The Preoperative Design Optimization And Clinical Application Of The Anterolateral Thigh Flap

Background and Objective: The gold standard for design of the anterolateral thigh flap was painting a circle with a radius of 3 cm,the center of which was the midpoint of the line linking the anterosuperior iliac spine and the superolateral border of the patella.Using a portable Doppler detected perforating the piercing point in the field of the circle and then designed a flap.This paper prospectively summary the position left out of the muscle, direction, distance and into the skin point position of the perforator and to investigate the preoperative axis design of the anterolateral thigh flap and the feasibility of its clinical application.Methods: From January 2014 to January 2016,Fifty-eight cases of anterolateral thin flap were designed on anterior thigh lateral region, preoperative used portable Doppler perforating piercing point detection regarded as point P, intraoperative observed perforator direction left out the muscle, the distance and the position I into the superficial fascia and dermis regarded as point P,. Accordingly, we increased the line B and the line C on the basis of the original line A.The line between the lateral margin of the patella and anterior superior iliac spine was regarded as the line A, The line between the front edge of the iliotibial band end and anterior superior iliac spine was regarded as the line B.And then the line between the midpoint of the upper edge patella and the anterior superior iliac spine was regarded as the line C. The cause of injury was distributed as follows: 10 cases of heavy pound, 38 cases of traffic injury, 7 cases of machine twist injury, 2 cases of burn injury combined with scar contracture deformity,1 case of skin cancer, including 2 cases of head wounds, 20 cases of upper limb, lower limb in 36 cases.The defect area ranged from 6 cm x 4 cm to 23 cm x 15 cm.And the flap area ranged from 8 cm x 6 cm to 23 cm x 12 cm.There were 12 cases in which a simple flap was used, 11 cases in which a flap chimeric broad fascia flap was used, 8 cases in which a flap chimeric fascia flap was used, 8 cases in which a flap chimeric muscle flap was used,5 cases in which a lobulated flap was used,12 cases in which a lobulated thin flap flap and 2 cases in which a broad fascia flap was used.Fascia flaps and muscle flaps were covered by skin grafts.Results: Preoperative design results,58 cases of preoperative and postoperative found all branches were located in line A or between the line A and B, no perforating branch was located between line A and C.Perforators away from the sarcolemma walking anteromedial,perforator subcutaneous segment(the distance between P and P’) was about 2 cm.If the point P was located on the line A, the point P’ was located in the nearby the line C.The branch of the lateral femoral artery had a branch of the rectus muscle and was not found in the cutaneous branch of the rectus muscle.In this group, 21 cases were found to have an oblique branch,in which 12 cases adopt with oblique branch perforator flap.20 cases were designed by the one line method,12 cases were designed by using two line method and 26 cases were designed by three line method.Other clinical outcomes were distributed as follows:all the cases were followed up for 2 to 18 months(mean 12 months). Among the cases,57 flaps were survived. 1 case that suffered arterial crisis survived completely by surgical exploration.Venous crisis occurred in 2 cases,survived by surgical exploration. 1 case that suffered the arteriovenous refractory spasm in the operation cured after changing the operative proposal.The texture of the flaps was good and the color was slightly dark.All skin grafts were partly necrosis in 6 cases, cured by dressing change. The donor sites of 51 cases leaving only the S-shaped scar were primary suture. Others were repaired by perforator flaps in one-stage.Conclusion: Adoption of the optimized three-line design facilitates the detection of the perforators on the anterior thigh lateral region,reduce the intraoperative injury perforators and make the clinical application of the anterior lateral thigh flap simple and reliable.