Anterolateral Abdominal Free Transregional Perforator Flap:Anatomy,Optimal Design And Clinical Application

Objective: To explore the number,types,origin,diameter,and distribution of anastomotic branches of anterolateral abdominal perforator vessel,to guide design and harvestation of anterolateral abdominal free transregional perforator flap.Materials and methods: 8 fresh adult anterior abdominal lateral wall specimens with red latex infusion were selected for microdissection,to observe and measure the number and outer diameter of perforating vessels in the anterior lateral wall of the abdomen,as well as the pattern,initiation and distribution of anastomotic branches.Result: the main blood supply of the anterior and lateral abdominal wall comes from the inferior epigastric artery,the superior epigastric artery,the superficial epigastric artery,the superficial circumflex iliac artery,the deep circumflex iliac artery and the posterior intercostal artery.the inferior epigastric artery and the superior epigastric artery are the main sources of blood supply to the central region of the anterior abdominal wall,while the superficial epigastric artery and the posterior intercostal artery are the main sources of blood supply to the lateral region of the anterior abdominal wall.the superficial circumflex iliac artery and the deep circumflex iliac artery are the main blood supply sources of the lower part of the anterior abdominal wall.there are extensive anastomotic branches between these perforating branches of the anterior abdominal wall.Conclusion: there are a wide range of anastomotic branches between perforating branches of the anterior lateral wall of the abdomen,and a variety of combinations can be optimized preoperatively according to the blood supply area of perforating artery:(1)the middle part of the anterior abdominal wall: inferior epigastric artery + superior epigastric artery;(2)the lateral part of the anterior abdominal wall: superficial abdominal wall artery + posterior intercostal artery;(3)lower anterior abdominal wall: superficial circumflex iliac artery + deep circumflex iliac artery;to enlarge the area of the flap and form a transregional perforator flap,and to provide reasonable and safe guidance for the large-area transregional perforator flap.Objective: To investigate the clinical effect of anterolateral abdominal transregional perforator flap.Methods: From October 2017 to January 2020,20 cases of skin and soft tissue defects of extremities were selected,and 20 cases of free transregional perforator flaps were designed and cut out.After 6-12 months of follow-up,the shape,texture,blood supply,color of the flaps were observed,and the activity function,donor area recovery and function of the repaired limb.Results: There were 17 cases of upper limbs and 3 cases of feet in the 20 cases of anterolateral trans-regional perforator flap.among them,18 cases survived successfully,1 case developed partial necrosis,and healed after dressing change;one case developed subcutaneous hematoma,and the flap survived after suture removal and drainage.there was no infection in this group,19 flaps healed in one stage,1 flap wound healed in delay,and closed one week after dressing change.twenty patients were followed up for 6-12 months,with an average of 9 months.18 flaps had good blood circulation,soft texture,good color,sensation,thickness and movement.two cases of the flaps were slightly bloated,and the appearance was satisfactory after reoperation to repair the thin flaps.and the donor flap was sutured directly and healed well.according to the DASH questionnaire,which is widely used to evaluate the therapeutic effect of limb injury,the evaluation results showed that all the 17 cases had good functional recovery after upper limb injury: excellent7 cases,good 9 cases,poor 1 case,the excellent and good rate was 94.1%.among them,3 cases of foot injury were all recovered,walking,jumping and other functions were not significantly reduced,according to the Maryland foot function score standard evaluation,the results were excellent.the sensory function of flap was evaluated according to the criteria of sensory function established by British Medical Research Association in 1954(S4,S3 + were excellent,S3 was good,S2 was ok,S1,S0 were poor).The results showed that S2: 2 cases,S3: 11 cases,S3 +: 6 cases,S4: 1 case,the excellent rate is 94%.Conclusion: There are many perforating branches in the anterolateral wall of abdomen,and the shape and position of perforating branches are constant,according to the blood supply area of perforating artery,the optimal design of pairwise cross-region combination can be made before operation.in addition,the donor area of the flap is hidden and the functional damage is small.