Anterolateral thigh flap combined with great saphenous vein transplantation in the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical outcomes of anterolateral thigh flap combined with great saphenous vein transplantations for the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism.Methods:A retrospective case series study was carried out to investigate the clinical data of 19 patients with extensive elbow soft tissue defects accompanied by brachial artery embolism admitted to Fuyang People's Hospital of Anhui Medical University from March 2017 to March 2020. There were 15 males and 4 females，aged 14-59 years［（37.6±14.1）years］. The areas of elbow soft tissue defects ranged from 7 cm×3 cm to 12 cm×5 cm. Before operation，angiography test was performed to confirm brachial artery embolism of the affected upper limb. The length of embolization ranged from 5 to 12 cm［（7.3±1.6）cm］. All patients were treated using the anterolateral thigh flap combined with great saphenous vein transplantation. The operation time and intraoperative blood loss were recorded. Angiography test was re-examined one week after operation. The degree of flap swelling，elbow Broberg-Morrey functional score and scar contracture were evaluated at postoperative 3，6，and 12 months. Healing of donor site and postoperative complications were observed.Results:All patients were followed up for 12-24 months［（18.1±3.0）months］. The operation duration was 3.5-6.4 hours［（4.9±0.8）hours］，with intraoperative blood loss of 200-600 ml［（338.7±101.6）ml］. The blood flow of repaired brachial artery was unobstructed in all patients one week after operation，with all flaps survived. The degree of flap swelling was（0.9±0.3）cm at postoperative 12 months，significantly reduced from that at postoperative 3 and 6 months［（1.2±0.3）cm，（1.1±0.3）cm］（ P<0.05）. The elbow Broberg-Morrey functional score was（87.8±4.8）points，significantly higher than those at postoperative 3 and 6 months［（71.4±7.0）points，（80.2±4.8）points］（ P<0.05）. The rating of elbow function score was excellent in 9 patients，good in 8 and fair in 2 at postoperative 12 months，with the excellent and good rate of 90%. The rate of scar contracture was 63%（12/19）at postoperative 12 months，significantly higher than that at postoperative 3［11%（2/19）］（ P<0.05），while not different from that at postoperative 6 months［42%（8/19）］（ P>0.05）. The donor site was healed in all patients，without complications related to blood vessels or flaps. Conclusions:For extensive elbow soft tissue defect accompanied by brachial artery embolism，the anterolateral thigh flap combined with great saphenous vein transplantations can successfully restore the blood supply of the distal site of the affected limb with a high survival rate of the flap and well recovered limb function，and hence is a feasible method for severe elbow trauma. However，due to various factors such as elbow joint immobilization during perioperative period，scar contracture is prone to occur in the area of the flap.