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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Shao Zhuoheng,Li Lei,Li Changsong,et al.Clinical efficacy of free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection in repairing wounds formed after lower limb salvage surgery[J].Chin J Burns Wounds,2025,41(12):1-9.DOI: 10.3760/cma.j.cn501225-20250225-00085.
Citation: Shao Zhuoheng,Li Lei,Li Changsong,et al.Clinical efficacy of free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection in repairing wounds formed after lower limb salvage surgery[J].Chin J Burns Wounds,2025,41(12):1-9.DOI: 10.3760/cma.j.cn501225-20250225-00085.
shu

Clinical efficacy of free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection in repairing wounds formed after lower limb salvage surgery

doi: 10.3760/cma.j.cn501225-20250225-00085
  • 1.

    Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China

  • 2.

    Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China

Funds:

Suzhou Science and Technology Development Plan SKYD2023026

Suzhou Key Technology Research Program SYWD2025068

More Information
  • Corresponding author: Li Lei, Email: 12057640@qq.com
  • Received Date: 2025-02-25
    Available Online: 2025-11-27
    Abstract
  •   Objective  To investigate the clinical efficacy of free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection in repairing wounds formed after lower limb salvage surgery.  Methods  This study was a retrospective observational study. From January 2020 to June 2024, 66 patients with wounds formed after lower limb salvage surgery were admitted to the Department of Orthopaedics Trauma of Suzhou Ruihua Orthopedic Hospital, including 46 males and 20 females, aged 19-76 years. The microbiological culture results of wound secretion specimens from 8 patients were positive before flap transplantation. The wounds were all located on unilateral lower leg, with a wound area of 9 cm×6 cm to 40 cm×30 cm after debridement, which were repaired with free anterolateral thigh flaps measuring from 10 cm×8 cm to 35 cm×11 cm. Large wounds were repaired with additional split-thickness skin grafting or double anterolateral thigh flap transplantation. According to the anatomical location form low to high, the three non-major recipient arteries adjacent to the wound, namely the medial sural artery, the descending genicular artery, and the descending branch of the lateral circumflex femoral artery, were graded in a stepwise manner, and the lowest-grade uninjured artery was selected as the blood supply artery for the free flap covering the wound. Wounds in flap donor area were closed directly or covered with full-thickness skin grafts from the abdomen. Data recorded included the type of the lowest-grade usable non-major artery in the recipient area confirmed by preoperative digital subtraction angiography (DSA) examination, intraoperatively used type of non-major artery in the recipient area, the ratio of the calibers of the non-major artery in the recipient area to the flap vessel, type of vascular anastomosis, flap pedicle length, wound repair method, and arterial and venous connection method for double anterolateral thigh flaps, as well as flap survival and vascular crisis occurrrence, wound healing in recipient and donor areas, and occurrrence of specific donor-site complications after surgery before discharge. The flap's color, texture, and wound infection control were followed up. The outcome of the flap transplantation was evaluated using a comprehensive assessment scale at the final follow-up.  Results  Preoperative DSA examination identified the lowest-grade usable non-major recipient artery as the medial sural artery in 35 cases, the descending genicular artery in 24 cases, and the descending branch of the lateral circumflex femoral artery in 7 cases, which were consistent with the non-major artery in the recipient area used intraoperatively. The caliber ratio of recipient artery-to-flap vessel that were anastomosed intraoperatively was 0.5-1.0 for the medial sural artery, 0.5-0.8 for the descending genicular artery, and 0.5-0.7 for the descending branch of the lateral circumflex femoral artery. End-to-end direct anastomosis was performed in 20 cases, and end-to-end "fish-mouth" anastomosis was performed in 46 cases. The flap pedicle length was 8-18 cm. Wounds were repaired with flap transplantation alone in 57 cases and transplantation of flap combined with skin graft in 9 cases. For double anterolateral thigh flaps, the main arterial and venous trunk of the primary flap was connected to the main arterial and venous trunk of the secondary flap in 2 cases, and the arterial and venous branches of the primary flap was connected to the main arterial and venous trunk of the secondary flap in 1 case. Postoperatively, 67 flaps survived successfully, while vascular crisis occurred in 2 flaps, which survived after surgical exploration and re-anastomosis. Preoperatively non-infected wounds in 55 cases and infected wounds in 4 cases healed successfully postoperatively, while preoperatively non-infected wounds in 3 cases developed postoperative infection leading to delayed healing, and preoperatively infected wounds in 4 cases healed with delay. All donor site wounds healed well without specific complications like infection or muscle necrosis. Follow up for 6-24 months showed that all 69 flaps exhibited good color and texture with no wound infection. At the final follow-up, the outcome of the flap transplantation was evaluated as excellent in 39 cases, good in 21 cases, and fair in 6 cases.  Conclusions  The free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection demonstrates abundant blood supply, which can be used to repair wounds formed after lower limb salvage surgery in one time, without increasing the risk of further damage to the distal limb blood vessels, and can effectively control infections. This technique merits clinical promotion.

     

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