Harvesting the free anterolateral thigh flap to repair the multiple and complex skin and soft tissue defect at lower limb / 中华显微外科杂志

ABSTRACT

Objective To investigate the clinical effect of harvesting the free anterolateral thigh flap irregularly for the repair of the multiple and complex skin and soft tissue defect at lower limb.Methods From January,2009 to January, 2014, 7 patients with multiple and complex skin and soft tissue defect at lower limb were treated with transplantation of the free anterolateral thigh flap with harvesting irregularly.The parts of wound defect: 2 cases of medial leg andlateral leg, 3 cases of foot back andankle, and 2 cases of medial malleolus and lateral malleolus.All the cases were operated in fracture fixation and wound without obvious infection.The vascular pedicle of free flaps were descending branch of lateral circumflex femoral artery.The types of the harvesting the free anterolateral thigh flap irregularly: 3 cases of the anterolateral thigh flap and terminal branch of lateral femoral circumflex artery muscle flap, 2 cases of the anterolateral thigh flap and transverse branch of lateral circumflex femoral artery muscle flap, and 2 cases of reconstructed lobar femoral anterolateral thigh perforator flap (vascular anastomosis of pedicle of lobulated anterolateral thigh perforator flap with the main stem branch artery of the lateral femoral circumflex vessels).The area of harvesting the free anterolateral thigh flap irregularly were 6 cm × 4 cm to 16 cm × 12 cm;The donor site were closed directly.All the patientsbegined to early rehabilitative exercise under the protection of orthosis after 4 weeks of the operation.Results All cases were followed up for 6 to 14 months, and the average of 8.2 months.All the flaps survived, besides 2 cases with necrosis of small area in distal, and which were healed by dressing, debridement,skin grafting and so on;The healing time were 12 to 34 days, and the average of 17.1 days.The area of flaps without obvious retraction, color were the same as the region, no obvious scar contracture.Conclusion The anterolateral thigh flap feed by the same source vessels for the repair of the multiple and complex skin and soft tissue defect at lower limb is a safe and effective strategy.The flap can be combinated differently to repair multiple and irregular wound one-time, the donor site is small invasive, shorten the treatment cycle, and relieve the suffering.