12-18 weeks[(14.5±4.3)weeks]. The donor sites of the myocutaneous flap and fibular flap also showed primary healing with only linear scars left. Three patients had numbness in the lower and outer side of the donor sites of the thigh but were gradually recovered to the normal 6 months after the repair of the fibula. The joint function of the knee and ankle at the donor sites of the fibular flap recovered well. There showed slight swelling appearance of the flap,a protective feeling of the myocutaneous flap and sound healing of the bone flaps,at the last follow-up,with no complications such as resorption or osteomyelitis of the fibula flap. The Maryland foot function evaluation score was increased from(23.5±5.2)points preoperatively to(44.3±5.3)points at postoperative 1 month,(52.1±7.4)points at postoperative 6 months,and(84.5±11.1)points at the last follow-up( P<0.05),with statistically significant difference at each time point after operation( P<0.05). The foot function was excellent in 3 patients,good in 2,and fair in 1.

Conclusion:

For complex tissue defects of the foot,the anterolateral femoral myocutaneous flap and subsequent fibular flap can effectively repair the wound of the foot,reduce the occurrence of serious infection-related complications,ensure the healing of bone defects,restore the shape of the foot,reduce the occurrence of serious infection-related complications and promote the functional recovery of the affected limb.

Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of Trauma Year: 2021 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of Trauma Year: 2021 Type: Article