Application of free skin flap combined with the lateral circumflex femoral artery for the repair of soft tissue defects in the lower leg

Abstract

Objective To discuss the treatment and clinical efficacy of applying free skin flap combined with the reversed descending branch of lateral circumflex femoral artery to repair soft tissue defects in the lower leg after trauma. Methods Clinical data of 24 patients with severe soft tissue defects of calf from October 2008 to February 2015 were analyzed retrospectively. All patients underwent soft tissue coverage surgery using the free flaps combined with the reversed descending branch of lateral circumflex femoral artery. There were 19 males and 5 females aged from 19-56 years (mean, 38.4 years). The causes of injury were traffic accident in 15 cases, ore crushing injury in 8 cases, and high falling injury in 1 case, with 10 patients suffering injury on the left side and 14 cases on the right side. Firstly, the fractures of limb were treated by external fixator following debridement, and after the legs were revascularized, vacuum sealing drainage was applied in emergency surgery. Secondly, the free flaps were transplanted and anastomosed with the descending branch of lateral circumflex femoral artery to cover the wound. Thirdly, bone graft and internal fixation were performed or bone lengthening was operated on patients. Sizes of the tissue defects were 8 cm×12 cm-22 cm×36 cm, and the flap sizes were 12 cm×15 cm-25 cm×40 cm. Among them, 12 patients were grafted with anterolateral thigh flap, 9 with latissimus dorsal myocutaneous flap, and 3 with thoracic umbilical flap. Finally, the postoperative curative efficacy was assessed from five aspects including flap healing, flap appearance, the temperature and sensation of flaps, and the scar. Results Altogether 23 limbs were survived, and the wounds healed by first intention; while the remaining 1 case suffered amputation due to severe infection with multidrug-resistant bacteria. Twenty patients were followed up for 12-66 months (mean, 31 months). Patients obtained nearly unaffected walking and weight-bearing function, with protective feeing in the feet. The flaps survived well, without overstaffed appearance. The score of curative effect score was 7-10. It turned out that the procedures were satisfactory. Conclusions The free flap anastomosed with the descending branch of lateral circumflex femoral artery can effectively repair the soft tissue defects in the lower leg. Key words: Soft tissue injury/therapy; Lower leg; Surgical flaps/blood supply; Free tissue flaps