Clinical Study Of Flow-through Anterolateral Thigh Perforator Flap For Repair Of Extremities Soft Tissue Defect

BackgroundThe anterolateral thigh flap was first discovered by Xu Dachuan’s anatomical studies in 1983. It-was first applied in clinical by Luo Lisheng and got ahead.It has been matured for 30 years’development.Nowdays,the flap has become one of the most commonly used flaps in international. It is not only widely used in the repair of skin and soft tissue defects of the whole body, but also can be used in the formation and reconstruction of most organs, such as the formation of urethra, anus and vagina,reconstruction surgery of perineum and tongue and other organs organ.The clinical application of the anterolateral thigh flap with pedicle is limited,vascularized free anterolateral thigh flap can complete any surface wound repair the body,it is one of the ideal skin flap for repair of wound.ObjectiveTo investigate clinical effects of the flow-through anterolateral thigh perforator flap of extremity soft tissue defects,MethodsWe extensively search literature in recent years about the basic research of perforator flap and its clinical application in repair of soft tissue defects,review the patients with severe skin and soft tissue defects of the extremities, such as bone, tendon, nerve, blood vessel, etc. using anterolateral flow-through perforator flap to repair wound. From April 2010 to May 2014,26 cases of patients described above were taking blood bridging repair, among which 18 cases were male,8 cases were females, aged 10-55 years old.Among the 26 cases,the causes of injury were:traffic accidents in 15 cases, six cases of machine injuries, burns, electrical injury in 1 case,3 cases of chronic ulcer with osteomyelitis.15 cases had severe wound contamination,11 cases with infection,all of the cases were associated with bone or tendon exposed. Skin and other soft tissue defects ranged from 8cm x 5 cm to 28cm x 18cm, the flap size ranged from 10cm×8 cm to 30cm×20cm. we review the Similar patients using anterolateral perforator flap to repair wound during the same period, among which 24 cases were male,11 cases were females, aged 13-56 years old.Among the 35 cases,the causes of injury were:traffic accidents in 22 cases, six cases of machine injuries, Other causes of injury in 7 cases, the flap size ranged from 12cm x 8 cm to 28cm x 20cm. We studied these two types of flaps with Many projects, such as Shape and Sensory recovery of flap, Shape and function of patient donor site, the color, blood circulation and subjective feeling of distal limb.ResultsAll of the 27 flaps in the group with 26 patients survived,two cases of venous vascular crisis, two cases occurred venous crisis, timely operation, found formation of thrombosis near the venous anastomotic.After intravenous vascular anastomosis,the crisis released.Except lost of 1 cases of migrant worker patient, the remaining postoperative cases,25 patients were followed up,follow-up from 12 months to 48 months, the flaps had no obvious collapse, no obvious loss of muscle tone, myopathy.l cases of scar physique patient donor site had obvious scar hyperplasia, with scar skin paresthesia, and compared with the the surrounding area transplanted flap appeared similar skin surface, no pigmentation, good blood supply, ruddy color, skin texture and good elasticity.The distal finger or toe of limb had a good blood supply,no significant swelling, low skin temperature,frostbite and so on.ConclusionAnterolateral thigh artery perforator flap with quadriceps artery is relatively constant.Perforator carried less tissue volume, less damage to the flap donor area, flaps appearance, skin color and the surrounding tissue are similar to that region, the flap may carry lateral femoral cutaneous nervere and reconstruct the affected sensory area.lt is important that vascular pedicle of the anterolateral thigh perforator flap is longer and thicker,both far and near ends can be consistent. Perforator flap can reconstruct the main blood vessels when it repairs wound, as well as supplying vascular anastomotic site for other skin flap.The flap is one of the ideal choices to repair the soft tissue defects of limbs skin especially with main part of vessel defect.