Effects of the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area

Li Hai; Deng Chengliang; Xiao Shun'e; Wu Xiangkui; Wu Bihua; Wei Zairong

doi:10.3760/cma.j.cn501225-20240202-00045

Volume 41 Issue 4

Apr. 2025

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(4): 370-377

Li H,Deng CL,Xiao SE,et al.Effects of the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area[J].Chin J Burns Wounds,2025,41(4):370-377.DOI: 10.3760/cma.j.cn501225-20240202-00045.

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Effects of the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area

doi: 10.3760/cma.j.cn501225-20240202-00045

Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China

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Collaborative Innovation Center of Chinese Ministry of Education 2020-39

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Corresponding author: Deng Chengliang, Email: cheliadeng@sina.com
Received Date: 2024-02-02

Abstract

Abstract

Objective To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area. Methods This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot. Results All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases. Conclusions The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.
- Wounds and injuries,
- Foot,
- Microsurgery,
- Surgical flaps,
- Soft tissue defect,
- Chimeric perforator flap,
- Wound repair

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References(40)

References

[1]	程二林,任鹏,阿不来提·阿不拉,等.两种类型游离股薄肌肌皮瓣修复小腿复杂创面[J].中华显微外科杂志,2024,47(3):254-260.DOI: 10.3760/cma.j.cn441206-20231114-00076.
[2]	李海,邓呈亮,肖顺娥,等.红外热成像仪辅助穿支定位的旋股外侧嵌合皮瓣在四肢关节复合组织缺损中的立体修复策略[J].中华手外科杂志,2024,40(4):325-329.DOI: 10.3760/cma.j.cn311653-20240124-00029.
[3]	SapinoG,GuillerD,OsingaR,et al.Muscle-only versus chimeric musculocutaneous gastrocnemius pedicled flap in complex orthoplastic reconstructions of the knee region: a retrospective study[J].J Plast Reconstr Aesthet Surg,2023,77:298-308.DOI: 10.1016/j.bjps.2022.12.006.
[4]	李琪琛,韩树峰,贾二龙,等.踝关节骨折伴三角韧带损伤的修复与重建[J].中国组织工程研究,2022,26(11):1793-1798.
[5]	赵宇,赵松,赵金忠.前交叉韧带损伤及重建后继发性膝骨关节炎的研究进展[J/OL].中华关节外科杂志(电子版),2023,17(3):415-423[2024-02-02].https://d.wanfangdata.com.cn/periodical/zhgjwkzz202303018.DOI: 10.3877/cma.j.issn.1674-134X.2023.03.018.
[6]	张清,向明,杨金松,等.肱二头肌长头腱转位上关节囊重建术治疗大及巨大肩袖损伤[J].中华骨科杂志,2022,42(4):195-203.DOI: 10.3760/cma.j.cn121113-20211020-00608.
[7]	KoshimaI,SoedaS.Inferior epigastric artery skin flaps without rectus abdominis muscle[J].Br J Plast Surg,1989,42(6):645-648.DOI: 10.1016/0007-1226(89)90075-1.
[8]	方杰,陈步国,吴尧,等.腓肠内侧动脉穿支皮瓣临床应用研究进展[J].中国修复重建外科杂志,2021,35(4):508-513.DOI: 10.7507/1002-1892.202011032.
[9]	ScaglioniMF,MeroniM,MeschinoA,et al.The superficial circumflex iliac artery perforator flap for head and neck reconstruction[J].Oral Maxillofac Surg Clin North Am,2024,36(4):489-495.DOI: 10.1016/j.coms.2024.07.008.
[10]	魏在荣,汪华侨,王达利,等.穿支皮瓣供瓣区选择原则[J].中华显微外科杂志,2016,39(5):417-419.DOI: 10.3760/cma.j.issn.1001-2036.2016.05.001.
[11]	SơnTT,DungPTV,ThúyTTH,et al.Using free chimeric anterolateral thigh flap for reconstruction of composite dorsal hand defect[J].JPRAS Open,2024,39:106-113.DOI: 10.1016/j.jpra.2023.11.011.
[12]	马宁,李养群,杨喆,等.扩张皮瓣在前臂和肘关节大面积软组织缺损修复中的应用[J].中国美容整形外科杂志,2022,33(7):421-423,427.DOI: 10.3969/j.issn.1673-7040.2022.07.011.
[13]	HallockGG.Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle[J].Ann Plast Surg,1991,27(2):126-131.DOI: 10.1097/00000637-199108000-00006.
[14]	葛成伟,蒋国栋,程俊楠,等.以旋股外侧动脉斜支为蒂并携带阔筋膜的股前外侧穿支皮瓣修复手足毁损性创面并重建功能的效果[J].中华烧伤与创面修复杂志,2024,40(9):842-848.DOI: 10.3760/cma.j.cn501225-20240508-00163.
[15]	丁伟,魏立勇,丁少华,等.“三明治”补片与单纯阔筋膜补片上关节囊重建治疗不可修复性肩袖撕裂的疗效比较[J].中华骨科杂志,2024,44(14):929-937.DOI: 10.3760/cma.j.cn121113-20240229-00123.
[16]	郭礼平,柳志锦,周荣,等.带血供阔筋膜瓣修复KuwadaⅢ~Ⅳ型跟腱断裂伴止点撕脱的疗效观察[J].中华解剖与临床杂志,2023,28(12):799-805.DOI: 10.3760/cma.j.cn101202-20230417-00106.
[17]	王辉,周彤,刘玉杰,等.四种皮神经营养血管带蒂穿支皮瓣修复手部掌侧创面的效果[J].中华烧伤与创面修复杂志,2023,39(11):1038-1046.DOI: 10.3760/cma.j.cn501225-20230720-00009.
[18]	仲海燕,陈勇,杜轩宇,等.足踝部高压电烧伤创面修复的带蒂轴型皮瓣选择策略[J].中华烧伤与创面修复杂志,2023,39(10):939-946.DOI: 10.3760/cma.j.cn501225-20230613-00212.
[19]	徐玉萍,郭峭峰,林炳远,等.改良诱导膜技术结合腓动脉穿支皮瓣治疗跟骨骨折术后慢性骨髓炎的疗效观察[J].浙江医学,2024,46(19):2093-2095,2098.DOI: 10.12056/j.issn.1006-2785.2024.46.19.2024-237.
[20]	王道明,张沈屹婷,庄智勇,等.远端蒂腓骨短肌肌瓣修复踝关节周围感染性创面[J].实用手外科杂志,2023,37(4):464-466.DOI: 10.3969/j.issn.1671-2722.2023.04.002.
[21]	胡兴权,尚永军,润海涛,等.腓动脉穿支蒂接力皮瓣旋转移位修复足踝部及供瓣区皮肤缺损[J].实用手外科杂志,2024,38(2):179-181,238.DOI: 10.3969/j.issn.1671-2722.2024.02.012.
[22]	张盼,李雷,唐林峰,等.不同闭合方式的背阔肌肌皮瓣移植术后供区并发症的分析[J].中国美容整形外科杂志,2024,35(3):133-135.DOI: 10.3969/j.issn.1673-7040.2024.03.002.
[23]	徐达传,钟世镇,刘牧之,等.股前外侧部皮瓣的解剖学一个新的游离皮瓣供区[J].临床应用解剖学杂志,1984,2(3):158-160.DOI: 10.13418/j.issn.1001-165x.1984.03.012.
[24]	李海,肖顺娥,邓呈亮,等.不同类型游离穿支皮瓣组合在四肢复杂创面修复中的临床应用[J].中华烧伤与创面修复杂志,2023,39(8):758-764.DOI: 10.3760/cma.j.cn501225-20220720-00300.
[25]	LiuZ,YangL,ChengJ,et al.Is the oblique branch of the lateral circumflex femoral artery a common variant?[J].J Plast Reconstr Aesthet Surg,2023,84:540-546.DOI: 10.1016/j.bjps.2023.06.024.
[26]	王磊,宋达疆,李赞,等.游离股前区域分叶皮瓣修复口颊癌的制备经验[J].中华耳鼻咽喉头颈外科杂志,2023,58(8):786-791.DOI: 10.3760/cma.j.cn115330-20221219-00761.
[27]	YooKE,KimDE,LeeKT.Reliability and safety of the superthin anterolateral thigh flap: evaluating perfusion-related complications and donor morbidity[J].Plast Reconstr Surg,2025,155(2):375-387.DOI: 10.1097/PRS.0000000000011513.
[28]	黄荣华,王杰,李和,等.旋股外侧动脉近端穿支皮瓣接力修复股前外侧皮瓣供区11例[J].中华显微外科杂志,2024,47(4):454-457.DOI: 10.3760/cma.j.cn441206-20240319-00079.
[29]	李俊杰,焦伟,郭灰灰,等.股前外侧穿支皮瓣结合阔筋膜移植修复手或足复合组织缺损[J].中华显微外科杂志,2024,47(4):423-429.DOI: 10.3760/cma.j.cn441206-20240326-00085.
[30]	宋鹏,李强,石霞,等.带阔筋膜的游离股前外侧皮瓣分叶组合修复前臂不规则创面[J].中华手外科杂志,2024,40(3):198-201.DOI: 10.3760/cma.j.cn311653-20230918-00037.
[31]	计鹏,曹涛,张智,等.股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果[J].中华烧伤与创面修复杂志,2023,39(10):926-932.DOI: 10.3760/cma.j.cn501225-20230627-00232.
[32]	GuptaR,PfennigM,GannonJ,et al.Utilization of the free fibular flap for first metatarsal reconstruction[J].Plast Reconstr Surg Glob Open,2022,10(12):e4706.DOI: 10.1097/GOX.0000000000004706.
[33]	刘飞,闫炜琪,马强,等.股前外侧血流桥接嵌合穿支皮瓣游离移植治疗伴主干动脉缺损的上肢复合组织缺损的临床效果[J].中华烧伤与创面修复杂志,2024,40(2):172-179.DOI: 10.3760/cma.j.cn501225-20231103-00176.
[34]	刘莉.嵌合(穿支)皮瓣的定义分类和临床应用进展[J].中国临床解剖学杂志,2017,35(2):232-235.DOI: 10.13418/j.issn.1001-165x.2017.02.024.
[35]	杨薛康,张栋梁,何亭,等.游离颞浅筋膜瓣/股前外侧筋膜瓣联合皮片移植修复四肢特殊部位深度组织缺损的临床经验[J].中华烧伤与创面修复杂志,2023,39(6):507-511.DOI: 10.3760/cma.j.cn501225-20220915-00407.
[36]	QingL,WuP,ZhouZ,et al.Customized reconstruction of complex three-dimensional defects in the extremities with individual design of vastus lateralis muscle-chimeric multi-lobed anterolateral thigh perforator flap[J].J Plast Surg Hand Surg,2019,53(5):271-278.DOI: 10.1080/2000656X.2019.1606004.
[37]	陈江伟,林尊文,黄跟东,等.皮瓣移植联合同种异体肌腱一期修复跟腱及周围软组织复合缺损[J].中华显微外科杂志,2023,46(5):522-526.DOI: 10.3760/cma.j.cn441206-20221221-00249.
[38]	胡雷鸣,段虹昊.同种异体肌腱移植修复手部肌腱缺损及指功能重建的疗效[J].实用骨科杂志,2020,26(1):23-26.
[39]	常树森,魏在荣,金文虎,等.股前外侧皮瓣三纵五横法设计方案的临床研究[J].中华整形外科杂志,2019,35(6):571-576.DOI: 10.3760/cma.j.issn.1009-4598.2019.06.011.
[40]	李海,肖顺娥,邓呈亮,等.红外热成像联合“二纵五横分区法”在儿童股前外侧穿支皮瓣穿支定位中的临床应用[J].中华显微外科杂志,2023,46(6):619-624. DOI: 10.3760/cma.j.cn441206-20230324-00053.