The Clinical Research Of Chimeric Free Anterolateral Thigh Perforator Flap In The Treatment Of Chronic Osteomyelitis With Soft Tissue Defects Of Limbs

Background:High energy trauma will lead to serious bone injuries of soft tissue, and, further, will lead to necrosis, infections and defections of soft tissue and bone during the treatment, what’s more, due to the fact that the soft tissue and bone cannot withstand the the second combat, such as operation, it will injury more seriously after several times of radical debridement. The treatment method both at home and abroad currently are main; the Papineau technology, the ilizarov technology, the bone handling technology, the skin flap cover technology, the muscle skin flap cover technology, the free bone transplant with vascular technology and so on, and among them, the Papineau technology, the ilizarov technology, the bone handling technology and the free bone transplant with vascular technology are mainly used for the treatment of cases with small range of soft tissue bone defection or large bone defection, while most of patients need cured through the skin flap and muscle skin flap cover technology (most of the cased should be treated through musculocutaneous flap technique). However, there is a serious injury for donor site and the recipient site will become bloated after the treatment of musculocutaneous flap technique, nevertheless, the effect of filling for the deep irregular bone defects is not clear. In recent years, with the development of microsurgery, the research of scholars at home and abroad mainly focuses on Perforator flap for the treatment of chronic osteomyelitis, but this technology cannot solve the deep cavity problem left by the schronic osteomyelitis with soft tissue defect. This study is use a flexible Perforator flap to fill the residual cavity, while overcoming the problem of defection of donor site and the bloat of the recipient site, reducing complications and promoting the development of Perforator flaps in the treatment of chronic osteomyelitis.Objective:Explore the curative effects of chimeric free Anterolateral thigh Perforator flap in the treatment of chronic osteomyelitis with soft tissue defects of limbs.Method:From June 2012 to June 2015, there are 15 cases treated by chimeric free Anterolateral thigh Perforator flap in the treatment of chronic osteomyelitis with soft tissue defects,11 males and 4 females. The cause of injury:6 cases of accident injury,4 cases bashed,3 cases crushed,2 cases of high falling injury. Among them, there are 11 cases featured with Chronic osteomyelitis in tibia,2 cases with chronic calcaneal osteomyelitis,1 cases with osteomyelitis in distal radius, and 1 case with osteomyelitis in metacarpal bone.Results:There are 15 cases treated by Perforator flap,1 case has vascular crisis. With the fact that the skin flap became slightly purple on the third day after surgery and tension is slightly higher, we speculated that the hematoncus had generated, and then we removed the sutures and blood clot overflowed as we squeezed the flap. After drainage and changing dressing, the color and tension of flaps restored.2 cases were featured with partial necrosis, and became better after skingrafting and local flap shift.1 cases was featured with the Recurrence of osteomyelitis, and became better after two times of debridement and excision of lesion.14 cases were free from the recurrence of infection, of which 10 cases were healed through autologous bone plus artificial bone,3 cases without artificial bone,1 case was healed through coalescence of the secondary traumatic arthritis joint. The periods of follow-up covered from 6 to 23 months and the average is 13.2 months, we concluded that the color of flap was similar to the recipient site without obvious bloat, and in nice appearance. The motor function of limbs of donor site had no been obviously affected and the incision of donor site was linearly healed, moreover, the scar was featured with little contraction.Conclusion:chimeric free Anterolateral thigh Perforator flap makes the skin flap and muscle flap independent to each other and keeping a contact to each other through the same feeding artery. The designed Perforator flaps will fill the lacunar of bone defect well, which will meet the needs of elimination of lacunar left by the bone defect in chronic osteomyelitis and simultaneously reduces the muscle injury of donor site and the functional effects. Moreover, linear incision is secret without bloat of recipient site, which meets the aesthetic demands, thus it is a better choice for the treatment of chronic osteomyelitis with soft tissue defects of limbs.