Microvascular Anastomo Anterolateral Thigh Flaps For Reconstruction Of Traumatic Defects Of Tissue In Crus

Objectives To investigate the clinical effect of anterolateral femoral free flap in repairing skin and soft tissue defects of calf.To observe the perforator vessels of anterolateral thigh flap in clinical and compare the situation of descending branch and lateral branch;The purpose was to establish the clinical basis for precisely cutting the split leaf flap and chimeric flap and better to guide the clinical applications.Methods A total of 32 patients who repair their skin and soft tissue defects with the anterolateral thigh flap were enrolled in the Department of Orthopedic Surgery,Affiliated Department of Orthopedics Hospital of North China University of Science and Technology,from September 2010 to September 2016.The involved cases included 25 males and 7 females,aged range from 15 to 58 years old,The area of the soft tissue defect varied from 5.0cm×12.0cm ~ 12.0cm×22.0cm,and the area of the flaps that cut away varied from 7.0cm×15.0cm ~ 13.0cm×25.0cm.Injury to surgery time is 12 to 45 days.Methods: Preoperative application of the femoral rectus and lateral femoral interstitial line vascular perforation localization method,supplemented by Doppler flow detector pre-detection of arterial pulsation points and mark,Design flap according to the marked perforated vascular parts and wound defect area,depth,etc.the detection of vascular perforation is generally designed in the upper 1/3 on the axis of the flap.Intraoperative incision flap to explore the perforation and retrograde anatomy along the vascular bundle,revealing the entire flap vascular pedicle of the situation,observe and record the location of intperforating branches that intraoperative observation and preoperative detection was consistent or not,the distribution of 50 perforator vessels and point A,the superficial point of perforating branches,the beginning of the diameter of perforating branches,perforating branches type,perforating branches of the length in the muscle and other datas about perforating branches of the blood vessels.Results In this group of 32 patients with anterior lateral free flap repair,31 flaps survived completely(1 case of vascular crisis occurred),1 case with distal necrosis,and the wound healed after skin grafting.We followed up all these cases 5 to 24 months,an average of 8 months,the wound no longer ruptured,flap skin color than the surrounding normal skin had no significant difference.The color and texture of the flaps were good.The appearance and the function were satisfactory.The all flaps had recoverd unequal degree of protective feeling.The wounds healed without leaving severe scar,no obvious paresthesia,no quadriceps dysfunction.A total of 68 perforation vessels were found during the operation,of which 50 were used for the removal of the flap,40(80%)from the descending branch,10(20%)from the lateral branch(high skin artery).The rate that the preoperative Doppler location was consistent with the utility point of formatting skin flap was 98%.The distribution of 50 perforator vessels and point A that we figured out and found is as follows: 70% of the perforating vessels from lateral branch is at the proximal side of the point A,the remaining 30% is at the far side of the point A;70% of the perforating vessels from descending branch is at the far side of the point A,12.5% is on the point A and another 22.5% is at the proximal side of the point A.The results showed that all the perforation are located on the rectus femoris and lateral femoral muscle muscle gap and its outside.The length from the lateral femoral artery(Or lateral branch)to the beginning of the length is 9.6cm ± 3.50cm(6.0cm~15.0cm).The length from the branch muscle to the travel of the length is 8.14cm±0.12 cm(5.0cm~10.5cm).The length from Out of the skin point to the skin point to the perforated muscle travel is1.95 cm ± 0.09(1.0cm~5.5cm).The length from the lateral femoral artery(or lateral branch)to the lateral diameter is 2.7mm±0.6mm(2.2mm~3.7mm).The length from the perforation to the outer diameter is 1.8mm±0.9mm(1.3mm~2.8mm),and the outside diameter is 0.6mm±0.1mm(0.4mm~1.2mm).Conclusions The anterolateral femoral flap is an effective and reliable method to repair the skin and soft tissue defects of the calf.It has satisfactory clinical efficacy.The Innovative intermuscular gap localization method combined with Doppler detection technology can improve the accuracy of preoperative localization of perforating branches.The effective perforating branches were located in the spatium intermusculare of rectus femoris muscle and the lateral femoral muscle or the area outside.