A technique analysis for dissection of anterolateral thigh perforator flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Yueliang ¹ ,  YIN Zuoming ² , WANG Jiaxiang ³ , Lü Qian ¹ , ZHAO Zeyu ¹ , PU Shaoquan ¹ , SHI Jian ¹ , XU Yongqing ¹

1. Department of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming Yunnan, 650032, P.R.China;
2. Department of Orthopaedics, General Hospital of Tibet Military Area, Lhasa Tibet, 850000, P.R.China;
3. Department of Orthopaedics, People’s Hospital of Luoping County, Luoping Yunnan, 655800, P.R.China;

Corresponding?author：

YIN Zuoming, Email: zhuyuelianghu@sina.com

Keywords：

Anterolateral thigh perforator flap; flap harvesting; Modification

DOI：

10.7507/1002-1892.201607112

Video：

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Objective To improve the harvesting techniques of anterolateral thigh perforator flap, and to reduce the operation time. Methods Between January 2008 and June 2015, 400 patients undergoing repair with anterolateral thigh perforator flap were included to analyze the technical factors, including 370 cases (92.5%) obtaining primary healing and 30 cases (7.5%) receiving re-exploration. Combined with the literature, a modified flap dissection was made: reverse tracing and sequential dissection of the descending branch of the lateral circumflex femoral artery. Between June 2015 and June 2016, the modified free anterolateral thigh perforator flap was used in 100 cases. Of 100 cases, 76 were male and 24 were female, aged from 11 to 71 years (mean, 35.6 years). The wound size ranged from 8 cm×5 cm to 23 cm×9 cm. The time between injury and surgery ranged from 5 to 31 days (mean, 14.3 days). Results The operation time of modified flap dissection was reduced to (30.1±19.3) minutes from (85.0±30.2) minutes (unmodified flap dissection). Postoperatively, 94 flaps survived uneventfully, and incision healed by first intention. Six flaps received re-exploration surgery because of vascular compromise; the flap survived after removal of thrombosis in 4 cases of vein thrombosis; the flap necrosed in 2 cases of vein and artery thrombosis, and skin grafting was performed. Ninety-four patients whose flaps survived were followed up 3-12 months (mean, 6.3 months); the flaps had good color and appearance, and second stage operation was performed to make the flap thinner in 21 cases. Conclusion Improved harvesting technique of free anterolageral thigh perforator flap could decrease surgery time and difficulty in dissection.

Citation： ZHUYueliang, YINZuoming, WANGJiaxiang, LüQian, ZHAOZeyu, PUShaoquan, SHIJian, XUYongqing. A technique analysis for dissection of anterolateral thigh perforator flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 57-61. doi: 10.7507/1002-1892.201607112 Copy

1.	?徐達傳, 鐘世鎮, 劉牧之, 等. 股前外側部皮瓣的解剖學一個新的游離皮瓣供區. 臨床應用解剖學雜志, 1984, 2(3): 158-160.
2.	Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
3.	Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolageral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
4.	Wei FC, Mardini S. Flaps and reconstructive surgery. New York: Elsevier Saunders, 2009: 539-558.
5.	Blondeel PN, Morris SF, Hallock GG, et al. Peforator flaps: anatomy, techniques, and clinical applications. 2nd eds. St.Louis: Quality Medical Publicshing, 2013: 718-739.
6.	唐茂林, 徐永清, 張世民. 穿支皮瓣的應用解剖與臨床. 北京: 科學出版社, 2013: 224-231.
7.	徐永清, 林澗, 鄭和平. 穿支皮瓣. 北京: 人民衛生出版社, 2015: 201-217.
8.	Koshima I, Fikuda H, Utumomiya R, et al. The anterolateral thigh flap: variations in its vascular pedicle. Br J Plast Surg, 1989, 42(3): 260-262.
9.	Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg, 2002, 109(7): 2211-2216.
10.	Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical application of the thin anterolateral thigh flap. Plast Reconstr Surg, 1996, 97(5): 985-992.
11.	Ji Y, Li T, Shamburger S, et al. Microsurgical anterolateral thigh fasciocutaneous flap or facial contour correction in patients with hemifacialmicrosomia. Microsurgery, 2002, 22(1): 34-38.
12.	Kimura N, Satoh K, Hasumi T, et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg, 2001, 108(5): 1197-1208.
13.	朱躍良, 徐永清, 李軍, 等. 一期原位修薄的游離股前外側穿支皮瓣修復足末端缺損. 中國臨床解剖學雜志, 2011, 29(5): 572-574.
14.	Boca R, Kuo YR, Hsieh CH, et al. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg, 2010, 126(5): 1558-1562.
15.	Yamada N, Kakibuchi M, Kitayoshi H, et al. A new way of elevating the anterolateral thigh flap. PlastReconstr Surg, 2001, 108(6): 1677-1682.

1. ?徐達傳, 鐘世鎮, 劉牧之, 等. 股前外側部皮瓣的解剖學一個新的游離皮瓣供區. 臨床應用解剖學雜志, 1984, 2(3): 158-160.
2. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
3. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolageral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
4. Wei FC, Mardini S. Flaps and reconstructive surgery. New York: Elsevier Saunders, 2009: 539-558.
5. Blondeel PN, Morris SF, Hallock GG, et al. Peforator flaps: anatomy, techniques, and clinical applications. 2nd eds. St.Louis: Quality Medical Publicshing, 2013: 718-739.
6. 唐茂林, 徐永清, 張世民. 穿支皮瓣的應用解剖與臨床. 北京: 科學出版社, 2013: 224-231.
7. 徐永清, 林澗, 鄭和平. 穿支皮瓣. 北京: 人民衛生出版社, 2015: 201-217.
8. Koshima I, Fikuda H, Utumomiya R, et al. The anterolateral thigh flap: variations in its vascular pedicle. Br J Plast Surg, 1989, 42(3): 260-262.
9. Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg, 2002, 109(7): 2211-2216.
10. Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical application of the thin anterolateral thigh flap. Plast Reconstr Surg, 1996, 97(5): 985-992.
11. Ji Y, Li T, Shamburger S, et al. Microsurgical anterolateral thigh fasciocutaneous flap or facial contour correction in patients with hemifacialmicrosomia. Microsurgery, 2002, 22(1): 34-38.
12. Kimura N, Satoh K, Hasumi T, et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg, 2001, 108(5): 1197-1208.
13. 朱躍良, 徐永清, 李軍, 等. 一期原位修薄的游離股前外側穿支皮瓣修復足末端缺損. 中國臨床解剖學雜志, 2011, 29(5): 572-574.
14. Boca R, Kuo YR, Hsieh CH, et al. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg, 2010, 126(5): 1558-1562.
15. Yamada N, Kakibuchi M, Kitayoshi H, et al. A new way of elevating the anterolateral thigh flap. PlastReconstr Surg, 2001, 108(6): 1677-1682.

Chinese Journal of Reparative and Reconstructive Surgery

A technique analysis for dissection of anterolateral thigh perforator flap

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