Clinical Study Of Bilateral Anterolateral Thigh Perforator Flap Combined Grafting For Repairing Large Skin And Soft Tissue Defects Of Extremities

Objective:The purpose of this paper is to discuss the clinical application and practical results of bilateral anterolateral thigh perforator flap combination grafting for repairing large skin and soft tissue defects in the extremities.Methods:Ten patients who applied bilateral anterolateral thigh perforator flaps combined with lateral flaps to repair large skin soft tissue defects in the extremities were collected from January 2018 to June 2020 at the department of hand surgery,China-Japan Union Hospital of Jilin University,and the area of skin soft tissue defects was measured preoperatively,and color doppler ultrasound was applied to the penetrating arteries in the thighs bilaterally,at the penetration of deep fascia the location was localized.The area that can be excised is evaluated according to the number of penetrations and their nutritional range,and the penetrations are searched for intraoperatively according to ultrasound localization.The anastomosis of the vascular tip when the flap is transferred to the recipient area also needs to be designed and adjusted according to the actual situation.If the recipient area is large and irregular or if there are multiple traumas,consider designing a lobed flap and adjusting it flexibly according to the shape and location of the trauma.The flap donor area should be closed in one stage as much as possible.In this study,the donor area was closed in one phase in 9 patients,and in one patient,the unilateral donor area was delayed in the second phase because of the high tension in the first phase closure.In this study,the trauma was distributed in the forearm,elbow,upper arm,foot and lower leg,and the skin defect area ranged from 19×12cm to 38cm×15cm.intraoperative assessment of bleeding and observation of flap blood flow after anastomosis of vessels were performed.Postoperatively,the viability of the flap and the presence of complications such as bleeding,infection,and arteriovenous crisis were closely observed.Patients were followed up at 1 month,3 months and 6 months after discharge to assess their satisfaction with the appearance of the flap graft and the degree of recovery of limb function.The quality of life of patients was assessed 6months after surgery.Results:All of the 10 bilateral anterolateral thigh perforator free flaps in this study were viable,and one flap had delayed healing,followed by complete healing with dressing exchange.In the present study,nine patients had first-stage closure of the donor area and one patient had delayed second-stage closure of the unilateral donor area.The time to remove the stitches in the donor area was prolonged by about 1 week compared with the tension-free suture wound.No complications such as postoperative flap donor hematoma,wound dehiscence,or infection occurred in the donor area in this study.The postoperative quality of life of the patients was good,and the technique achieved high patient satisfaction.Conclusion:The location of the first penetrating branch of the anterolateral femoral flap is relatively constant and simple to excise.Combined grafting of bilateral anterolateral thigh penetrating flaps can repair large skin defects in a single operation,reducing both the number of operations and hospitalization costs,in addition,it also reduces the injury of the limbs caused by the large area flap only taken from one side.This study showed that the combined transplantation of bilateral anterolateral thigh perforator flap did not affect the survival rate of the flap.According to the clinical practice and postoperative observation of this study,bilateral anterolateral thigh perforator flap combined transplantation could be an effective method to repair large area skin and soft tissue defects of the extremities,with high degree of patient satisfaction.