Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONG Lin , HE Liang , YIN Dong , JIN Zhe , NIU Yang , WANG Zifu , HUANG Jun , ZHOU Tao , ZHOU Ding ,  ZHOU Hongxiang

The Microscopic Repair and Reconstruction Department of Hand and Foot, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P. R. China;

Corresponding?author：

ZHOU Hongxiang, Email: zhouhx8888@163.com

Keywords：

Anterolateral thigh flap; calf; soft tissue defect; bridge flap; vascular bridge

DOI：

10.7507/1002-1892.202201093

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in repairing complex calf soft tissue defects. Methods The clinical data of 11 patients with complex calf soft tissue defects between April 2018 and October 2021 were retrospectively analyzed, including 9 males and 2 females, aged 11-60 years, with a median age of 39 years. There were 8 cases of calf soft tissue defect caused by traffic accident, and 3 cases of calf skin infection caused by chronic osteomyelitis. The skin and soft tissue defects ranged from 10 cm×8 cm to 35 cm×10 cm after thorough debridement and accompanied with bone and tendon exposure. There was only one main vessel in calf of 9 cases and no blood vessel that could be anastomosed with the flap vessel could be found in the recipient site of 2 cases. The anterolateral thigh skin flap (the flap size ranged from 12 cm×10 cm to 37 cm×12 cm) was taken to repair the soft tissue defect. The donor site of the flap was treated with direct suture (8 cases) or partial suture followed by skin grafting (3 cases), and the vascular bridge was wrapped with medium-thickness skin graft. Results The flaps of 11 patients survived completely without necrosis, infection, and vascular crisis. The blood supply of the vascular bridge was unobstructed and the pulse was good. The color of the medium-thickness skin graft were ruddy. All 11 patients were followed up 2-40 months, with an average of 19.4 months. The flaps healed well with the surrounding tissues without obvious exudation and color difference. The flaps had normal color and temperature, good blood supply, and soft texture. The shape of the flap and calf contour were satisfactory and the function of the limb recovered well. The donor area of thigh flap healed by first intention without obvious scar formation. The donor area of skin healed well with a longitudinal oblong scar only and the appearance was satisfactory. Conclusion The anterolateral thigh bridge flap transplantation with free skin wrapping vascular bridge is an effective method for the treatment of complex calf soft tissue defects.

Citation： ZHONG Lin, HE Liang, YIN Dong, JIN Zhe, NIU Yang, WANG Zifu, HUANG Jun, ZHOU Tao, ZHOU Ding, ZHOU Hongxiang. Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 619-624. doi: 10.7507/1002-1892.202201093 Copy

1.	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.
2.	Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg, 2004, 114(6): 1457-1466.
3.	劉軍, 芮永軍, 吳永偉, 等. 創傷性脛骨骨髓炎并軟組織及骨缺損的分期治療. 中國矯形外科雜志, 2018, 26(4): 378-381.
4.	Arslan H, Demir?z A. Comparison of subacute and delayed free flap reconstruction in the treatment of open lower extremity fractures. Ulus Travma Acil Cerrahi Derg, 2019, 25(2): 188-192.
5.	王強, 巨積輝, 劉杰, 等. Flow-through股前外側穿支皮瓣在斷肢再植創面修復中的應用. 中華顯微外科雜志, 2020, 43(6): 540-543.
6.	李海, 肖順娥, 鄧呈亮, 等. 游離分葉穿支皮瓣修復四肢復雜創面. 中國修復重建外科雜志, 2022, 36(1): 98-101.
7.	翟瑞華, 劉春娟, 王燕燕, 等. 健側小腿內側皮瓣橋接游離胸臍皮瓣修復下肢大面積軟組織缺損. 中華整形外科雜志, 2018, 34(7): 538-541.
8.	金文虎, 張子陽, 吳祥奎, 等. 改良橋式交叉游離皮瓣修復小腿軟組織缺損. 中華創傷雜志, 2021, 37(10): 900-905.
9.	張功林, 章鳴, 丁法明, 等. 橋式游離皮瓣移植血管蒂采用植皮包裹的方法介紹. 中華創傷骨科雜志, 2008, 10(12): 1200.
10.	周望高, 張振偉, 余少校, 等. 帶肌瓣的旋股外側動脈降支穿支皮瓣修復合并死腔的小腿軟組織缺損. 中國美容整形外科雜志, 2021, 32(7): 411-414.
11.	He J, Qing L, Wu P, et al. Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow-through anterolateral thigh perforator flap transfer. Microsurgery, 2021, 41(6): 533-542.
12.	Manrique OJ, Bishop SN, Ciudad P, et al. Lower extremity limb salvage with cross leg pedicle flap, cross leg free flap, and cross leg vascular cable bridge flap. J Reconstr Microsurg, 2018, 34(7): 522-529.
13.	Knobloch K, Herold C, Vogt PM. Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity. Oper Orthop Traumatol, 2012, 24(2): 122-130.
14.	趙鵬, 劉曉春, 牟勇, 等. 股前外側皮瓣聯合闊筋膜移植修復大段跟腱及皮膚缺損. 中國修復重建外科雜志, 2020, 34(12): 1585-1589.
15.	張功林, 章鳴, 郭翱, 等. 橋式交叉 “T” 形血管吻合游離背闊肌皮瓣移植修復小腿軟組織缺損. 中華骨科雜志, 2008, 28(5): 364-368.
16.	Salmon PJ, Gunson TH, Ong S, et al. Bridge flap repair of the lower limb: A hybrid alternative to the keystone. Australas J Dermatol, 2019, 60(3): 224-227.
17.	于仲嘉, 曾炳芳, 何鶴皋. 橋式交叉吻合血管游離組織移植. 中華骨科雜志, 1994, 14(6): 332-335, C2.
18.	周洪翔, 李鐘苗, 李俊杰, 等. 橋式皮瓣結合Ilizarov技術治療小腿GustiloⅢ-B、C型損傷. 中國矯形外科雜志, 2017, 25(4): 317-320.
19.	孫萍, 張功林, 師富貴, 等. 交腿橋式游離背闊肌肌皮瓣改進與臨床應用. 中華臨床醫師雜志 (電子版), 2021, 15(5): 360-364.
20.	Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: Its expanding role in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 235-248.
21.	Cherubino M, Stocco C, Ronga M, et al. Comparisons of fascio-cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery, 2020, 40(4): 452-459.

1. 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.
2. Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg, 2004, 114(6): 1457-1466.
3. 劉軍, 芮永軍, 吳永偉, 等. 創傷性脛骨骨髓炎并軟組織及骨缺損的分期治療. 中國矯形外科雜志, 2018, 26(4): 378-381.
4. Arslan H, Demir?z A. Comparison of subacute and delayed free flap reconstruction in the treatment of open lower extremity fractures. Ulus Travma Acil Cerrahi Derg, 2019, 25(2): 188-192.
5. 王強, 巨積輝, 劉杰, 等. Flow-through股前外側穿支皮瓣在斷肢再植創面修復中的應用. 中華顯微外科雜志, 2020, 43(6): 540-543.
6. 李海, 肖順娥, 鄧呈亮, 等. 游離分葉穿支皮瓣修復四肢復雜創面. 中國修復重建外科雜志, 2022, 36(1): 98-101.
7. 翟瑞華, 劉春娟, 王燕燕, 等. 健側小腿內側皮瓣橋接游離胸臍皮瓣修復下肢大面積軟組織缺損. 中華整形外科雜志, 2018, 34(7): 538-541.
8. 金文虎, 張子陽, 吳祥奎, 等. 改良橋式交叉游離皮瓣修復小腿軟組織缺損. 中華創傷雜志, 2021, 37(10): 900-905.
9. 張功林, 章鳴, 丁法明, 等. 橋式游離皮瓣移植血管蒂采用植皮包裹的方法介紹. 中華創傷骨科雜志, 2008, 10(12): 1200.
10. 周望高, 張振偉, 余少校, 等. 帶肌瓣的旋股外側動脈降支穿支皮瓣修復合并死腔的小腿軟組織缺損. 中國美容整形外科雜志, 2021, 32(7): 411-414.
11. He J, Qing L, Wu P, et al. Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow-through anterolateral thigh perforator flap transfer. Microsurgery, 2021, 41(6): 533-542.
12. Manrique OJ, Bishop SN, Ciudad P, et al. Lower extremity limb salvage with cross leg pedicle flap, cross leg free flap, and cross leg vascular cable bridge flap. J Reconstr Microsurg, 2018, 34(7): 522-529.
13. Knobloch K, Herold C, Vogt PM. Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity. Oper Orthop Traumatol, 2012, 24(2): 122-130.
14. 趙鵬, 劉曉春, 牟勇, 等. 股前外側皮瓣聯合闊筋膜移植修復大段跟腱及皮膚缺損. 中國修復重建外科雜志, 2020, 34(12): 1585-1589.
15. 張功林, 章鳴, 郭翱, 等. 橋式交叉 “T” 形血管吻合游離背闊肌皮瓣移植修復小腿軟組織缺損. 中華骨科雜志, 2008, 28(5): 364-368.
16. Salmon PJ, Gunson TH, Ong S, et al. Bridge flap repair of the lower limb: A hybrid alternative to the keystone. Australas J Dermatol, 2019, 60(3): 224-227.
17. 于仲嘉, 曾炳芳, 何鶴皋. 橋式交叉吻合血管游離組織移植. 中華骨科雜志, 1994, 14(6): 332-335, C2.
18. 周洪翔, 李鐘苗, 李俊杰, 等. 橋式皮瓣結合Ilizarov技術治療小腿GustiloⅢ-B、C型損傷. 中國矯形外科雜志, 2017, 25(4): 317-320.
19. 孫萍, 張功林, 師富貴, 等. 交腿橋式游離背闊肌肌皮瓣改進與臨床應用. 中華臨床醫師雜志 (電子版), 2021, 15(5): 360-364.
20. Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: Its expanding role in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 235-248.
21. Cherubino M, Stocco C, Ronga M, et al. Comparisons of fascio-cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery, 2020, 40(4): 452-459.

Chinese Journal of Reparative and Reconstructive Surgery

Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content