Efficacy of a thin ALTF designed based on an optimized perforator selection strategy for reconstructing skin soft tissue defects of the hand and foot in pediatric patients

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

doi:10.3760/cma.j.cn501225-20250603-00254

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

Li Hai,Xiao Shun’e,Wei Zairong,et al.Efficacy of a thin ALTF designed based on an optimized perforator selection strategy for reconstructing skin soft tissue defects of the hand and foot in pediatric patients[J].Chin J Burns Wounds,2026,42(11):1-8.DOI: 10.3760/cma.j.cn501225-20250603-00254.

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Efficacy of a thin ALTF designed based on an optimized perforator selection strategy for reconstructing skin soft tissue defects of the hand and foot in pediatric patients

doi: 10.3760/cma.j.cn501225-20250603-00254

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

Funds:

High-level Innovative Talents "Thousand" Level Talents of Guizhou Province of China xmrc120240201

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Corresponding author: Wei Zairong, Email:weizr@zmu.edu.cn
Received Date: 2025-06-03
Available Online: 2026-11-02

Abstract

Abstract

Objective To investigate the efficacy of a thin anterolateral thigh flap (ALTF) designed based on an optimized perforator selection strategy for reconstructing skin soft tissue defects of the hand and foot in pediatric patients. Methods This was a retrospective observational study. From January 2018 to April 2025, 10 pediatric patients (8 boys and 2 girls; aged 2-14 years) with hand and foot skin and soft tissue defects meeting the inclusion criteria were admitted to the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. The wounds were located on the upper limb in 4 cases and on the foot in 6 cases. After thorough debridement, the soft tissue defects ranged from 5.0 cm×3.5 cm to 16.0 cm×9.0 cm. Preoperatively, the anterolateral thigh region was divided into zones Ⅰ-Ⅳ using the modified two-longitudinal and five-transverse method, and perforators in each zone were detected with a handheld Doppler. Based on the detection results, an optimized perforator selection strategy was formulated: under equivalent conditions, perforators in zones Ⅱ and Ⅲ were preferred; when a longer vascular pedicle or a thinner flap was required, perforators in zones Ⅲ and Ⅳ were preferred; and when an iliac bone graft, a bulkier tissue component, or septocutaneous perforators were required, perforators in zone Ⅰ were preferred. Intraoperatively, the ALTF was designed according to this strategy and the defect size, perforators were dissected at the superficial layer of the superficial fascia, and a thin ALTF was harvested. The flap size ranged from 5.0 cm×3.5 cm to 20.0 cm×6.0 cm. The flap artery and vein were anastomosed end-to-end or end-to-side to the recipient artery and vein, respectively, and the recipient-site wound was then closed. All donor-site wounds were closed with tension-reducing sutures. The distribution and selection of perforators in each zone of anterolateral thigh region were recorded, and the accuracy of preoperative perforator selection was recorded using intraoperative exploration findings as the gold standard. Postoperatively, flap survival was observed; complications such as vascular crisis and subflap fluid collection were recorded; The time to Kirschner wire removal was recorded for pediatric patients with concomitant fractures and for pediatric patients with scar contracture release. During follow-up, flap color, texture, elasticity, and appearance were evaluated, the need for secondary thinning and scar revision was recorded, and hand and foot function was assessed at the last follow-up using the Hand Function Evaluation Standard of the Hand Surgery Society of the Chinese Medical Association and the Maryland Foot Score, respectively. Results A total of 25 perforators were detected preoperatively in the anterolateral thigh region of 10 pediatric patients, including 5 in zone Ⅰ, 7 in zone Ⅱ, 9 in zone Ⅲ, and 4 in zone Ⅳ. Of these, 17 perforators were selected as the preferred ones, including 2 in zone Ⅰ, 6 in zone Ⅱ, 8 in zone Ⅲ, and 1 in zone Ⅳ, with 1-2 preferred perforators selected for each patient. The accuracy of preoperative localization of the preferred perforators was 16/17. At 1 month postoperatively, serous exudation occurred beneath the flap in one patient and healed after dressing changes and drainage; all the other flaps survived uneventfully without vascular crisis. Kirschner wires were removed within 3 months postoperatively in 2 pediatric patients with concomitant fractures and at 1 month postoperatively in 3 pediatric patients with scar contracture release. All patients were followed up for 6-60 months. The color and texture of the flaps were similar to those of the adjacent normal skin, with good elasticity, and none of the patients' family members requested secondary thinning. One child presented with obvious hypertrophic scar at the donor site at 3 months of follow-up, which was relieved after corresponding treatment; linear scars were left at the donor and recipient sites of the other patients. At the last follow-up, the hand wounds were rated as excellent in 3 cases and good in 1, and the foot wounds as excellent in 5 cases and good in 1. Conclusions An ALTF designed based on an optimized perforator selection strategy yields flaps with good postoperative appearance and texture for reconstructing soft tissue defects of the hand and foot in pediatric patients, and represents an effective option for pediatric hand and foot wound repair.
- Child,
- Hand injuries,
- Foot injuries,
- Surgical flaps,
- Flap design,
- Thin flap,
- Wound repair

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References(45)

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