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Title: [Clinical application of anterolateral thigh polyfoliate perforator flap for vascular pedicle protection].
Author: Li H, Deng C, Wei Z, Jin W, Nie K, Tang X, Wang D, Chang S, Li S.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Oct 15; 31(10):1245-1249. PubMed ID: 29806329.
Abstract:
OBJECTIVE: To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect. METHODS: Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case. Wounds located in lower extremity in 16 cases, complicated with calcaneal or metatarsal, phalangeal fractures in 4 cases, Achilles tendon departure in 1 case, toe long extensor tendon and flexor digitorum longus tendon exposed in 8 cases. The wound area ranged from 8 cm×5 cm to 18 cm×12 cm. According to wound size, anterolateral thigh perforators were detected by conventional ultrasound Doppler (2-5 perforators). The irregular wounds were decomposed into multiple parts and the leaf number (2-4 leaves) of polyfoliate flap depended on the part number of the wound. The flap area ranged from 9 cm×6 cm to 20 cm×14 cm, and the largest area of single leaf was 24 cm×6 cm. The vascular pedicle length ranged from 7 cm to 12 cm. The foliate flap area with protecting pedicle ranged from 5 cm×3 cm to 7 cm×5 cm. RESULTS: All the flaps survived, and no vascular crisis occurred. All the patients were followed up 2-28 months (mean, 9 months). Sinus occurred in 1 case of calcaneal fracture after flap repair, and the sinus was healed after 3 months by conventional dressing. All the flaps were thin and had a good texture. Healing of soft tissue was found in 5 patients with fracture. The wrist and ankle plantar flexion and dorsiflexion function of recipient site were normal in all patients. CONCLUSION: It is safe and reliable to repair the extremities soft tissue defect with anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. And it is one of the ways to reduce the vascular crisis of the anterolateral thigh free perforator flap. 目的: 探讨增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损创面的临床疗效。. 方法: 2014 年 1 月—2017 年 1 月，采用增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损创面 24 例。其中男 15 例，女 9 例；年龄 5～64 岁，中位年龄 33.5 岁。上肢创面 8 例，合并桡骨茎突骨骨折 1 例，伸指肌腱外露 3 例，肱桡肌肌腱外露 1 例。下肢创面 16 例，合并跟骨或跖骨、趾骨骨折 4 例，跟腱离断 1 例，趾长伸趾肌腱、趾长屈趾肌腱外露 8 例。创面范围为 8 cm×5 cm～18 cm×12 cm。根据创面大小及缺损区域，常规超声多普勒探查旋股外侧动脉穿支（2～5 支）并标记；将不规则创面分解成多个部分（分 2～4 叶）分别计算面积，皮瓣切取范围 9 cm×6 cm～20 cm×14 cm，最大单叶瓣切取面积 24 cm×6 cm；分叶血管蒂长 7～12 cm；蒂部联合创面嵌入分叶瓣面积 5 cm×3 cm～7 cm×5 cm。. 结果: 术后皮瓣全部成活，无动、静脉危象发生。24 例均获随访，随访时间 2～28 个月，平均 9 个月。1 例合并跟骨骨折行内固定患者皮瓣修复后伴窦道形成，经常规换药后 3 个月愈合。所有皮瓣均菲薄，无需二次修薄；5 例合并骨折者软组织均Ⅰ期愈合。所有患者受区腕关节、踝关节跖屈、背屈功能正常。. 结论: 设计增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损安全可靠，是减少游离股前外侧穿支皮瓣动、静脉危象的方法之一。.

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