A Long-term Follow-up Study On Donor Site Of The Free Anterolateral Thigh Flap

PurposeThe purpose of this study was to investigate donor site morbidity after a free anterolateral thigh flap transfer,to evaluate the impact that the operation took on the donor site and so as to provide reference for clinical research and discussion on how to reduce the complications of the relevant donor area.MethodsWe retrospectively studied donor-site complications and morbidity in the patients after free anterolateral thigh flaps in China-Japan Union hospital of Jilin University from 01/2015 to 12/2018.The inclusion criteria were the patients older than 18 years old,with follow-up period more than 6 months,and with unilateral flap harvested.The demographics of the patients,primary defects,flap perforator types,and closure of the donor site were recorded.All the follow-up evaluation included appearance,sensation,and motion of the donor-site of the lower extremity.ResultsThe donor sites were available to examine for the follow-up study in 22 patients.There were 19 males and 3 females with an average age of 38 years old(18-66 years old).All the flaps belonged to the musculocutaneous perforator types,and the width were between 5.0cm and 15.0cm.Direct closure of the donor defect was performed in 15 patients,and skin grafting in others.The follow-up time was 6 to 21 months,with an average of 9 months.All the patients left scar hyperplasia around the donor-site incisions,and 20 patients had paresthesia at the anterolateral aspect of the thigh.There were 6 patients who experienced various degrees of limitation of the ankle joints,but all of them resulted from the primary injuries.Range of motion at the knee was limited in 5 patients.Among them,one patient with primary hand trauma had mild limitation in flexion of the knee,but he had no difficulty in daily life.Motion limitations in other 4 patients were owing to primary injuries of the lower extremity.In addition,only 2 patients complained about the weakness of the donor thigh.However,no significant changes in muscle strength were observed in both sides of the thighs during objective examinations.Moreover,these 2 people had no complaint about the walking and gaint.ConclusionsThe healing and scar hyperplasia of the donor site after the free anterolateral thigh flaps are related to the width of the flaps and the closure of the donor site.The wider the flaps,the greater the possibility of skin grafting,and the longer healing time,which can also lead to scar hyperplasia easily.Appropriate closure can be selected according to the width of the flaps.When the width is<7.2cm,direct closure can be selected.When the width<10.4cm,the local tension is large,which can be divided into two procedures.When the flap width was>10.4cm,skin grafting was required.The sensory paresthesia of the donor thigh is not limited around the scar or the skin grafting area,but the skin beyond these areas may also have different degrees of paresthesia.There was not significant changes about muscle strength and motor function.