A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect

Application of Flow-through Anterolateral Thigh Perforator Flaps in Replantation of Complex Severed Limb

OBJECTIVE

To explore the clinical application value of flow-through anterolateral thigh perforator (ALTP) flaps in replantation of complex severed limbs.

METHODS

Thirteen severe vascular, nerve injury, and skin or soft tissue defects in patients with complex severed limbs from August 2017 to January 2019 were enrolled in this retrospective study. The skin flap has covered the wound by using the flow-through ALTP flap technique. The main vascular defect was repaired by using the descending branch of the lateral circumflex femoral artery, and the blood supply of the transplanted limb was reconstructed. The blood supply of the flap and wound healing observed were observed after the operation. Regular follow-up was performed to observe the survival and functional recovery of the replanted limb.

RESULTS

Eleven cases of replanted limb and perforator flap survived completely. Limb shortening occurred in 3 patients owing to bone defects caused by distal amputation. After the second stage of bone transplantation, the limb length and function of those 3 patients recovered well. One case showed necrosis of the little finger after replantation of the severed palm. One case showed that the crushed forearm was severed completely. The anastomotic vascular inflammatory embolism was caused by infection and necrosis of soft tissue after replantation for 2 weeks, and then the stump wound was covered with a survived skin flap in the second stage.

CONCLUSION

The flow-through ALTP flap technique has a good therapeutic effect on the functional reconstruction of complex severed limbs with severe skin and vascular injuries.

Reconstruction of Soft Tissues of the Postamputation Lower Leg Stump with a Free Anterolateral Thigh Flap for Optimal Prosthesis

Patients without proper covering of the bone stump with soft tissues after below-knee amputation have limited opportunities for prosthesis. The resulting high degree of disability severely restricts their proper functioning in social and professional life. The commonly used significant reduction of the bone length for local coverage limits rehabilitative options to the less comprehensive prosthesis. We aimed to describe a delayed reconstruction with soft tissues of the lower leg stump using free anterolateral thigh flap as an alternative surgical method allowing for optimal prosthesis. A 20-year-old patient was consulted because of right lower leg stump, covered only with a skin graft following posttraumatic amputation. Previously, the patient had ineffective attempts of using a prosthesis. He asked to determine the possibility of recovering the functionality of the lower limb. We performed reconstruction of soft tissues of the stump with a free anterolateral thigh flap. Postoperatively, the patient achieved good coverage of the remaining part of the tibia with a thick layer of soft tissues, allowing the subsequent adequate forming of the stump. Therefore, a fixed prosthesis with the dynamic foot could be implemented. A significant increase in physical activity contributed to a full return to the patient's professional and private life. In conclusion, the free anterolateral thigh flap provides a robust amount of good-quality tissues for supportive function of the lower limb stump. The resulting adaptation of the stump to numerous modern prosthetic devices significantly increases the range of physical activity and contributes to the full return of the patient to their professional and private life.

Flow-through flap with wrist epithelial branch of ulnar artery for repair of finger soft tissue defect: a case series

OBJECTIVE

To evaluate the surgical technique and the efficacy of flow-through flap with a wrist epithelial branch of the ulnar artery to repair a finger soft tissue defect.

METHODS

Between June 2015 and December 2017, 12 cases of soft tissue defects of fingers and injured digital artery were repaired by flow-through flap with wrist epithelial branch of the ulnar artery, including 7 males and 5 females (age range: 18-45 years old, average age: 23.6 years old). The causes of injury included electric saw injury in 7 cases, and machine crush injury in 5 cases. 5 cases were combined with tendon injury, 4 cases with fracture, 12 cases with vessel injury and 2 cases with nerve injury. The area range of the flap was 3.0 cm ×1.8 cm to 6.0 cm ×3.0 cm. The length of the pedicles of the flaps ranged from 2.3 cm to 4.7 cm, with an average length of 3.7 cm. The donor sites were sutured directly in 10 cases, and 2 cases were repaired with a full-thickness skin graft from the ilioinguinal region. Flow-through anastomoses of the distal and proximal end of the wrist epithelial branch of the ulnar artery to the distal and proximal end of the digital artery were created, so as to connect the vessels and reach the physiologic state of blood supply.

RESULTS

All flaps and skin grafts survived after operation, and all wounds healed at I phase. All patients were followed up 6-12 months (mean: 9 months). The flaps exhibited smooth appearance and soft texture, similar to that of the normal surrounding skin. At last follow-up, the two-point distance of flaps was 9-15 mm (mean: 11 mm). According to the assessment of upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 10 cases, and good in 2 cases. The ulnar wrist donor areas only had linear scar.

CONCLUSION

Flow-through flap with wrist epithelial branch of ulnar artery exhibits strength in a concealed donor site, reliable blood supply, and simple operation. Flow-through method can be used to repair a broken or defective digital artery in I stage. It is a good method to repair a soft tissue defect of fingers.

[Clinical application of Flow-through chimeric anterolateral thigh perforator flap]

Objective

To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities.

Methods

Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients' mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly.

Results

All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction.

Conclusion

The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.