Flow-through anterolateral thigh flap transfer combined with bone transport technique for repairing the segamental mutilating injury in lower extremity

Abstract

Objective To explore the clinical application and effect of Flow-through anterolateral thigh flap transfer combined with bone transport technique for repairing the segamental mutilating injury in lower extremity. Methods From June, 2010 to June, 2016, Flow-through anterolateral thigh flap transfer combined with Ilizarov technique were applied to repair the segamental mutilating injury in lower extremity in 10 cases. Of the 10 cases, there were 8 males and 2 females (their ages ranged from 26 to 55, 36 on average). Four caused by road accident, 4 caused by crush injury, 2 cases caused by squeeze injury. First stage, Flow-through anterolateral thigh flap transfer were applied to revascularize the lower limb and repair the soft tissue defect in emergency. Second stage, bone transfort with external fixator were applied to repair bone defect in second stage. The area of the flap ranged from 12.0 cm×15.5 cm to 20.0 cm×25.0 cm. The repair of bone defect ranged from 4.0 cm to 10.0 cm. Time interval between two stages ranged from 2 to 4 months, 3 months on average. Followed-up method was regular outpatient-care after discharge. The main contents include: the presence of red swollen with pus, the condition of infection in the pin, if the fixed pin was loosening, and adjust the speed of bone transport according to the mineralization of new bone. Results All cases were successfully repaired in 10 cases. Ten cases were followed-up with a mean followed-up time of 42 months. All flaps survived, in with 6 cases were healed in first stage, 4 case were healed in second stage (healing time ranged from 14 to 30 days), and bone transfort time ranged from 6 to 16 months. The docking site union occurred in 6 cases and were healed by use of bone debridement, bone graft and compression. Deformity in foot and ankle occurred during the bone transport in 2 cases and were cured by draft therapy with adding ring fixator. The functions of donor sites were not found malfunctional. Conclusion Flow-through anterolateral thigh flap transfer combined with bone transport have high success rate of limb salvage, good quality of osteogenesis, and satisfactory function recovery. It is an optimal method to repair the segamental mutilating injury of the lower extremity. Key words: Anterolateral thigh flap; Flow-through flap; Bone transport technique; Segamental mutilating injury; Lower extremity