Modified Anterolateral Perforator Flap Design Method Clinical Application

Objective: To explore the advantages and disadvantages of the modified anterior and posterior perforator flap design in clinical application and its impact on donor scar.Methods: 3-5 perforation exploration method,spindle design/diamond design method,upward eccentric design method,lobulated perforator flap/multi-leaf perforator flap method,conjoined perforator flap method,chimeric perforator Flap method,composite perforator flap method,S-shaped incision method,upper anterior and posterior narrowing method for anterior and posterior femoral perforator flaps,and the advantages and disadvantages of the modified anterior and posterior perforator flap design method and its scar on the donor site influences.From January 2015 to August 2018,286 flaps were taken(total number of patients: 281).202 males and 79 females.The age range is 3-87 years old and the mean age ± standard deviation is 40 ± 13 years.ALTP flap range: 3cm ×5cm ~ 35 cm × 10 cm.According to the size of the patient's wound surface,the comprehensive repair program is divided into 4 categories,small area,medium area,large area,and extra large area.There are 10 cases in a small area,89 cases in the middle area,120 cases in a large area,and 67 cases in a large area.In the small area,6 cases were treated with transverse branch perforator flap and 4 cases were treated with oblique branch perforator flap.In the middle area,3 cases of transverse branch perforator flap,25 cases of oblique branch perforator flap and 61 cases of descending branch perforator flap were used.In the large area,20 cases were treated with single perforator flap,25 cases with double perforator flap,15 cases with multiple perforation,45 cases with lobulated perforator flap and 15 cases with multi-leaf perforator flap.In the extra large area,the transverse branch perforator flap combined with the relay perforator flap was used to repair the donor area in5 cases,the upper width and the lower width,the relay perforator flap repaired the donor area in 26 cases,and the fascial flap composite perforator flap in 30 cases.There were 5 cases of muscle-fitting perforator flap and 1 case of perforating and perforating flap.Results: Nine improved designs each have their own suitable repair wounds.The advantages and disadvantages are different.After the improved design method,the scars in the donor area are hidden.The patient has no scar traction and no lower limb movement disorders.There were 8 cases of vascular crisis after operation,4 survived after the second stage vascular exploration,and 4 cases failed.Of the 286 clinical cases,all survived 274flaps;some survived 8 flaps,of which 3 were necrotic 1 in the lobulated flap,5 were partially necrotic,and 4 were necrotic.Partial necrosis was debridement and second stage skin graft repair.All necrotic patients were repaired with pedicle flaps.Conclusion: The clinical application of improved ALTP design method is worthy of promotion.It can quickly find out the perforation,more efficient use of donor tissue,and more concealed scars.Together with the precise cutting and anatomical reduction and suture in the later stage,the scar in the donor area will be minimized and the care will be provided.The purpose of the district.