Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap

Abstract

Objective: To evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.Methods: Clinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm  10 cm to 35 cm  20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep-tissue injury of the soft-tissue defects. The skin flap and muscle flap were fanned out on the wound, and single-or two-staged split-thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post-operationally. Complications at both recipient site and donor site were carefully recorded. Results:The mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post-traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6-8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12-36 months post-operational follow-up. Conclusion:The chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space.

Ortho‐oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft‐tissue defects after oncologic resections

“…One‐hundred‐fourteen full‐text articles were assessed for eligibility. Seventy of these were excluded and the remaining forty‐four have been divided based on type of technique reported: local flaps (Liu et al, 2014; Masquelet et al, 1992; Nguyen et al, 2023; Ring et al, 2016; Woo et al, 2022; Zelken & Lin, 2016), free flaps (Akdag et al, 2018; Battiston et al, 2015; Calotta et al, 2018; Cherubino et al, 2020; Colterjohn et al, 1997; He et al, 2022; Kim et al, 2021; Kozusko et al, 2019; Medina 3rd et al, 2014; Musharafieh et al, 2001; Namdar et al, 2010; Nosrati et al, 2012; Periasamy et al, 2023; Sailon et al, 2009; Sayyed et al, 2022; Ulusal et al, 2005; Yu et al, 2021), perforator flaps (D'Arpa et al, 2014; Ellabban et al, 2020; Khan et al, 2020; Kwon et al, 2021; Lee et al, 2017; Li et al, 2021; Lin et al, 2021; Pignatti et al, 2011; Ring et al, 2016; Toia et al, 2017), skin grafts (Asif et al, 2018; Kang et al, 2019; Leclère & Casoli, 2016; Schneider et al, 2009; Shimizu & Kishi, 2012) and free bone (fibula) or osteocutaneous transfer (de Boer et al, 1990; El‐Gammal et al, 2002; Han et al, 1992; Toma et al, 2007).…”

“…Recipient vessels of different types have been used, with the posterior tibial vessels being the most frequently employed. Flap thickness is controlled using primary defatting procedures, resulting in TDAP and lateral circumflex femoral perforator flaps being approximately 5-8 mm in thickness and the SCIP flap being approximately 3-5 mm in thickness (Li et al, 2021). The TDAP flap is preferred for plantar reconstruction due to its thick skin tissue and relatively thin fat layer, which provides durability and resistance to sliding.…”

Individualized design program of multiple flaps for adapting different zones to repair large irregular wounds in children

“…Segmentation design of wounds as “like with like” principle is vital to the design of free flaps. Among the abovementioned flaps, ALTP was performed to be one of the best options due to reliability and versatility [ 31 ] and multiple advantages including [ [32] , [33] , [34] , [35] ] (1) flow-through vessel for chaining other flaps or recovering continuity of the superficial blood vessels damage; (2) multiple levels of muscle flaps for the three-dimensional functional repair; (3) sensation transference for wear-resistant and skin ulcer avoidance; (4) enough donor site for covering the wide and huge defect area; (5) micro-dissected thin technique for improved bulky flap shape, if necessary. Additionally, a novel option of double skin paddle ALTP flaps was presented by our team [ 14 ], showing the useful reference of three variants for microvascular reconstruction of complex soft tissue defects.…”

Apoptotic Bodies Derived from Fibroblast‐Like Cells in Subcutaneous Connective Tissue Inhibit Ferroptosis in Ischaemic Flaps via the miR‐339‐5p/KEAP1/Nrf2 Axis

“…Flap transplantation is the best treatment method to repair large wounds. [ 36 ] However, none of the available solutions for preventing ischaemic necrosis at the distal end of the flap are ideal. Oxidative stress damage, inflammation, and cell death due to flap ischaemia eventually led to necrosis of the distal end of the flap if not managed properly.…”