Application of lateral circumflex femoral artery chimeric flap to repair complex wounds of foot and ankle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIN Wenhu , ZHANG Ziyang , WU Xiangkui , QUAN Hui , QI Jianping ,  WEI Zairong

Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China;

Corresponding?author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

Lateral circumflex femoral artery; free flap; chimeric flap; foot and ankle; wound repair

DOI：

10.7507/1002-1892.202102039

Video：

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Objective To investigate the effectiveness of lateral circumflex femoral artery chimeric flap transplantation in repair of complex wounds of foot and ankle.Methods A retrospective study was conducted to analyze the clinical data of 20 patients with complex wounds of foot and ankle treated with lateral circumflex femoral artery chimeric flap between June 2017 and June 2020. There were 14 males and 6 females with an average age of 42.8 years (range, 21-65 years). Among them, 8 cases had dorsalis pedis tendon defect with or without bone exposure, 4 cases had partial or total Achilles tendon defect without bone exposure, and 8 cases had deep cavity and bone exposure. The wound area ranged from 10 cm×6 cm to 21 cm×11 cm. The time from injury to operation ranged from 6 to 22 days, with an average of 9.4 days. The lateral femoral circumflex artery flap was used in 6 cases with fascia lata flap, 6 cases with rectus femoris aponeurosis flap, and 8 cases with lateral femoral muscle flap. The flap area ranged from 12.0 cm×6.5 cm to 35.0 cm×7.5 cm. All flap donor sites were sutured directly. The survival, appearance, texture, sensation of the flap, and complications of the donor site were observed. The foot and ankle function was evaluated by Kofoed score.Results All patients were followed up 8-24 months (mean, 14.2 months). On the 3rd day after operation, 1 case had partial necrosis of 1 flap with fascia lata flap and healed after dressing change; 1 case of chimeric muscle flap developed venous crisis at 12 hours after operation; the chimeric flaps survived successfully in the other 18 patients and the wounds were primary healing. The color and texture of the flaps were good, the flaps recovered protective sensation. Only linear scar remained in the donor site of thigh. There was no sensory disturbance around the incision or walking disturbance. The Kofoed score of the foot and ankle function at last follow-up was 75-96, with an average of 89.8. Among them, 15 cases were excellent, 4 cases were good, and 1 case was qualified. The excellent and good rate was 95.0%.Conclusion The application of lateral circumflex femoral artery chimeric flap can accurately and stereoscopically repair the complex wounds of foot and ankle and achieve satisfactory effectiveness.

Citation： JIN Wenhu, ZHANG Ziyang, WU Xiangkui, QUAN Hui, QI Jianping, WEI Zairong. Application of lateral circumflex femoral artery chimeric flap to repair complex wounds of foot and ankle. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(7): 891-895. doi: 10.7507/1002-1892.202102039 Copy

1.	Abdelfattah U, Power HA, Song S, et al. Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases. Plast Reconstr Surg, 2019, 144(5): 1202-1213.
2.	Silva AK, Humphries LS, Maldonado AA, et al. Chimeric vs composite flaps for mandible reconstruction. Head Neck, 2019, 41(6): 1597-1604.
3.	Franchi A, H?feli M, Scaglioni MF, et al. The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand. Microsurgery, 2019, 39(5): 416-422.
4.	郭翱, 宋達疆, 鄭良軍, 等. 游離股前外側嵌合股直肌肌腱皮瓣移植修復腕背部復合組織缺損. 中華顯微外科雜志, 2018, 41(5): 454-458.
5.	Kofoed H, S?rensen TS. Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: prospective long-term study of cemented replacements. J Bone Joint Surg (Br), 1998, 80(2): 328-332.
6.	唐舉玉, 卿黎明, 吳攀峰, 等. 游離腹壁下動脈嵌合穿支皮瓣修復合并深部死腔的下肢皮膚軟組織缺損. 中華整形外科雜志, 2015, 31(6): 425-428.
7.	王晨, 羅鵬飛, 何飛, 等. 神經松解肌腱移植術治療上肢嚴重熱壓傷的療效評價. 中華創傷雜志, 2020, 36(4): 347-352.
8.	Diniz P, Pacheco J, Flora M, et al. Clinical applications of allografts in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc, 2019, 27(6): 1847-1872.
9.	陳黎明, 劉毅, 張誠, 等. 帶肌瓣的嵌合穿支皮瓣修復合并深部死腔的難愈性創面. 中華整形外科雜志, 2020, 36(3): 279-283.
10.	Pourtaheri N, Wang D, Calva D, et al. Adipofascial flaps with acellular dermal matrix compared with myocutaneous flap reconstruction in lumbar myelomeningocele defects. J Craniofac Surg, 2018, 29(5): 1137-1142.
11.	徐承新, 劉毅, 陳黎明, 等. 臀部筋膜脂肪瓣修復坐骨結節和大轉子復發性竇道型壓瘡. 中國修復重建外科雜志, 2020, 34(10): 1354-1355.
12.	Ipaktchi R, Boyce MK, Mett TR, et al. Reconstruction using the tensor fasciae latae muscle flap. Oper Orthop Traumatol, 2018, 30(4): 228-235.
13.	Tanaka K, Mii S, Ishida M, et al. Salvage of infected prosthetic grafts at the groin or thigh using muscle flap coverage. Ann Vasc Dis, 2020, 13(4): 404-409.
14.	周丕育, 楊紹浦, 李尚權, 等. 兩種不同方式髂骨瓣游離移植在脛骨骨缺損修復中的應用. 中華整形外科雜志, 2019, 35(12): 1230-1233.
15.	Yu J, Luo Z, Wu P, et al. Novel design of the chimeric deep inferior epigastric artery perforator flap that provides for three-dimensional reconstruction of composite tissue defects of the heel in children. Orthop Surg, 2021, 13(1): 216-224.
16.	彭漢偉, 林建英, 郭海鵬, 等. 以旋髂深動脈為蒂的髂骨-腹內斜肌筋膜嵌合瓣修復下頜骨口腔黏膜復合缺損. 中國修復重建外科雜志, 2018, 32(12): 1567-1571.
17.	Ki SH, Ma SH, Sim SH, et al. Unplanned change from double free flap to a chimeric anterolateral thigh flap in recurrent laryngeal cancer. Arch Craniofac Surg, 2019, 20(6): 416-420.
18.	張世民, 王欣, 唐茂林, 等. 穿支皮瓣的爭論與當前共識. 中華顯微外科雜志, 2014, 37(1): 3-4.
19.	鄧呈亮, 肖順娥, 魏在榮. 旋股外側動脈斜支作為股前外側游離皮瓣優選血管蒂的可行性研究. 中華燒傷雜志, 2020, 36(7): 636.

1. Abdelfattah U, Power HA, Song S, et al. Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases. Plast Reconstr Surg, 2019, 144(5): 1202-1213.
2. Silva AK, Humphries LS, Maldonado AA, et al. Chimeric vs composite flaps for mandible reconstruction. Head Neck, 2019, 41(6): 1597-1604.
3. Franchi A, H?feli M, Scaglioni MF, et al. The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand. Microsurgery, 2019, 39(5): 416-422.
4. 郭翱, 宋達疆, 鄭良軍, 等. 游離股前外側嵌合股直肌肌腱皮瓣移植修復腕背部復合組織缺損. 中華顯微外科雜志, 2018, 41(5): 454-458.
5. Kofoed H, S?rensen TS. Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: prospective long-term study of cemented replacements. J Bone Joint Surg (Br), 1998, 80(2): 328-332.
6. 唐舉玉, 卿黎明, 吳攀峰, 等. 游離腹壁下動脈嵌合穿支皮瓣修復合并深部死腔的下肢皮膚軟組織缺損. 中華整形外科雜志, 2015, 31(6): 425-428.
7. 王晨, 羅鵬飛, 何飛, 等. 神經松解肌腱移植術治療上肢嚴重熱壓傷的療效評價. 中華創傷雜志, 2020, 36(4): 347-352.
8. Diniz P, Pacheco J, Flora M, et al. Clinical applications of allografts in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc, 2019, 27(6): 1847-1872.
9. 陳黎明, 劉毅, 張誠, 等. 帶肌瓣的嵌合穿支皮瓣修復合并深部死腔的難愈性創面. 中華整形外科雜志, 2020, 36(3): 279-283.
10. Pourtaheri N, Wang D, Calva D, et al. Adipofascial flaps with acellular dermal matrix compared with myocutaneous flap reconstruction in lumbar myelomeningocele defects. J Craniofac Surg, 2018, 29(5): 1137-1142.
11. 徐承新, 劉毅, 陳黎明, 等. 臀部筋膜脂肪瓣修復坐骨結節和大轉子復發性竇道型壓瘡. 中國修復重建外科雜志, 2020, 34(10): 1354-1355.
12. Ipaktchi R, Boyce MK, Mett TR, et al. Reconstruction using the tensor fasciae latae muscle flap. Oper Orthop Traumatol, 2018, 30(4): 228-235.
13. Tanaka K, Mii S, Ishida M, et al. Salvage of infected prosthetic grafts at the groin or thigh using muscle flap coverage. Ann Vasc Dis, 2020, 13(4): 404-409.
14. 周丕育, 楊紹浦, 李尚權, 等. 兩種不同方式髂骨瓣游離移植在脛骨骨缺損修復中的應用. 中華整形外科雜志, 2019, 35(12): 1230-1233.
15. Yu J, Luo Z, Wu P, et al. Novel design of the chimeric deep inferior epigastric artery perforator flap that provides for three-dimensional reconstruction of composite tissue defects of the heel in children. Orthop Surg, 2021, 13(1): 216-224.
16. 彭漢偉, 林建英, 郭海鵬, 等. 以旋髂深動脈為蒂的髂骨-腹內斜肌筋膜嵌合瓣修復下頜骨口腔黏膜復合缺損. 中國修復重建外科雜志, 2018, 32(12): 1567-1571.
17. Ki SH, Ma SH, Sim SH, et al. Unplanned change from double free flap to a chimeric anterolateral thigh flap in recurrent laryngeal cancer. Arch Craniofac Surg, 2019, 20(6): 416-420.
18. 張世民, 王欣, 唐茂林, 等. 穿支皮瓣的爭論與當前共識. 中華顯微外科雜志, 2014, 37(1): 3-4.
19. 鄧呈亮, 肖順娥, 魏在榮. 旋股外側動脈斜支作為股前外側游離皮瓣優選血管蒂的可行性研究. 中華燒傷雜志, 2020, 36(7): 636.

Chinese Journal of Reparative and Reconstructive Surgery

Application of lateral circumflex femoral artery chimeric flap to repair complex wounds of foot and ankle

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