Reconstruction of soft tissue defects of extremities with polyfoliate anterolateral thigh perforator flap / 中华显微外科杂志

ABSTRACT

Objective:To report the clinical effect of using polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects of extremities.Methods:From April 2017 to January 2020, 21 cases of soft tissue defect in extremities were repaired by polyfoliate ALTPF, including 11 cases of traffic accident trauma, 8 of machine crush injury, and 2 of iatrogenic complications. There were 14 cases in calf and ankle, and 7 in hand and wrist. The area of defect was 17.0 cm×12.0 cm-20.0 cm×14.0 cm. Eight cases were complicated with fracture and bone exposure, 13 with tendon and nerve exposure. Thirteen cases had 2 adjacent wounds and 8 had large wound. The polyfoliate ALTPF was designed for wound repair. The patients entered follow-up regularly. The last follow-up included the colour, texture, shape, sensation of the flap and the scar of the donor area.Results:There was no infection in the recipient site of all 21 patients after operation, and all flaps survived. Two cases had venous crisis, with 1 was found in 5 hours after operation. Emergency exploration found that there were thrombosis in anastomosed veins. The flap survived completely after the thrombus removed and the embolized vein was anastomosed again. Another case was found with venous crisis at 1 lobe of flap in 2 hours after operation. Emergency exploration found that the anastomotic site between the superficial vein from the medial edge of the flap to the great saphenous vein and the superficial vein of the recipient area was embolised. The flap survived completely after the thrombus removed and the embolized veins was anastomosed again. The wounds of all donor sites healed in the first stage. All patients were followed-up for 6-30 (mean 12.3) months. All flaps had good colour and texture, with slightly bloated appearance and dull sensation. There was only a linear scar in the donor area, and the appearance evaluation was good.Conclusion:Polyfoliate ALTPF can be used to repair 2 large or adjacent wounds in 1 stage, reduce the damage of donor site. It is an ideal method to repair large or adjacent wounds of limb.