Application of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of foot

Abstract

Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot. Methods From March 2013 to December 2015, eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study. They were seven males and one female, with age range of 18-51 years (mean, 34.5 years). The foot skin defect area ranged from 18 cm×12 cm to 13 cm×10 cm. All patients underwent computed tomography angiography (CTA) in lower extremities preoperatively. The CTA data were entered into Mimics 15.0 software in DICOM format. Based on perforating condition of descending branch of lateral femoral circumflex artery and the size of foot defect, one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap. The flap size ranged from 24 cm×9 cm to 19 cm×7 cm. All reconstructive surgeries were performed secondarily. Patients were all at II stage recovery. The survival of flaps and healing status of flap donor sites were observed in one month after surgery. The number of debulking flaps was recorded. The appearance of flaps, shoe wearing, gait and related complications were recorded. Results The follow-up was 10-21 months (mean, 15.5 months). All flaps survived uneventfully, and all donor sites were sutured directly. Three patients had twice debulking procedures, three patients had one debulking procedure, and two patients had no debulking. At the last visit in follow-up, the color and texture of flaps were good. All patients were able to wear shoes normally, two patients remained mild abnormal gait, and one patient presented superficial ulcer at the medial of the forefoot. Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications. Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh flap for reconstruction of degloved injury of foot, which makes precise preoperative planning and intraoperative accurate cutting. Key words: Foot injuries; Soft tissue injuries; Surgical flaps; Computer-aided design