Clinical application effects of the "novel three-vertical five-horizontal method" for perforator localization in anterolateral thigh chimeric flaps

Wu Xiangkui; Li Hai; Wu Bihua; Wei Zairong; Deng Chengliang

doi:10.3760/cma.j.cn501225-20240520-00188

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > > Accepted Manuscript

Wu Xiangkui,Li Hai,Wu Bihua,et al.Clinical application effects of the 'novel three-vertical five-horizontal method' for perforator localization in anterolateral thigh chimeric flaps[J].Chin J Burns Wounds,2026,42(3):1-8.DOI: 10.3760/cma.j.cn501225-20240520-00188.

Citation:

Wu Xiangkui,Li Hai,Wu Bihua,et al.Clinical application effects of the "novel three-vertical five-horizontal method" for perforator localization in anterolateral thigh chimeric flaps[J].Chin J Burns Wounds,2026,42(3):1-8.DOI: 10.3760/cma.j.cn501225-20240520-00188.

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Clinical application effects of the "novel three-vertical five-horizontal method" for perforator localization in anterolateral thigh chimeric flaps

doi: 10.3760/cma.j.cn501225-20240520-00188

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

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Guizhou Provincial Clinical Medical Research Center for Wound Repair (LCZX〔2025〕005) 黔科合平台LCZX〔2025〕005

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Corresponding author: Deng Chengliang, Email: cheliadeng@sina.com
Received Date: 2024-05-20
Available Online: 2026-03-09

Abstract

Abstract

Objective To evaluate the clinical application effects of the "novel three-vertical five-horizontal method" for perforator localization in anterolateral thigh chimeric flaps. Methods This study was a retrospective study of case series. From June 2021 to June 2023, 15 patients with destructive limb wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University. The wounds were located on the upper limbs in 5 cases and the lower limbs in 10 cases, with a post-debridement area ranging from 12 cm×5 cm to 22 cm×7 cm. The "novel three-vertical five-horizontal method" was employed. The anterior superior iliac spine was defined as Point P, the superolateral border of patella was defined as Point A, and the lateral femoral epicondyle was defined as Point B, then Lines PA and PB were drawn, respectively. The point C, the midpoint between Point A and Point B, was connected with Point P to form line PC. A perpendicular line was drawn from the midpoint of Line PA as Line E. Line E was translated 5 cm proximally to form Line D, while Lines F, G, and H were drawn 5, 10, and 15 cm distally, respectively. The intersections of Lines PA and PB with Lines D, E, F, G, and H were defined as Zones Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. These zones served as the guide for designing and harvesting the anterolateral thigh chimeric flaps to repair the wounds. The area of harvested flap ranged from 13.0 cm×6.0 cm to 23.0 cm×8.0 cm. The donor site wounds were closed directly. During surgery, the number and origin of perforators observed in each zone, as well as the vertical distance from the perforator's skin entry point to Line PC, were recorded. After surgery, flap survival was observed. During follow-up, the color, texture, appearance, and occurrence of complications of flaps were observed. Results During surgery, a total of 75 perforators was identified. Their distribution by zone was as follows: 18 perforators in Zone Ⅰ (3 originating from the oblique branch of anterolateral thigh artery and 15 originating from the descending branch of anterolateral thigh artery), 17 perforators in Zone Ⅱ (all originating from the descending branch of anterolateral thigh artery), 21 perforators in Zone Ⅲ (all originating from the descending branch of anterolateral thigh artery), and 19 perforators in Zone Ⅳ (12 originating from the descending branch of anterolateral thigh artery and 7 originating from the peripheral vessels in distal thigh). The 24 perforators' skin entry points were located directly on Line PC, while 51 perforators' skin entry points were located adjacent to it, with the vertical distances to Line PC all less than 1.0 cm. After surgery, one patient developed distal flap bruising, and two patients had minor exudation at the flap margin, which all healed after dressing change. The flaps in the remaining patients survived smoothly. During the follow-up period of 6 to 40 months, all flaps demonstrated favorable color, texture, and appearance, with no complications observed; the scars in donor sites were mild, with no muscle herniation. Conclusions The "novel three-vertical five-horizontal method" method can effectively locate anterolateral thigh chimeric flap perforators. The method is simple and reliable. The anterolateral thigh chimeric flaps designed and harvested based on this method have good clinical effect in repairing destructive limb wounds, which is worthy of promotion.
- Perforator flap,
- Microsurgery,
- Wounds and injuries,
- Novel three-vertical five-horizontal method,
- Chimeric flap,
- Wound repair

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References(40)

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