Clinical effects of anterolateral thigh perforator flap with sensory nerves in repairing the plantar skin and soft tissue defects

Objective To explore the clinical effects of anterolateral thigh perforator flap with sensory nerves in repairing the plantar skin and soft tissue defects. Methods From January 2016 to March 2019, 13 male patients with plantar skin and soft tissue defects were admitted to the Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, aged 27 to 73 years. The retrospective cohort study was conducted. The wounds of 4 patients underwent 2 times of debridement. The wounds of 9 patients underwent 1 time of debridement and 1 or 2 time(s) of vacuum sealing drainage. Then all the wounds of patients were repaired with flaps when the wounds were clean and dry with no purulent exudation and were negative in secretion culture. The wound areas of this group of patients after wound debridement were 13.0 cm×5.5 cm to 36.0 cm×10.5 cm, and the wounds were repaired with anterolateral thigh perforator flaps with sensory nerves with area of 14 cm×6 cm to 37 cm×11 cm. The wound of 1 patient was repaired with a bilobed flap. The oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein in the flap were anastomosed with the posterior tibial artery and its accompanying vein or the medial plantar artery and its accompanying vein in recipient sites. The lateral femoral cutaneous nerve in the flap was anastomosed with the recipient saphenous nerve or medial plantar cutaneous nerve. The donor sites were directly sutured. The survival of flaps and the healing of wounds in the donor and recipient areas were recorded, and the ulcers of the plantar repaired flap were followed up for 3 months after operation. The sensory function of the flap was evaluated by the sensory evaluation standard of British Medical Research Council (BMRC), and the ankle and foot function score system of American Orthopedic Foot and Ankle Society (AOFAS) was used for comprehensive functional evaluation at the last follow-up. Results All the 14 flaps in 13 cases survived, and venous crisis occurred in two cases and the flaps survived smoothly after the venous re-anastomosis. One patient developed deep tissue infection after being discharged and was healed after secondary debridement. The donor and recipient areas of the remaining patients healed well. The patients were followed up for 6 to 18 months, the shape of flaps was slightly bloated in 5 patients, and the shape and texture of flaps in the other 8 patients were good. Six patients had ulcers in flaps at 3 months of follow-up after operation, which were healed after stopping weight-bearing activities. At the last follow-up, little linear scar hyperplasia could be seen in the donor site of patients; the BMRC sensory function evaluation results were S₁ grade in 4 cases, S₂ grade in 7 cases, and S₃ grade in 2 cases; the AOFAS scores were excellent in 3 cases, good in 7 cases, fair in 2 cases, and poor in 1 case. Conclusions The anterolateral thigh perforator flaps with sensory nerves can repair the plantar skin and soft tissue defects with the donor sites directly sutured and good shape of flaps, which provide a good treatment method for the recovery of plantar proprioceptive sensation and weight-bearing function.