| ChapterⅠThe anatomic study of anterolateral thigh perforator flapObjective To explore the number, types, origin, diameter, course and distributionof anterolateral thigh perforator vessel, to guide design and harvestation of anterolateral thigh perforator flap.Methods Microsurgical dissected 6 thighs of fresh adult cadavers injected with red latex, observed and measured the number, types, origin, diameter, course and distribution of anterolateral thigh perforators.Results There are 22 cutaneous perforators(>0.5mm) were found, 3.6 per side on average. There are 18 (83.3%) perforators originated from the descending branch, 4 (18.1% ) perforators originated from the transverse branch. The length between the origin of desending branch(or transverse branch) and perforator branches in the superficial fascia is 17.5±3.1cm(14.5cm～22.5cm), the length between the origin of perforator and its branches in the superficial fascia is 7.6±4.1cm(2.3cm～12.5cm) and the length of perforator course in the superficial fascia is 2.7±0.5cm(2.0～3.5 cm). The diameter of descending branch(or tansverse branch) on its original level is 2.8±0.5mm(2.1mm～3.5mm), the diameter of perforator on its original level is 1.9±0.8mm(1.4mm～2.7mm), its diameter on the fascia lata level is 1.5±0.1mm(1.2mm～1.6mm). The perforator distribute dendriticly in the superficial fascia, there are large linking vessels among the perforators.Conclusion Anterolateral thigh perforator has constant vascular anatomy, large-diameter, enough length of vascular pedicle, independent blood supply to skin paddle, et al. These characteristics build up anatomic foundation of anterolateral thigh perforator flap harvestation. The characteristics among vascularize zone composed of various branches and transverse branch and descending branch consist of anatomic foundation to harvest flow-through ALTPF, combined ALTPF, chimeric ALTPF and compound ALTPF. ChapterⅡThe clinical study of anterolateral thigh perforator flapObjective To investigate the clinical effect of anterolateral thigh perforator flap and the feasibility of flow-through ALTPF, combined ALTPF, chimeric ALTPF and compound ALTPF.Methods Between 2007, October to 2010, January, 48 cases of soft tissue defects in the limbs and 1 case of scrotum eczema carcinoma were reconstructed with various anterolateral thigh perforator flaps, by using the simple ALTPF, flow-through ALTPF, combined ALTPF, chimeric ALTPF, compound ALTPF and pedicled ALTPF according to the various features of wound surface. The patients were elevated 3, 6, 9 and 12 months postoperaticely, the follow-up parameters include flap shape, blood supply, color and limb function, appearance and function of donor site.Results In all 49 cases, 47 flaps survived completely, 2 flaps suffered from venous crisis postoperatively and received reexploration, one is venous thrombosis, the other one dues to hematoma under the flap, after removed the hematoma and thrombus the flaps survived smoothly. In this group, no infection occurred in any flap, 43 flaps survived in one-stage, 6 flaps healed delayed, received debridment and survived 2～3w postoperatively. Post-operative follow-up ranged from 3 to 24 months (12 months on average), only linear scar was left on donor site, the muscle strength of quadriceps was not suffered, in 3 (6.1%) cases paresthesia occurred. The donor site's appearance, color and texture was satisfying, flap clumsy happened in 2 (4%) cases, in 2 cases the flaps were scalded later and scar was left.Conclusion The optimal recipient site reconstruction can be gained with anterolateral thigh perforator flaps, meanwhile, the morbidity of donor sites was decreased minimally, anterolateral thigh perforator flap is an ideal flap for limb superficial defects reconstructionn. Flow-though, conjoined, chimeric and combined transplantation of anterolateral thigh perforator flap is safe and plausible, the techniques broaden the spectrum of anterolateral thigh perforator flap. |
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