Clinical Observation Of Optimized Design Of Free Anterolateral Femoral Perforator Flap For Treatment Of Complex Soft Tissue Defects Of Limbs

Objective:To explore the free thigh anterolateral perforators flap by the application of personalized design on treatment of skin and soft tissue defect of limbs.Methods:From January 2014 to Match 2020,a total of 43 cases of patients who met the criteria and received personalized flap surgery were selected.There were 42 males and 1 female,ranging in age from 8 to 68years old,with the average age of 44.93±16.54.Injury mechanism:22cases of car accidents;11 cases of heavy crush injuries;6 cases of mechanical strangulation;1 case of agricultural mechanical injury;2cases of spoke injury;1 case of thermal compression injury.Defect sites:36 cases of lower limbs and 7 cases of upper limbs.The incision range of anterolateral thigh perforator flap was 9*6cm~2-37*8cm~2.After thorough debridement of the wound followed by the classification the wound by the standard of limb skin defects of soft tissue wound in Xiangtan city central hospital,the flap design was optimized according to the final classification results and the demand of wound reconstruction(area,depth and defect of tissue),the optimization design contents included the area optimization design,three-dimensional optimization design,optimizing design for defect in the tissues and a variety of combination optimization design when necessary.Results:Among the 43 clinical cases,there were 36 cases that all survived,4 cases of partial survivals and 3 cases of necrosis of skin flap.There were 37 cases of primary closure of donor sites and 6 cases of primary skin graft.Postoperative complications:6 cases of vascular crisis;6 cases of infection;3 cases of subcutaneous hemoperitoneum;4cases of partial necrosis of skin margin.Postoperative donor area:1 case with partial necrosis of skin margin,2 cases with infection.Evaluation of flap recovery:30 cases were excellent;6 cases were good;3 cases were general;3 cases were poor,the rate of excellent and good cases was86.04%.Conclusion:The optimal design of free anterolateral thigh perforator flap for the reconstruction of the wound surface of the limbs is a perfect method to treat the complex skin and soft tissue defects of the limbs.