Objective To investigate the anatomic variations of the perforator vessels of anterolateral thigh (ALT) flap and the clinical indications. Methods From March 1985 to August 2004, the anterolateral thigh flapgraft was performed in 112 patients. The clinical data were analyzed. There were 67 males and 45 females, aging from 5 to 65 years with an average of 38.5 years. According to recipient site condition, four methods of flap harvesting were as follows:① 78 received free fasciocutaneous flaps;② 22 received free adipofascial flaps;③ 5 received pedicled island fasciocutaneous flaps; ④ 7 received pedicled reverse-flow island fasciocutaneous flaps. Facial, neck, breast, extremityjoint, plantar, and perineum defects were repaired and the effectiveness and donor site morbidity were evaluated. Results The blood supply of ALT flap came from the descending branch or transverse branch of the lateral circumflex femoralartery. The skin vessels were found to be septocutaneous perforators in 33% of flaps and to be musculocutaneous perforators in 77% of flaps. Of 112 flaps, 107 survived completely, the survival rate was 95.6% with little donor site morbidity. Conclusion ALT flap is a versatile softtissue flap. If refined to perforator flap, it can achieve better results in reconstructing defect and minimizing donor-site morbidity.
Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoralflap(forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, whichwas used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect; with shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combinedwith palms of feet;with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm×4.8 cm to 17.0 cm×12.0 cm, the sizes of lobulate flaps ranged from 3.5 cm×2.8 cm to 7.5 cm×4.5 cm. Results Allflaps survived without vascular crisis after operation. Except the fascia flapall recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injuryand1 case of carding machine injury whose function was not satisfactory, theremaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.Conclusion The application of irregular anterolateral femoralflap is an optimal choice for complex skin defect of hand.
ObjectiveTo investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects.MethodsThe clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side.ResultsEighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° (t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° (t=0.444, P=0.660).ConclusionThe application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.
ObjectiveTo investigate the effectiveness of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection.MethodsBetween December 2012 and December 2016, 18 patients with large scalp defect after malignant tumor resection were treated. There were 16 males and 2 females with an average age of 52.6 years (range, 43-62 years). There were 17 cases of squamous carcinoma and 1 case of dermatofibrilsarcoma protuberan. The size of scalp defect ranged from 15 cm×10 cm to 17 cm×12 cm after resection of tumors. The scalp defects were repaired with the free anterolateral thigh Kiss flap. And the size of flap ranged from 15 cm×6 cm to 20 cm×8 cm. The skull was completely resected in 2 cases, and repaired with Titanium mesh. The sizes of skull defects were 12 cm×10 cm and 10 cm×8 cm. The donor site was sutured directly.ResultsEighteen flaps survived with primary healing of wounds; and healing by first intention was obtained at the donor sites. One patient died because of intracranial metastasis at 5 months after operation, and no local recurrence occurred in the other 17 patients. The follow-up time ranged from 6 months to 4 years (mean, 26.6 months). The results of both appearance and function were satisfactory, without ulceration during follow-up. No obvious scar was found at donor sites and no obvious impairment was observed after harvesting free anterolateral thigh flap.ConclusionLarge scalp defects after malignant tumor resection can be effectively repaired by free anterolateral thigh Kiss flap. The donor site can be sutured directly, without skin grafting, thus avoiding the secondary donor site.
Objective To explore the effectiveness of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in repairing complex calf soft tissue defects. Methods The clinical data of 11 patients with complex calf soft tissue defects between April 2018 and October 2021 were retrospectively analyzed, including 9 males and 2 females, aged 11-60 years, with a median age of 39 years. There were 8 cases of calf soft tissue defect caused by traffic accident, and 3 cases of calf skin infection caused by chronic osteomyelitis. The skin and soft tissue defects ranged from 10 cm×8 cm to 35 cm×10 cm after thorough debridement and accompanied with bone and tendon exposure. There was only one main vessel in calf of 9 cases and no blood vessel that could be anastomosed with the flap vessel could be found in the recipient site of 2 cases. The anterolateral thigh skin flap (the flap size ranged from 12 cm×10 cm to 37 cm×12 cm) was taken to repair the soft tissue defect. The donor site of the flap was treated with direct suture (8 cases) or partial suture followed by skin grafting (3 cases), and the vascular bridge was wrapped with medium-thickness skin graft. Results The flaps of 11 patients survived completely without necrosis, infection, and vascular crisis. The blood supply of the vascular bridge was unobstructed and the pulse was good. The color of the medium-thickness skin graft were ruddy. All 11 patients were followed up 2-40 months, with an average of 19.4 months. The flaps healed well with the surrounding tissues without obvious exudation and color difference. The flaps had normal color and temperature, good blood supply, and soft texture. The shape of the flap and calf contour were satisfactory and the function of the limb recovered well. The donor area of thigh flap healed by first intention without obvious scar formation. The donor area of skin healed well with a longitudinal oblong scar only and the appearance was satisfactory. ConclusionThe anterolateral thigh bridge flap transplantation with free skin wrapping vascular bridge is an effective method for the treatment of complex calf soft tissue defects.
Objective To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. MethodsAccording to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them (n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m2 (mean, 23.09 kg/m2). There was no significant difference in the age and body mass index between groups (P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. Results In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant (P<0.05). There was no significant difference between the groups in the VSS scores and scar widths (P>0.05). ConclusionModerate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.
ObjectiveTo investigate the feasibility of the anterolateral thigh free flap with the oblique branch in reconstructing the soft tissue defects of lower extremity. MethodsBetween June 2009 and February 2013,12 patients (including 7 males and 5 females) with soft tissue defects of lower extremity were treated with the anterolateral thigh free flap with the oblique branch,aged from 8 to 42 years (median,32 years).The locations of soft tissue defect were the dorsum of the foot in 5 cases,the ankle and foot in 4 cases,the lower leg in 2 cases,and the distal foot in 1 case.All defects were associated with exposure of tendon and bone.The size of the wound was from 15 cm×7 cm to 27 cm×12 cm.The interval of injury and operation was 1 to 7 days (mean,3.7 days).The anterolateral thigh flap was pedicled with only the oblique branch in 7 patients,and with the both descending branch and oblique branch in 5 patients,and the size of flap was from 17 cm×9 cm to 30 cm×15 cm.The donor sites were repaired by suture in 3 patients,and by skin graft in 9 patients. ResultsDistal skin flap necrosis occurred in 1 case,and was cured after dressing change and skin graft.The other flaps survived,and the donor site healed primarily.The follow-up time was from 10 months to 2 years (mean,18 months).Thinning operation was performed in 3 cases,and the other flaps recovered pain and warm sensation with good appearance. ConclusionIt is a safe and effective method to reconstruct soft tissue defects of the lower extremity with the anterolateral thigh flap pedicled with the oblique branch.
Objective To introduce the application of the pedicled anterolateral thigh flap transferring for coverage of the oversized skin defect of the hand. Methods The pedicled anterolateral thigh flap was transferred to cover the large skin defects of the hands or the skin defects of theabdomen after the abdominal flap transferred to the hand in 5 male patients aged 16-44 years from April 2002 to August 2005. The injured sites were as follows:4 right hands and 1 left hand, including 2 hands injured by a machine and 3 hands injured by burning.The mechanically injured patients underwent an operation within 6 hours after the injury. The burned patients were reconstructed by the flap transferring 4-7 days after the burn when the decayed tissues could be clearly indentified.The areas of the hand defects were 12.19 cm×18.22 cm.The areas of the pedicled anterolateral thigh flaps were 7.12 cm×16.24 cm. The areas of the abdominal flaps were 13.20 cm×19.23 cm.The pedicles were separated 3 weeks after the repairing operation. Results All the flaps survived well and there was no vascular crisis, with the wound healing of the first intention. The skin defects of the hand were covered completely. Five patients were followed up for 6-12 months. The texture of the flaps was soft and the flaps had a good blood circulation. Of the patients, 3 underwent the finger exclusion and degreasing operation 47 months after operation. All the flaps of the hands had protective sensation, which could meet the requirement of the daily life. Conclusion The pedicled anterolateral thigh flap can provide the large coverage for the skin defects of the hands. The risk of the operation can be greatly decreased by obviation of the vessel anastomosis. It can be an optimal choice for themanagement of the oversized skin defects of the hands.
ObjectiveTo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect. MethodsBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft. ResultsAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up. ConclusionThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.