Application of perforators positioning technique in preventing anterolateral thigh flap donor site complications

Abstract

Objective By preoperative perforator positioning of anterolateral thigh flap and intraoperative surgical method improved to prevent and reduce the incidence of anterolateral thigh flap donor site complications. Methods From October, 2013 to October, 2015, total of 134 cases underwent the surgery of more than 6.0 cm width of anterolateral thigh flap repairing limb wounds. Preoperative perforator positioning of the anterolateral thigh flap through the method of CT angiography (CTA) combined color Doppler ultrasound (CDS) . After ensure the location and caliber of perforators, when cut flaps made some improvements as follows: ① Retain the integrity of the donor site fascia lata. Harvest super-thin flaps so that the flap donor sites whose width were in 8.0 cm or less can be sutured directly. ② For the cases that the width of flaps were over 8cm, single block flap with its longitudinal direction is divided into two leaves according to the wounds..After harvesting the flaps, .donor sites were primary closed. ③ Based on preoperative traveling positioning on descending branch of lateral femoral circumflex artery and perforating branches, reduced the trauma to muscle and protected the femoral nerve branches of vastus lateralis muscle. Results Surgery confirmed perforator coincidence rate of 93.22%. 97 cases of unifoliate flap account for 72.39% of the total cases. Among total unifoliate flap, there were super-thin flap 69 cases and their donor site was closed directly with 1 case of short-term complications; the rest 28 cases of unifoliated flap whose width were more than 8.0 cm were grafted with the full-thickness skin graft coming from the both ends of donor site, all skin grafts survived and the wound were primary healing. 37cases of lobulated flap account for 27.61% of the total cases, donor site were closed directly. All 134 cases survived and the survival rate was 100%. At postoperative 3-24 months, conducted follow-up about the flap donor site scar, vastus lateralis muscle function and lateral femoral sensation and so on. Direct closed wound were linear scar, long-term complications occurred in 1 case, donor sites were with no local discomfort and pain, vastus lateralis muscle function was good. According the number of short-term complications and long-term complications, the donor site complication rate was 1.49%. Conclusion Perforator positioning technology has played a guiding role to the preoperative design of anterolateral thigh flap. By modified operation of the harvesting flap including reserving the fascia lata of donor site and reducing the flap width that try to make the donor site primary closed or the least amount of skin graft to significantly reduced the incidence of donor site complications. Key words: Anterolateral thigh flap; Complications; Perforators; CTA; CDS