Clinical effects of free bilateral turbocharged anterolateral thigh flaps in tandem in repairing extensive wounds in the foot and ankle

Yang Liang; Zhou Rong; Ju Jihui; Niu Zefeng; Liu Zhongzheng; Guo Liping; Liu Zhijin; Jin Qianheng; Ge Chengwei; Wang Guiyang; Yang Lin; Cheng Junnan

doi:10.3760/cma.j.cn501225-20240508-00164

Volume 41 Issue 1

Jan. 2025

Turn off MathJax

Article Contents

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(1): 61-69

Yang L,Zhou R,Ju JH,et al.Clinical effects of free bilateral turbocharged anterolateral thigh flaps in tandem in repairing extensive wounds in the foot and ankle[J].Chin J Burns Wounds,2025,41(1):61-69.DOI: 10.3760/cma.j.cn501225-20240508-00164.

Citation:

PDF( 12282 KB)

Clinical effects of free bilateral turbocharged anterolateral thigh flaps in tandem in repairing extensive wounds in the foot and ankle

doi: 10.3760/cma.j.cn501225-20240508-00164

1.
Department of Wound Repair Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
2.
Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
3.
Department of Foot and Ankle Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202127

More Information

Corresponding author: Ju Jihui, Email: jjh2006@263.net
Received Date: 2024-05-08

Abstract

Abstract

Objective To explore the clinical effects of free bilateral turbocharged anterolateral thigh flaps in tandem in repairing extensive wounds in the foot and ankle. Methods The study was a retrospective observational study. From April 2020 to June 2023, 12 patients with extensive wounds in the foot and ankle who met the inclusion criteria were admitted to the Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 8 males and 4 females, aged 21 to 65 years. The wound area after debridement ranged from 27 cm×14 cm to 37 cm×20 cm. The bilateral perforator flaps pedicled with either oblique or descending branches of the lateral circumflex femoral artery were designed and harvested based on the size and shape of the wounds. The individual flap incision area ranged from 16 cm×9 cm to 34 cm×12 cm. The non-homologous perforator of the flap on the one side was turbocharged by anastomosing it with the gross muscular branch or main vessel of the oblique or descending branch of the lateral circumflex femoral artery from the flap. Subsequently, the proximal end of the oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein from the flap on the one side were connected end-to-end with either the anterior tibial artery and vein, posterior tibial artery and vein, or dorsal foot artery and vein in the recipient area, the distal end of the oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein from the flap on the one side were anastomosed end-to-end with a source vessel originating from flap on the other side. The wounds in the flap donor areas were sutured directly. The number and source of perforators carried by the flaps and the duration of the flap repair surgery were recorded. The survival of the flap, the occurrence of vascular crisis, and the wound healing at both donor and recipient areas were observed after surgery. The flap condition, appearance and function of the affected limb were observed during follow-up. At the last follow-up, the sensory function of the flap was assessed using the British Medical Research Council's sensory rating standard, the foot and ankle function of the affected limb was evaluated according to the American Orthopedic Foot and Ankle Society scoring standard. Results A total 24 flaps were successfully harvested, carrying 60 perforators, including 34 perforators from the oblique branch of the lateral circumflex femoral artery, 24 perforators from the descending branch of the lateral circumflex femoral artery, one perforator from the transverse branch of the lateral circumflex femoral artery, and one perforator from the direct branch of the femoral artery. The duration of the flap repair surgery ranged from 4.2 to 9.0 hours. The flaps of 12 patients exhibited complete survival after surgery. A total of two flaps of two patients experienced venous crisis after surgery but survived through emergency exploration. One patient encountered undesirable wound healing at the donor area of flap on the one side after surgery, which healed after dressing change, debridement, and suturing. The remaining patients' donor area wounds healed. Two patients displayed impaired wound healing in the recipient area, which improved after dressing change and resection of residual sequestrum, and the wounds in the recipient area of other patients healed successfully. During the follow-up of 4-26 months, the flaps demonstrated favorable color and texture, slight edematous appearance, and partial sensory recovery, as well as good aesthetic and functional restoration of the affected limbs. At the last follow-up, the sensory function of the flap was assessed as grade S2 in 9 cases and grade S3 in 3 cases; the foot and ankle function of the affected limb was evaluated as excellent in two cases, good in 9 cases, and fair in one case. Conclusions The bilateral turbocharged anterolateral thigh flaps have numerous sources of perforators. By implementing supercharging of non-homologous perforators within the flap, the vascular supply to the flap is turbocharged, thereby mitigating the risk of extensive flap necrosis. The flap is an effective approach for repairing extensive wounds in the foot and ankle, resulting in improved function of the affected limb after repair.
- Wounds and injuries,
- Perforator flap,
- Foot,
- Ankle,
- Microsurgery,
- Anterolateral thigh flap,
- Wound repair

FullText(HTML)

References(56)

References

[1]	石建国,王继宏,杨彦君.不同类型皮瓣修复足踝部软组织缺损的效果对比[J].组织工程与重建外科,2022,18(4):315-318.DOI: 10.3969/j.issn.1673-0364.2022.04.006.
[2]	丁汉文,陈勇,王倩,等.带蒂轴型皮瓣修复踝周皮肤软组织缺损:病例报道与策略分析[J].组织工程与重建外科,2023,19(3):253-257.DOI: 10.3969/j.issn.1673-0364.2023.03.007.
[3]	石玲玲,吴进,郭志民,等.游离股前外侧皮瓣修复足底负重区软组织缺损的效果[J].组织工程与重建外科,2023,19(6):541-543,548.DOI: 10.3969/j.issn.1673-0364.2023.06.004.
[4]	唐举玉,贺继强,吴攀峰,等.股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用[J].中华显微外科杂志,2020,43(4):326-330.DOI: 10.3760/cma.j.cn441206-20190309-00089.
[5]	柳志锦,巨积辉,程俊楠,等.以旋股外侧动脉斜支为源动脉的股前外侧双叶穿支皮瓣修复四肢创面[J].中华显微外科杂志,2021,44(2):152-156.DOI: 10.3760/cma.j.cn441206-20210111-00012.
[6]	杨照,祝勇刚,李军,等.健侧供血Flow-through串联双股前外侧皮瓣修复下肢超大面积软组织缺损[J].中国急救复苏与灾害医学杂志,2022,17(9):1220-1224,1237.DOI: 10.3969/j.issn.1673-6966.2022.09.025.
[7]	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.
[8]	肖飞鹏,柳志锦,刘胜哲,等.综合评价量表在股前外侧皮瓣修复术后疗效评价中的应用[J].中国美容整形外科杂志,2021,32(6):348-351. DOI: 10.3969/j.issn.1673-7040.2021.06.010.
[9]	周树萍,李士民,石英光,等. 并联组合血流桥接穿支皮瓣治疗伴血运障碍肢体环形热压伤的临床效果[J]. 中华烧伤与创面修复杂志,2024,40(7):665-672. DOI: 10.3760/cma.j.cn501225-20231201-00222.
[10]	魏在荣,王达利,黄广涛,等.毁损性创面的治疗进展[J/CD].中华损伤与修复杂志(电子版),2019,14(2):85-90.DOI: 10.3877/cma.j.issn.1673-9450.2019.02.002.
[11]	叶琪毅,林浩,张文广,等.削薄股前外侧穿支皮瓣修复足踝部较大面积软组织缺损[J].中华显微外科杂志,2020,43(6):544-548.DOI: 10.3760/cma.j.cn441206-20200728-00301.
[12]	沈余明.毁损性创面的修复策略[J/CD].中华损伤与修复杂志(电子版),2019,14(2):81-84.DOI: 10.3877/cma.j.issn.1673-9450.2019.02.001.
[13]	袁长勇,刘洪全,刘跃廷,等.游离股前外侧皮瓣联合负压封闭引流修复足底皮肤缺损[J].中国美容医学,2022,31(12):8-12.
[14]	魏在荣,常树森.穿支皮瓣简述[J].中华烧伤杂志,2019,35(7):481-485.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.001.
[15]	DongKX,ZhouY,ChengYY, et al. Clinical application of digital technology in the use of anterolateral thigh lobulated perforator flaps to repair complex soft tissue defects of the limbs[J/OL].Burns Trauma,2024,12:tkae011[2024-11-18]. https://pubmed.ncbi.nlm.nih.gov/38737342/.DOI: 10.1093/burnst/tkae011.
[16]	HsuCC, LohCYY, WeiFC. The anterolateral thigh perforator flap: its expanding role in lower extremity reconstruction[J]. Clin Plast Surg,2021,48(2):235-248.DOI: 10.1016/j.cps.2020.12.008.
[17]	戚建武,陈邵,孙斌鸿,等.游离背阔肌肌皮瓣联合人工真皮及刃厚皮治疗下肢脱套伤的临床效果[J]. 中华烧伤与创面修复杂志,2022,38(4):347-353.DOI: 10.3760/cma.j.cn501120-20210421-00145.
[18]	于冰,熊猛,林鹤,等.背阔肌皮瓣游离移植修复复杂创面:重建组织完整及功能需要[J].中国组织工程研究,2015,19(15):2351-2355.DOI: 10.3969/j.issn.2095-4344.2015.15.011.
[19]	沈余明,覃凤均,杜伟力,等.濒临截肢四肢高压电烧伤患者的保肢策略[J].中华烧伤杂志,2019,35(11):776-783.DOI: 10.3760/cma.j.issn.1009-2587.2019.11.003.
[20]	金俊俊,李平松,刘宏君,等.游离下腹部皮瓣修复足背软组织缺损[J].中华整形外科杂志,2018,34(7):549-551.DOI: 10.3760/cma.j.issn.1009-4598.2018.07.014.
[21]	刘东,欧昌良,周鑫,等.股前外侧穿支皮瓣与腹壁下动脉穿支皮瓣修复大面积下肢软组织缺损的疗效比较[J].创伤外科杂志,2021,23(6):412-416.DOI: 10.3969/j.issn.1009-4237.2021.06.003.
[22]	杨曦,徐永清,段家章,等.数字重建技术辅助设计分叶腹壁下动脉穿支皮瓣修复下肢远端巨大创面[J].中华显微外科杂志,2023,46(5):527-533.DOI: 10.3760/cma.j.cn441206-20230604-00098.
[23]	顾荣,王海文,江新民,等.髂腹股沟联体穿支皮瓣移植修复上肢较大面积皮肤缺损[J].中华显微外科杂志,2017,40(5):433-437.DOI: 10.3760/cma.j.issn.1001-2036.2017.05.005.
[24]	徐军辉,张伟,周锦秀,等.游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(11):1030-1037.DOI: 10.3760/cma.j.cn501225-20230804-00039.
[25]	胡锐,任义军,严立,等.游离胸脐皮瓣治疗复杂足踝部大面积皮肤软组织缺损[J].创伤外科杂志,2017,19(11):805-808.DOI: 10.3969/j.issn.1009-4237.2017.11.002.
[26]	周荣,巨积辉,杨亮,等.双叶股前外侧皮瓣移植修复足踝部复杂创面[J].中华整形外科杂志,2019,35(8):779-784.DOI: 10.3760/cma.j.issn.1009-4598.2019.08.011.
[27]	ZhangN, LiuF, HuangC, et al. Application of flow-through anterolateral thigh perforator flap in replantation of complex severed limb[J]. Transplant Proc,2024,56(8):1856-1860.DOI: 10.1016/j.transproceed.2024.08.013.
[28]	巨积辉,周荣,刘跃飞,等.超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果[J].中华烧伤杂志,2019,35(7):495-500.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.004.
[29]	吴育煜,胡朝波,陈绵川,等.股前内侧穿支内增压技术在股前外侧穿支皮瓣修复大面积缺损中的应用[J].组织工程与重建外科,2023,19(2):141-145.DOI: 10.3969/j.issn.1673-0364.2023.02.007.
[30]	董全宇,张芳萍,祝恩霞,等.吻合高位穿支的内增压大面积游离股前外侧皮瓣修复四肢大面积软组织缺损6例[J].中华显微外科杂志,2023,46(4):391-397.DOI: 10.3760/cma.j.cn441206-20221114-00231.
[31]	谭延曦,潘志军,黄路,等.内增压在修薄股前外侧穿支皮瓣游离移植修复四肢软组织缺损中的应用[J].中华显微外科杂志,2020,43(4):342-346.DOI: 10.3760/cma.j.cn441206-20191129-00365.
[32]	吴攀峰,黄承雄,卿黎明,等.联体穿支皮瓣游离移植修复四肢环形皮肤软组织缺损[J].中华手外科杂志,2021,37(5):325-328.DOI: 10.3760/cma.j.cn311653-20201117-00373.
[33]	胡浩良,李学渊,田敏涛,等.内增压技术在游离穿支皮瓣修复大面积皮肤缺损创面中的应用[J].中华整形外科杂志,2019,35(9):862-867.DOI: 10.3760/cma.j.issn.1009-4598.2019.09.004.
[34]	胡朝波,裴世杰,孔令福,等.血管增压和超回流技术在游离股前外侧皮瓣中的临床应用[J].中华显微外科杂志,2023,46(3):241-246.DOI: 10.3760/cma.j.cn441206-20220417-00076.
[35]	张世民.皮瓣远侧血液循环增强技术:外增压、内增压和超回流[J].中华显微外科杂志,2016,39(6):524-525.DOI: 10.3760/cma.j.issn.1001-2036.2016.06.002.
[36]	周征兵,唐举玉,吴攀峰,等.双侧旋股外侧动脉降支穿支皮瓣组合移植修复下肢大面积软组织缺损[J].中华显微外科杂志,2020,43(6):535-539.DOI: 10.3760/cma.j.cn441206-20200314-00150.
[37]	刘胜哲,巨积辉,柳志锦,等.串并联双侧股前外侧超长穿支皮瓣修复四肢大面积创面的临床效果[J].中华烧伤杂志,2021,37(3):250-256.DOI: 10.3760/cma.j.cn501120-20200226-00096.
[38]	郑浩,刘勇,王丽丽,等.胸脐皮瓣联合腹部随意皮瓣修复儿童小腿大面积软组织缺损[J].中华显微外科杂志,2022,45(5):528-533.DOI: 10.3760/cma.j.cn441206-20220403-00066.
[39]	黄宇,黄波,刘安铭,等.下腹壁联合皮瓣修复四肢大面积软组织环形缺损[J].中华显微外科杂志,2023,46(1):44-49.DOI: 10.3760/cma.j.cn441206-20220829-00172.
[40]	郭路齐,鲍鲲,张正善,等.双侧股前外侧皮瓣拼接组合法在肢体大面积复杂创面修复中的应用[J].中国实用医药,2020,15(30):22-25.DOI: 10.14163/j.cnki.11-5547/r.2020.30.007.
[41]	程俊楠,柳志锦,杨林,等.基于解剖学研究的三级命名法在旋股外侧动脉主要分支命名中的应用探讨[J].中华解剖与临床杂志,2022,27(1):13-18.DOI: 10.3760/cma.j.cn101202-20210410-00093.
[42]	杨林,曹阳,程俊楠,等.以旋股外侧动脉斜支为蒂股前外侧皮瓣的穿支分布特点与临床应用[J].中华整形外科杂志,2023,39(5):463-471. DOI: 10.3760/cma.j.cn114453-20230213-00031.
[43]	黄永涛,杨林,巨积辉.以旋股外侧动脉各分支为蒂的股前外侧皮瓣临床应用研究进展[J].中国美容整形外科杂志,2023,34(7):412-415.DOI: 10.3969/j.issn.1673-7040.2023.07.009.
[44]	贺继强,唐举玉,卿黎明,等.动脉插管造影CTA与普通CTA显影股前外侧穿支的比较研究[J].中国临床解剖学杂志,2017,35(5):508-512.DOI: 10.13418/j.issn.1001-165x.2017.05.007.
[45]	TzoumaG,KopanakisNA,TsakotosG,et al.Anatomic variations of the deep femoral artery and its branches:clinical implications on anterolateral thigh harvesting[J].Cureus,2020,12(4):e7867. DOI: 10.7759/cureus.7867.
[46]	HallockGG. Musculoseptocutaneous perforator of anterolateral thigh perforator flap: a clinical study[J].Plast Reconstr Surg,2022,149(1):148e-149e.DOI: 10.1097/PRS.0000000000008642.
[47]	周荣,巨积辉,唐林峰,等.带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果[J].中华烧伤杂志,2021,37(5):453-459.DOI: 10.3760/cma.j.cn501120-20200309-00136.
[48]	高秋芳,牛雪涛,马彬,等.血液循环增强技术在超大游离股前外侧皮瓣修复四肢大面积皮肤软组织缺损中的临床应用效果[J].中华烧伤杂志,2019,35(11):814-818.DOI: 10.3760/cma.j.issn.1009-2587.2019.11.009.
[49]	González MartínezJ, Torres PérezA, Gijón VegaM, et al. Preoperative vascular planning of free flaps: comparative study of computed tomographic angiography, color Doppler ultrasonography, and hand-held Doppler[J].Plast Reconstr Surg,2020,146(2):227-237. DOI: 10.1097/PRS.0000000000006966.
[50]	ShenY,LuLG,LowDW,et al.Perforator navigation using color Doppler ultrasound and three-dimensional reconstruction for preoperative planning of optimal lateral circumflex femoral artery system perforator flaps in head and neck reconstruction[J].J Plast Reconstr Aesthet Surg,2019,72(6):990-999.DOI: 10.1016/j.bjps.2018.12.025.
[51]	ViscontiG,BianchiA,HayashiA, et al. Designing an anterolateral thigh flap using ultrasound[J].J Reconstr Microsurg,2022,38(3):206-216.DOI: 10.1055/s-0041-1740126.
[52]	孙丰文,杨林,程俊楠,等.股前外侧皮瓣术中“降支陷阱”的识别和处理策略[J].中国美容整形外科杂志,2024,35(3):140-144,156.DOI: 10.3969/j.issn1673-7040.2024.03.004.
[53]	刘族安,黄志锋,马亮华,等.股前外侧皮瓣斜支血管的认识及斜支“陷阱”的处理[J].中华显微外科杂志,2021,44(2):146-151.DOI: 10.3760/cma.j.cn441206-20200724-00299.
[54]	李文涛,董中洋,刘伟,等.串联组合皮瓣修复前足负重区及周围大面积软组织缺损[J].中华手外科杂志,2023,39(2):147-149.DOI: 10.3760/cma.j.cn311653-20220907-00234.
[55]	林樾,谭谦,王淑琴,等.股前外侧穿支皮瓣游离移植在复杂创面修复中的应用及其并发症处理[J].中国美容医学,2019,28(4):4-8.
[56]	李雷,周正虎,鞠文,等.以膝降动脉为蒂的游离股前外侧穿支皮瓣修复小腿保肢术后创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(5):450-455.DOI: 10.3760/cma.j.cn501225-20220725-00308.