Clinical Research Of The Free Anterolateral Thigh Flap For Repairing Of Severe Skin-soft Tissue Defects

Anterolateral thigh flap is a kind of perforator flaps whose vessel pedicle is mainly of the lateral femoral circumflex artery descending branch. In 1983, Baek first reported the anatomical researches of the femoral skin blood supply, and designed the anterolateral thigh flap whose vessel pedicle is the 3rd perforating branch of deep femoral artery. In 1984, Chinese scholar Xu Dachuan reported the anatomical researches of anterolateral thigh flap and brought up a free flap whose axis vessel is intramuscular cutaneous perforator of lateral circumflex femoral artery. Then Luo Lisheng applied the free anterolateral thigh flap to clinical application and succeeded. In the same year, Song Yeguang reported the anatomic studies and clinical applications of the anterolateral thigh flap whose vessel pedicle is the muscle perforator of lateral femoral circumflex artery. In 1988, Xu Dachuan reported more details about anterolateral thigh flap, and the flaps became popular all over the world. At present, the flaps are widely applied for skin and soft tissue defects repair in the neck and limbs and trunk front-man perineal areas .Also they can be used in the forming of urinary tract, vagina and anus, and the reproduction of vaginal, the penis, orbital and tongue. There are two kinds of anterolateral thigh flaps. Compared with free flaps, pedicle flaps are available for repair of skin and soft tissue defects of the groin area, knee, and perineal area. But their applications are limited. The free anterolateral thigh flaps can realize the distant repair of the skin and soft tissue defects by using microsurgical technique. The free anterolateral thigh flap is one of the most extensive clinical application and the ideal flaps.Objective: This article mainly analyzes the anatomical characteristics and clinical application value of the free anterolateral thigh flap.Methods: 16 cases with soft tissue defects were treated by means of transplantation of free anterolateral thigh flap from June 2007 to March 2009. There were 15 males and 1 female. The tissue defects were located at face in 1 case, at hands in 3 cases, at cruris in 2 cases, at ankles in 3 cases and at feet in 9 cases. The areas of soft tissue defects ranged from 5×5cm~2 to 20×20cm~2 and the flaps were harvested from 7×5cm~2 to 24×14cm~2 in size. All the cases were followed up postoperatively from 6 months to 18 months. The shape, circulation and the restoration of sensation of the flaps were observed and studied.Results: Flaps survived in 14 cases after operation, and patients were satisfied with local function and appearance; flap necrosis occurred only in 2 cases and healed after changing dressings. 14 cases were followed up from 6 months to 18 months. The appearance and the sense of recipient site were similar to the adjacent tissue. No obvious malformation of the donor site was observed. 12 anterolateral thigh flaps were good in circulation. 4 anterolateral thigh flaps were fat. Most of 16 flaps were satisfactory with restoration of protective sensation.Conclusion: Free anterolateral thigh flap has advantages of long va- scular pedicle, massive area, covert, less morbidity at the donor site, and the better result at the recipient site. Free anterolateral thigh flap can provide enough tissue to repair large skin-soft tissue defects which are from head, hand, crus, foot and ankle. So free anterolateral thigh flap is one of the ideal free flaps in repairing severe large skin-soft tissue defects.