Repair Of Extremity Skin Defects With ALT Perforator Free Flaps Based On The Oblique Branch

Objective To sum up the clinical efficacy of ALT(anterolateral thigh)perforator free flap based on the oblique branch of lateral circumflex femoral artery for repair of skin defects of extremities and analyze the perforator type of the oblique branch of lateral circumflex femoral artery.Methods A retrospective study was conducted including 67 patients with skin defects of extremities treated with free ALT flaps based on oblique branch from March 2017 to May 2019.A total of 58 male and 9 female patients were enrolled in this study.The age ranged from 17 to 72 years with the average of 40.4 years.There were 42 upper limb injuries(34 handand 8 forearm)and 25 lower limb(13 foot and 12 ankle)injuries.The skin defect area was from 50 mm×30 mm to 330 mm×80 mm.Tendons,bones,and blood vessels were exposed.49 of the cases were severely contaminated and 18 were moderately contaminated.There were 12 cases were treated by flap in emergency and 55 cases were by flap in second stage.The flap was 70?330mm in length(Average 128mm);and 40?100mm in width(Average 68mm).The position,number,and caliber of the perforator were determined by high-frequency color ultrasound before surgery.We repaired the wound by ALT perforator free flap based on the oblique branch of lateral circumflex femoral artery and sutured the donor area during surgery.Antispasmodic,anticoagulant,anti-infective treatment should be applied after the operation.The harvest time and type of perforator were counted,and the position,number,caliber,source artery and color Doppler localization of perforator found during the operation were analyzed to evaluate the clinical effect of flap repair.Results Of the 67 skin flaps in this group,64 flaps survived successfully.Arterial spasm occurred in 3 cases of skin flaps with paleness,decreased skin temperature,and prolonged capillary response time 48 hours after surgery.After suture removal and spasmolysis treatment,vascular crisis was resolved in one of the cases.In the other 2 cases,the crisis was not resolved after 1 hour of observation,and emergency surgery was performed.It was confirmed as an arterial embolism during surgery.The blood supply of the flap was restored after the thrombus was removed and the blood vessel was anastomosed.The flaps in 3 patients with vascular crisis finally survived.The wounds in 67 recipients healed from 14 to 28 days after surgery.In 2 cases of thigh donor area,the skin cracked due to patients getting out of bed prematurely,and the incision healed after suture again.The other donor sites healed in one stage without hematoma or active bleeding.The follow-up time ranged from 6 to 29 months,with an average of 10 months.The transplanted flap showed good blood flow and soft texture,and no obvious pigmentation.All of them recovered protective sensation,without complications such as infection or ulceration.Linear scars were left in the donor site of the flap in 60 cases.Scars were wide in 7 cases,and the scars were slightly hyperplastic.No obvious scar contracture occurred.The skin around the scar did not feel noticeably allergic or dull.The self-made anterolateral femoral skin flap repair efficacy evaluation standard was used to score at follow-up,and the last evaluation was used as the result for patients who had multiple follow-ups.Among 67 cases of skin flap,the excellent was in 13 cases,the good in 45 cases and the fair in 9 cases.The excellent and good rate was 86.57%.Conclusion It is feasible to use ALT perforator free flap based on the oblique branch of lateral circumflex femoral artery to repair skin defects of extremities.It is characterized by a higher ratio of intramuscular perforator,is easier harvesting,less operation time and less donor site injury.The perforator of the oblique branch is issued at a high position and the donor area is hidden.High-frequency color ultrasound has high accuracy and reliability,which can meet the clinical needs for preoperative examination of ALT perforator free flap based on the oblique branch of lateral circumflex femoral artery.The oblique branch is an important supplement to ALT perforator free flap based on the lateral circumflex femoral artery,which can obtain satisfactory clinical results.