Application of modified three longitudinal and five transverse method in perforating branch location before anterolateral thigh perforator flap repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Taotao , CHANG Shusen ,  WEI Zairong , MO Xiaojin , LI Hai , ZHOU Jian , DENG Chengliang , NIE Kaiyu , LI Shujun , CHEN Wei , JIN Wenhu

Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China;

Corresponding?author：

WEI Zairong, Email: zairongwei@163.com

Keywords：

Modified three longitudinal and five transverse method; anterolateral thigh perforator flap; lateral femoral circumflex artery; perforating branch; lateral femoral cutaneous nerve

DOI：

10.7507/1002-1892.202103074

Video：

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Objective To explore the feasibility and accuracy of modified three longitudinal and five transverse method in locating perforating branches before anterolateral thigh perforator flap (ALTP) repair.Methods Between January 2019 and December 2019, 41 patients with skin and soft tissue defects were repaired with ALTP. There were 31 males and 10 females. The age ranged from 18 to 61 years, with an average of 32 years. The soft tissue defects were caused by trauma in 38 cases, and the time from injury to operation was 3-7 days, with an average of 4 days. The wounds left after excision of scar contracture deformity because of burn in 3 cases. Soft tissue defects located at upper limbs in 16 cases and lower limbs in 25 cases. The size of soft tissue defects ranged from 10 cm×4 cm to 25 cm×12 cm. Before operation, zonesⅠ, Ⅱ, Ⅲ, and Ⅳwere formed on the anterolateral thigh by modified three longitudinal and five transverse method. The perforating branches were detected in these four zones by Doppler ultrasound, and the skin flaps were designed according to the wound area. The perforating branches were explored during operation, and the distribution and types of perforating branches in each zone and the relationship between perforating branches and lateral femoral cutaneous nerve were observed. The ALTP with the size of 12 cm×5 cm to 30 cm×10 cm was used to repair the wound, and the donor site was sutured directly or repaired with the flap. Results A total of 117 perforating branches were detected in 41 patients before operation, and 111 perforating branches were found during operation, with a false positive rate of 5%. The probability of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were 56%, 73%, 76%, and 66% respectively, and the false positive rates were –9%, 7%, 16%, and 4%, respectively. All perforating branches located near the trunk of lateral femoral cutaneous nerve, especially in posterolateral area. There were only 1 perforating branch in 6 cases, 2 perforating branches in 12 cases, 3 perforating branches in 10 cases, and 4 perforating branches in 13 cases. The main types of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were transverse perforating branches, oblique perforating branches, descending perforating branches, and descending perforating branches, respectively. Partial distal necrosis occurred in 2 cases and complete necrosis occurred in 1 case after operation, and the wounds were repaired with skin grafts. The remaining 38 flaps survived successfully, and the wounds and the incisions of donor sites healed by first intention. All patients were followed up 3 to 12 months, with an average of 6 months. The appearance and texture of the skin flap were acceptable, and linear scar remained in the donor site.Conclusion It can simply locate and distinguish the perforating branches and better protect the lateral femoral cutaneous nerve by using the modified three longitudinal and five transverse method before ALTP repair.

Citation： HU Taotao, CHANG Shusen, WEI Zairong, MO Xiaojin, LI Hai, ZHOU Jian, DENG Chengliang, NIE Kaiyu, LI Shujun, CHEN Wei, JIN Wenhu. Application of modified three longitudinal and five transverse method in perforating branch location before anterolateral thigh perforator flap repair. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 1027-1032. doi: 10.7507/1002-1892.202103074 Copy

1.	楊琴, 李靖, 李學擁, 等. 彩色多普勒超聲在穿支皮瓣術前定位中的應用. 中國美容整形外科雜志, 2018, 29(2): 101-104.
2.	莫勇軍, 許林, 程志琳, 等. 增強現實技術聯合數字化設計在股前外側穿支皮瓣的應用. 中華顯微外科雜志, 2019, 42(2): 189-192.
3.	常樹森, 魏在榮. 穿支皮瓣術前影像學導航技術的研究進展. 中國臨床解剖學雜志, 2016, 34(5): 596-598.
4.	Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2): 305-310.
5.	Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg, 2006, 118(4): 928-935.
6.	Deng CL, Chang SS, Wei ZR, et al. Alternative design for anterolateral thigh multi-paddled flaps: the 3-5 system. Med Sci Monit, 2018, 24: 9102-9109.
7.	Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
8.	韓婷璐, 臧夢青, 朱珊, 等. 以旋股外側動脈不同分支來源的穿支為蒂的螺旋槳皮瓣手術設計和臨床應用. 中華整形外科雜志, 2019, 35(9): 854-861.
9.	Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
10.	常樹森, 金文虎, 魏在榮, 等. 股前外側皮瓣術前設計優化及臨床應用. 中華顯微外科雜志, 2017, 40(2): 118-122.
11.	常樹森, 魏在榮, 金文虎, 等. 股前外側皮瓣三縱五橫法設計方案的臨床研究. 中華整形外科雜志, 2019, 35(6): 571-576.
12.	Deng CL, Wu BH, Wei ZR, et al. A systematic study of vascular distribution characteristics and axis design of various flap types. Med Sci Monit, 2019, 25: 721-729.
13.	den Brave PS, Vas Nunes SE, Bronkhorst MW. Anatomical variations of the lateral femoral cutaneous nerve and iatrogenic injury after autologous bone grafting from the iliac crest. J Orthop Trauma, 2015, 29(12): 549-553.
14.	Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.

1. 楊琴, 李靖, 李學擁, 等. 彩色多普勒超聲在穿支皮瓣術前定位中的應用. 中國美容整形外科雜志, 2018, 29(2): 101-104.
2. 莫勇軍, 許林, 程志琳, 等. 增強現實技術聯合數字化設計在股前外側穿支皮瓣的應用. 中華顯微外科雜志, 2019, 42(2): 189-192.
3. 常樹森, 魏在榮. 穿支皮瓣術前影像學導航技術的研究進展. 中國臨床解剖學雜志, 2016, 34(5): 596-598.
4. Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2): 305-310.
5. Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg, 2006, 118(4): 928-935.
6. Deng CL, Chang SS, Wei ZR, et al. Alternative design for anterolateral thigh multi-paddled flaps: the 3-5 system. Med Sci Monit, 2018, 24: 9102-9109.
7. Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
8. 韓婷璐, 臧夢青, 朱珊, 等. 以旋股外側動脈不同分支來源的穿支為蒂的螺旋槳皮瓣手術設計和臨床應用. 中華整形外科雜志, 2019, 35(9): 854-861.
9. Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
10. 常樹森, 金文虎, 魏在榮, 等. 股前外側皮瓣術前設計優化及臨床應用. 中華顯微外科雜志, 2017, 40(2): 118-122.
11. 常樹森, 魏在榮, 金文虎, 等. 股前外側皮瓣三縱五橫法設計方案的臨床研究. 中華整形外科雜志, 2019, 35(6): 571-576.
12. Deng CL, Wu BH, Wei ZR, et al. A systematic study of vascular distribution characteristics and axis design of various flap types. Med Sci Monit, 2019, 25: 721-729.
13. den Brave PS, Vas Nunes SE, Bronkhorst MW. Anatomical variations of the lateral femoral cutaneous nerve and iatrogenic injury after autologous bone grafting from the iliac crest. J Orthop Trauma, 2015, 29(12): 549-553.
14. Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified three longitudinal and five transverse method in perforating branch location before anterolateral thigh perforator flap repair

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