| Objective: The anterolateral femoral perforator flap(ALTP)has a clinical history of 25 years.The complications in the donor flap area of ALTP include scar hyperplasia,muscular hernia,depression deformity and sensory dysfunction.There have been many reports on the methods to reduce the complications in the donor flap area,but there are few reports on the methods to reduce the complications in the donor flap area with the comprehensive improved surgical program.This paper discussed the influence of the method by improving the methods of preoperative design,intraoperative incision and postoperative suture,on the reduction of complications in the donor flap area.Methods: From January 2015 to June 2019,365 pieces of ALTP were cut from 360 patients in our department.There were 245 flaps from January 2015 to December 2017(in the traditional surgery group)and 120 flaps from January 2018 to June 2019(in the modified surgery group).In the traditional group,the skin flap was designed with three vertical and five horizontal methods before operation,and ultrasonic doppler was used to explore perforating branches,conventional subsuperficial fascia(or subfascia latta)incision,subcutaneous vertical mattress tensioning and skin intermittent suture.The improved group: the skin flap was designed with the new three longitudinal and five transverse methods before surgery,the perforator vessels of anterolateral femoral artery were explored by ultrasound doppler,the skin flap was cut in the superficial layer of superficial fascia,the fascia lata and the cutaneous nerve were retained,and the skin was sutured with in-situ needle-pad suture.(1)The incision range of ALTP flap was 3cm×5cm~35cm×10cm.The patients were divided into 4 categories according to the wound area: small area(?6cm×5cm),medium area(6cm×5cm~6cm×15cm),especially large area(6cm×15cm~6cm×25cm),large area(?6cm×25cm,or the donor area was repaired with perforator flap,or complex wound surface of composite tissue defect).In this group,there were 11 cases with small area,89 cases with medium area,174 cases with large area and 91 cases with large area.The effect of donor site was reviewed and the method of improving anterolateral femoral perforator flap was summarized.(2)The lateral circumflex femoral artery has three branches: transverse branch,oblique branch and descending branch.Forty-one patients in the improved group were randomly selected and the perforation of the four-zone perforation was investigated by the new 3-5system.(3)The traditional method was used to cut 57 pieces of the wound surface of the flap,and the modified method was used to cut 32 pieces of the wound surface of the flap.The fascia lata could not be closed in 53 large-area defects of different forms.Patients of medium area were randomly selected(all patients had fascia lata sutured),16 pieces of patients repaired with traditional methods(referred to as the traditional group),15 pieces of patients repaired with improved methods(referred to as the improved group),and 17 pieces of patients with fascia lata defect of different forms and unable to close the fascia lata(referred to as the fascia lata group).The distance between the lowest point of donor scar and the outer upper margin of patella(distance),the scar vancouver score(score),the circumference of the donor thigh minus the circumference difference(difference)of the opposite side of the thigh,the range of sensory dysfunction(range),the widest width(width)of the scar and its position were analyzed.Results :(1)353 cases of flap survival,8 cases of distal partial necrosis,There were 3cases with 1 lobe necrosis and 5 cases with 2 lobes necrosis.Complete necrosis in 4 cases.Four major categories and 17 surgical design methods were reviewed.(2)A total of 112 perforations were found in 41 patients.Areas I,II,III and IV have penetration rates of 56%,73%,76% and 66%.The probability of wearing out in zone II and III is 97.6%.(3)Through analysis of variance,it was found that the distance between the lowest scar point and the outer upper margin of patella between the three groups was not statistically significant(P > 0.05).The vancouver score improvement group was lower than the other two groups,and P < 0.05 was found.The traditional group and the improved group were significantly lower than the fascia lata group(P < 0.05).Kruskal-wallis test showed that the improved sensory barrier range group and the traditional group compared with the fascia lata group,P < 0.05.Comparison between the three groups with the widest scar,P <0.05.Pairwise comparison between the improved group,the traditional group and the fascia lata group showed P < 0.05.Conclusion: Adopt the new three vertical and five horizontal design can accurately locate the perforating vessels.The flap was removed from the superficial fascia.The fascia lata and the cutaneous nerve were retained,and the skin sensation in the donor area was retained.In situ needle suture method can minimize postoperative scar hyperplasia extremely.The above improved surgical methods can significantly reduce the complications of ALTP donor flap area and achieve the purpose of protecting the donor flap area. |
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