Free anterolateral thigh perforator flap pedicled with the oblique branch of lateral circumflex femoral artery assisted by three-dimensional CT angiography for repairing soft tissue defects of limbs / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical effect of the anterolateral femoral perforator flap（ALTP）pedicled with the oblique branch of lateral circumflex femoral artery（LCFA）assisted by CT angiography（CTA）examination for repairing soft tissue defects of limbs.Methods:A retrospective case series study was made on 51 patients with soft tissue defects of limbs treated in Ningbo No.6 Hospital from March 2015 to March 2020，including 31 males and 20 females at age of 26-63 years［（42.0±8.9）years］. The defects were located at the forearm in 15 patients，at the hand in 13，at the lower leg in 15 and at the ankle in 8. The size of defects ranged from 9 cm×6 cm to 18 cm×10 cm，with the size of flaps from 10 cm×6 cm to 20 cm×12 cm. A total of 33 patients were examined with CTA scanning and Doppler ultrasound（CTA group）and 18 patients with Doppler ultrasound（Doppler group）. All patients underwent debridement and negative pressure closed drainage（VSD）at stage I and were repaired by ALTP pedicled with the oblique branch of LCFA at stage II. The diameter and length of the vessel pedicle was recorded in CTA group before operationand in both groups during operation. The time of flap harvesting in both groups was recorded during operation. The survival of the flap in both groups was observed one week after operation. Zhang Hao's scoring standard was applied to evaluate the outcome at the last follow-up.Results:All patients were followed up for 6-12 months［（9.1±1.5）months］. In CTA group，the diameter of LCFA vessel pedicle measured before operation had no significant difference from that during operation（ P>0.05），while the length of LCFA vessel pedicle before operation［（12.3±2.1）cm］was longer than（10.9±2.2）cm during operation（ P<0.05）. The two group showed no significant differences in the diameter and length of LCFA vessel pedicle during operation（ P>0.05）. The time of flap harvesting in CTA group was（38.5±6.2）minutes，significantly shorter than（51.4±8.4）minutes in Doppler group（ P<0.05）. One week after operation，all flaps survived. Two patients developed flap arterial congestion in CTA group，among whom one survived after surgical revision and one with partially necrosis was healed after dressing change. One patient was found with flap arterial congestion with partial necrosis in Doppler group，who was healed after dressing change. There was no significant difference in postoperative flap arterial congestion between the two groups（ P>0.05）. The patients' satisfaction score in CTA group was（8.5±1.5）points at the last follow-up，higher than（7.4±2.0）points in Doppler group（ P<0.05）. Conclusion:For repairing soft tissue defects of limbs，free ALTP pedicled with the oblique branch of LCFA assisted by three- dimensional CT angiography can accurately get the information of perforator，shorten the flap harvesting time，and obtain satisfactory clinical results as compared to Doppler ultrasound.