Application of thin free lateral femoral circumflex artery perforator flap in repair of scar contracture deformity in hand and foot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAO Shun’e , ZHANG Tianhua , WU Bihua , LI Hai , WEI Zairong , WANG Dali ,  DENG Chengliang

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

Corresponding?author：

DENG Chengliang, Email: cheliadeng@sina.com

Keywords：

Lateral femoral circumflex artery perforator flap; thin flap; scar contracture; wound repair

DOI：

10.7507/1002-1892.202109065

Video：

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Objective To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot. Methods Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly. Results The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites. Conclusion The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.

Citation： XIAO Shun’e, ZHANG Tianhua, WU Bihua, LI Hai, WEI Zairong, WANG Dali, DENG Chengliang. Application of thin free lateral femoral circumflex artery perforator flap in repair of scar contracture deformity in hand and foot. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 220-223. doi: 10.7507/1002-1892.202109065 Copy

1.	Cinal H, Barin EZ, Kara M, et al. Reconstruction of postburn contractures due to tandir oven. J Plast Surg Hand Surg, 2020, 54(2): 120-129.
2.	Boffeli TJ, Gorman CM. Achilles lengthening and multiple Z-plasty in parallel for correction of toe walking associated with burn scar equinus contracture. J Foot Ankle Surg, 2019, 58(5): 1025-1029.
3.	金光哲, 巨積輝, 熊勝, 等. 單葉或雙葉帶闊筋膜的股前外側皮瓣在手足背皮膚肌腱缺損中的應用. 中華手外科雜志, 2019, 35(4): 241-243.
4.	江吉勇, 蘭榮玉, 鄒芬, 等. 削薄股前外側穿支皮瓣修復手部術后瘢痕攣縮畸形12例. 中華顯微外科雜志, 2020, 43(5): 446-449.
5.	柳志錦, 巨積輝, 程俊楠, 等. 以旋股外側動脈斜支為源動脈的股前外側雙葉穿支皮瓣修復四肢創面. 中華顯微外科雜志, 2021, 44(2): 152-156.
6.	柳志錦, 巨積輝, 周榮, 等. 帶闊筋膜血流橋接型股前外側穿支皮瓣修復伴伸肌腱缺損的手、足背側創面. 中華創傷雜志, 2021, 37(10): 894-899.
7.	常樹森, 何春念, 金文虎. 股前外側皮瓣的供區并發癥. 中華顯微外科雜志, 2018, 41(1): 101-104.
8.	胡濤濤, 常樹森, 魏在榮, 等. 改良三縱五橫法在股前外側穿支皮瓣修復術前穿支定位中的應用研究. 中國修復重建外科雜志, 2021, 35(8): 1027-1032.
9.	常樹森, 莫小金, 魏在榮, 等. 遵義縫合法在股前外側皮瓣供區縫合中的應用研究. 中國修復重建外科雜志, 2021, 35(4): 477-482.
10.	潘達德, 顧玉東, 侍德. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
11.	Seth AK, Iorio ML. Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg, 2017, 33(7): 466-473.
12.	Suh YC, Kim NR, Jun DW, et al. The perforator-centralizing technique for super-thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate. Arch Plast Surg, 2021, 48(1): 121-126.
13.	Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg, 2003, 112(7): 1875-1885.
14.	Yang WG, Chiang YC, Wei FC, et al. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
15.	Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al. Suprafascial anterolateral thigh flap harvest: A better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg, 2016, 138(3): 689-698.
16.	Lu M, Sun G, Hu Q, et al. Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects. Med Oral Patol Oral Cir Bucal, 2015, 20(6): e757-e762.
17.	魏在榮, 常樹森. 穿支皮瓣簡述. 中華燒傷雜志, 2019, 35(7): 481-485.
18.	Bali ZU, Ozkan B, Parspanc? A, et al. Reconstruction of lower lip defects with free super-thin anterolateral thigh flap. Microsurgery, 2021, 41(3): 216-222.

1. Cinal H, Barin EZ, Kara M, et al. Reconstruction of postburn contractures due to tandir oven. J Plast Surg Hand Surg, 2020, 54(2): 120-129.
2. Boffeli TJ, Gorman CM. Achilles lengthening and multiple Z-plasty in parallel for correction of toe walking associated with burn scar equinus contracture. J Foot Ankle Surg, 2019, 58(5): 1025-1029.
3. 金光哲, 巨積輝, 熊勝, 等. 單葉或雙葉帶闊筋膜的股前外側皮瓣在手足背皮膚肌腱缺損中的應用. 中華手外科雜志, 2019, 35(4): 241-243.
4. 江吉勇, 蘭榮玉, 鄒芬, 等. 削薄股前外側穿支皮瓣修復手部術后瘢痕攣縮畸形12例. 中華顯微外科雜志, 2020, 43(5): 446-449.
5. 柳志錦, 巨積輝, 程俊楠, 等. 以旋股外側動脈斜支為源動脈的股前外側雙葉穿支皮瓣修復四肢創面. 中華顯微外科雜志, 2021, 44(2): 152-156.
6. 柳志錦, 巨積輝, 周榮, 等. 帶闊筋膜血流橋接型股前外側穿支皮瓣修復伴伸肌腱缺損的手、足背側創面. 中華創傷雜志, 2021, 37(10): 894-899.
7. 常樹森, 何春念, 金文虎. 股前外側皮瓣的供區并發癥. 中華顯微外科雜志, 2018, 41(1): 101-104.
8. 胡濤濤, 常樹森, 魏在榮, 等. 改良三縱五橫法在股前外側穿支皮瓣修復術前穿支定位中的應用研究. 中國修復重建外科雜志, 2021, 35(8): 1027-1032.
9. 常樹森, 莫小金, 魏在榮, 等. 遵義縫合法在股前外側皮瓣供區縫合中的應用研究. 中國修復重建外科雜志, 2021, 35(4): 477-482.
10. 潘達德, 顧玉東, 侍德. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
11. Seth AK, Iorio ML. Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg, 2017, 33(7): 466-473.
12. Suh YC, Kim NR, Jun DW, et al. The perforator-centralizing technique for super-thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate. Arch Plast Surg, 2021, 48(1): 121-126.
13. Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg, 2003, 112(7): 1875-1885.
14. Yang WG, Chiang YC, Wei FC, et al. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
15. Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al. Suprafascial anterolateral thigh flap harvest: A better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg, 2016, 138(3): 689-698.
16. Lu M, Sun G, Hu Q, et al. Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects. Med Oral Patol Oral Cir Bucal, 2015, 20(6): e757-e762.
17. 魏在榮, 常樹森. 穿支皮瓣簡述. 中華燒傷雜志, 2019, 35(7): 481-485.
18. Bali ZU, Ozkan B, Parspanc? A, et al. Reconstruction of lower lip defects with free super-thin anterolateral thigh flap. Microsurgery, 2021, 41(3): 216-222.

Chinese Journal of Reparative and Reconstructive Surgery

Application of thin free lateral femoral circumflex artery perforator flap in repair of scar contracture deformity in hand and foot

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