The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lin , ZHOU Xin , HUANG Yu , HUANG Bo , LIU Anming ,  ZOU Yonggen

Department of Burn and Plastic Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

ZOU Yonggen, Email: yonggenzou1975@163.com

Keywords：

Anterolateral thigh perforator flap; combined transplantation; circumferential defect; degloving injury

DOI：

10.7507/1002-1892.202108002

Video：

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Objective To investigate the effectiveness of the combination of the anterolateral thigh perforator (ALTP) flap and other flaps for repairing the extreme circumferential defects on the limb. Methods Between October 2016 and June 2019, 9 patients with the extreme circumferential defects on the limb were admitted, which resulted by degloving injury, including 8 males and 1 female with a median age of 42 years (range, 32-65 years). The etiology involved twist injury in 5 cases, traffic accident in 2 cases, and high voltage electric injury in 2 cases. The location of the defects was left forearm in 2 cases, right forearm in 3, left foot in 3, and right foot in 1. The injected wound bed followed by the exposure of bone, joint, tendon, and blood vessel. The dimension of defects was 25 cm×20 cm to 40 cm×28 cm. The period between the injury and admission was 1-12 hours (mean, 5 hours). All contaminated wounds were taken thorough and radical debridement and covered by the vacuum sealing drainage device during the emergency operation. The ALTP flap and the other one flap were tailored according to the dimension of the wound when the wound surface became granulating, including the thoracodorsal artery perforator (TAP) flap in 3 cases, superficial inferior epigastric artery perforator flap in 3 cases, superficial circumflex iliac artery perforator flap in 3 cases. And the donor site was primary closure. Results After operation, all the flaps survived except 1 case of partial necrosis at the edge of TAP flap and healed after secondary skin grafting, and the wounds in the donor and recipient areas healed by first intention. All patients were followed up 14-24 months (mean, 16 months). The shape of the flap was satisfactory and the texture was soft. There was no abnormal hair growth and obvious pigmentation during the follow-up. Only linear scar was left in the donor area, there was no complication such as abdominal wall hernia, and the activity of hip and knee was not affected. The functional reconstruction of upper limb and ankle was satisfactory, and the disabilities of the arm, shoulder, and hand (DASH) score was excellent in 4 cases and good in 1 case; the American Orthopaedic Foot and Ankle Association (AOFAS) score was excellent in 3 cases and good in 1 case. Conclusion ALTP flap combined with different flaps can reconstruct the circumferential extreme defects after limb damage in one-stage, which can achieve limb salvage to the greatest extent.

Citation： TANG Lin, ZHOU Xin, HUANG Yu, HUANG Bo, LIU Anming, ZOU Yonggen. The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1609-1614. doi: 10.7507/1002-1892.202108002 Copy

1.	Hakim S, Ahmed K, El-Menyar A, et al. Patterns and management of degloving injuries: a single national level 1 trauma center experience. World J Emerg Surg, 2016, 11: 35. doi: 10.1186/s13017-016-0093-2.
2.	Zhou X, You P, Huang S, et al. Resection and reconstruction of a giant primitive neuroectodermal tumour of the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap: a case report. BMC Surg, 2021, 21(1): 90. doi: 10.1186/s12893-021-01095-5.
3.	Hung SY, Loh CYY, Chen HC. Supercharging extra-large anterolateral thigh flaps for single-stage resurfacing of massive burn defects over upper extremity elbow joints. J Burn Care Res, 2018, 39(5): 831-834.
4.	Weise H, Naros A, Blumenstock G, et al. Donor site morbidity of the anterolateral thigh flap. J Craniomaxillofac Surg, 2017, 45(12): 2105-2108.
5.	Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg, 2013, 41(1): 15-21.
6.	Pachón Suárez JE, Sadigh PL, Shih HS, et al. Achieving direct closure of the anterolateral thigh flap donor site-an algorithmic approach. Plast Reconstr Surg Glob Open, 2014, 2(10): e232. doi: 10.1097/GOX.0000000000000205.
7.	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.
8.	賀繼強, 唐舉玉, 卿黎明, 等. 動脈插管造影CTA與普通CTA顯影股前外側穿支的比較研究. 中國臨床解剖學雜志, 2017, 35(5): 508-512.
9.	陳勝華, 徐達傳, 周小兵, 等. 以旋股外側動脈降支為蒂分葉股前外側肌皮瓣設計的解剖學研究. 中國臨床解剖學雜志, 2010, 28(3): 237-241.
10.	Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
11.	Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
12.	施權, 魏在榮. 旋髂淺動脈穿支皮瓣的應用進展. 中華顯微外科雜志, 2018, 41(5): 插 5-1, 5-2.
13.	王曉敏, 張凱, 馬士崟, 等. 腹壁淺動脈皮瓣的應用解剖研究. 中國修復重建外科雜志, 2010, 24(11): 1357-1360.
14.	Mahajan AL, Van Waes C, D’Arpa S, et al. Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients. J Plast Reconstr Aesthet Surg, 2016, 69(7): 920-927.
15.	Harii K, Iwaya T, Kawaguchi N. Combination myocutaneous flap and microvascular free flap. Plast Reconstr Surg, 1981, 68(5): 700-711.
16.	劉安銘, 周鑫, 歐昌良, 等. 攜帶雙側旋髂淺動脈的腹部游離皮瓣修復足踝部大面積皮膚軟組織缺損. 中國修復重建外科雜志, 2021, 35(7): 886-890.
17.	周鑫, 宋達疆, 鄒永根. 游離胸背動脈穿支皮瓣聯合旋髂淺動脈穿支皮瓣移植修復下肢大面積環周軟組織缺損一例. 中國修復重建外科雜志, 2021, 35(3): 399-400.
18.	Qing L, Li X, Wu P, et al. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1909-1916.
19.	周征兵, 唐舉玉, 吳攀峰, 等. 雙側旋股外側動脈降支穿支皮瓣組合移植修復下肢大面積軟組織缺損. 中華顯微外科雜志, 2020, 43(6): 535-539.
20.	Ou Q, Wu P, Zhou Z, et al. Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation. Injury, 2021, 52(6): 1356-1362.

1. Hakim S, Ahmed K, El-Menyar A, et al. Patterns and management of degloving injuries: a single national level 1 trauma center experience. World J Emerg Surg, 2016, 11: 35. doi: 10.1186/s13017-016-0093-2.
2. Zhou X, You P, Huang S, et al. Resection and reconstruction of a giant primitive neuroectodermal tumour of the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap: a case report. BMC Surg, 2021, 21(1): 90. doi: 10.1186/s12893-021-01095-5.
3. Hung SY, Loh CYY, Chen HC. Supercharging extra-large anterolateral thigh flaps for single-stage resurfacing of massive burn defects over upper extremity elbow joints. J Burn Care Res, 2018, 39(5): 831-834.
4. Weise H, Naros A, Blumenstock G, et al. Donor site morbidity of the anterolateral thigh flap. J Craniomaxillofac Surg, 2017, 45(12): 2105-2108.
5. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg, 2013, 41(1): 15-21.
6. Pachón Suárez JE, Sadigh PL, Shih HS, et al. Achieving direct closure of the anterolateral thigh flap donor site-an algorithmic approach. Plast Reconstr Surg Glob Open, 2014, 2(10): e232. doi: 10.1097/GOX.0000000000000205.
7. 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.
8. 賀繼強, 唐舉玉, 卿黎明, 等. 動脈插管造影CTA與普通CTA顯影股前外側穿支的比較研究. 中國臨床解剖學雜志, 2017, 35(5): 508-512.
9. 陳勝華, 徐達傳, 周小兵, 等. 以旋股外側動脈降支為蒂分葉股前外側肌皮瓣設計的解剖學研究. 中國臨床解剖學雜志, 2010, 28(3): 237-241.
10. Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
11. Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
12. 施權, 魏在榮. 旋髂淺動脈穿支皮瓣的應用進展. 中華顯微外科雜志, 2018, 41(5): 插 5-1, 5-2.
13. 王曉敏, 張凱, 馬士崟, 等. 腹壁淺動脈皮瓣的應用解剖研究. 中國修復重建外科雜志, 2010, 24(11): 1357-1360.
14. Mahajan AL, Van Waes C, D’Arpa S, et al. Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients. J Plast Reconstr Aesthet Surg, 2016, 69(7): 920-927.
15. Harii K, Iwaya T, Kawaguchi N. Combination myocutaneous flap and microvascular free flap. Plast Reconstr Surg, 1981, 68(5): 700-711.
16. 劉安銘, 周鑫, 歐昌良, 等. 攜帶雙側旋髂淺動脈的腹部游離皮瓣修復足踝部大面積皮膚軟組織缺損. 中國修復重建外科雜志, 2021, 35(7): 886-890.
17. 周鑫, 宋達疆, 鄒永根. 游離胸背動脈穿支皮瓣聯合旋髂淺動脈穿支皮瓣移植修復下肢大面積環周軟組織缺損一例. 中國修復重建外科雜志, 2021, 35(3): 399-400.
18. Qing L, Li X, Wu P, et al. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1909-1916.
19. 周征兵, 唐舉玉, 吳攀峰, 等. 雙側旋股外側動脈降支穿支皮瓣組合移植修復下肢大面積軟組織缺損. 中華顯微外科雜志, 2020, 43(6): 535-539.
20. Ou Q, Wu P, Zhou Z, et al. Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation. Injury, 2021, 52(6): 1356-1362.

Chinese Journal of Reparative and Reconstructive Surgery

The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb

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