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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Wang Jing,Huang Shuqing,Liu Jingyi,et al.Clinical effects of different types of chimeric perforator flap transplantation in the treatment of lower extremity wounds with bone exposure[J].Chin J Burns Wounds,2026,42(10):1-9.DOI: 10.3760/cma.j.cn501225-20250527-00245.
Citation: Wang Jing,Huang Shuqing,Liu Jingyi,et al.Clinical effects of different types of chimeric perforator flap transplantation in the treatment of lower extremity wounds with bone exposure[J].Chin J Burns Wounds,2026,42(10):1-9.DOI: 10.3760/cma.j.cn501225-20250527-00245.
shu

Clinical effects of different types of chimeric perforator flap transplantation in the treatment of lower extremity wounds with bone exposure

doi: 10.3760/cma.j.cn501225-20250527-00245

  • Department of Plastic Surgery, the Second Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400015, China

Funds:

The Young PhD Talents Cultivation Project of the Second Affiliated Hospital of Army Medical University 2024YQB090, 2022YQB084

More Information
  • Corresponding author: Yang Zhibin, Email: yanzhibin321@163.com
  • Received Date: 2025-05-27
    Available Online: 2026-09-28
    Abstract
  •   Objective  To investigate the clinical effects of different types of chimeric perforator flap transplantation in the treatment of lower extremity wounds with bone exposure.  Methods  This study was a retrospective case series study. From January 2019 to August 2024, 15 patients with lower extremity wounds with bone exposure who met the inclusion criteria were admitted to the Department of Plastic Surgery of the Second Affiliated Hospital of Army Medical University (the Third Military Medical University), among whom 12 patients were combined with osteomyelitis. Among the 15 patients, there were 8 males and 7 females, aged 27-66 years, and the wound area after the last debridement ranged from 3.0 cm×2.0 cm to 22.0 cm×4.5 cm. According to the wound area, depth, composition of defective tissue, anatomical site, and vascular conditions of the affected limb, chimeric perforator flaps containing muscle flaps, muscle flaps and iliac bone flaps, or muscle flaps and fascial flaps were used, including circumflex iliac artery chimeric perforator flaps, superficial circumflex iliac artery combined with superficial inferior epigastric artery chimeric perforator flaps, lateral circumflex femoral artery chimeric perforator flaps, and thoracodorsal artery chimeric perforator flaps, to repair lower extremity wounds with bone exposure. The area of the chimeric perforator flaps ranged from 4.0 cm×3.0 cm to 25.0 cm×5.0 cm. The donor site wounds of the chimeric perforator flaps were repaired by direct suture, free skin grafting, or local flap transfer. The survival of the transplanted chimeric perforator flaps in the early postoperative period was observed. Follow-up was conducted to observe the survival and appearance of the transplanted chimeric perforator flaps, wound healing and complications in both donor and recipient sites, scar formation in the donor site, and weight-bearing activity of all patients, and signs of osteomyelitis recurrence in patients combined with osteomyelitis.  Results  One patient who underwent transplantation of a chimeric perforator flap based on the descending branch of the lateral circumflex femoral artery containing a muscle flap and a fascial flap developed venous vascular crisis within 24 hours after surgery, with the flap becoming dark purple; the flap survived after emergency vascular exploration and secondary venous anastomosis and recanalization. One patient who underwent transplantation of a chimeric perforator flap based on the oblique branch of the lateral circumflex femoral artery containing a muscle flap developed partial necrosis of the distal end of the flap 10 days after surgery, and the flap survived after dressing changes and free skin grafting. The transplanted chimeric perforator flaps in the remaining 13 patients survived smoothly. Postoperative follow-up of 3-6 months showed that the transplanted chimeric perforator flaps in 15 patients all survived well, among whom 7 patients had bulky flaps; all the wounds in both donor and recipient sites healed well in 15 patients, with no complications such as infection, sinus tract formation, or persistent pain, and only linear scars remained in the donor sites, but 3 patients had abnormal skin sensation in the donor sites; all 15 patients were able to perform weight-bearing activities; no signs of osteomyelitis recurrence were observed in the 12 patients combined with osteomyelitis.  Conclusions  The use of different types of chimeric perforator flap to repair lower extremity wounds with bone exposure has the advantages of fewer complications, high flap survival rate, high cure rate of osteomyelitis, and good recovery of lower extremity function, and is a reliable clinical regimen for repairing wounds and reconstructing lower extremity function in lower extremity injuries with bone exposure.

     

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