The application of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation

Abstract

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation. Methods From January, 2013 to October, 2017, 29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair. Fifteen cases treated with multiple end-to-side anastomosis on flap arteries, and 2-3 arteries were anastomosed, with the average of 2.13. Nine cases were treated with venous multiple end-to-side anastomosis, and 2-4 veins were anastomosed, with the average of 3.11. Five cases treated with arterial and venous multiple end-to-side anastomosis, and 4-6 vessels were anastomosed, with the average of 5.20. Distribution of wounds: 10 cases with hands and wrists wounded, 15 cases with forearms and elbow joints wounded, and 4 cases with lower legs and feet wounded. The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm, and the flap area was 6 cm×15 cm-12 cm×29 cm. Postoperative followed-up was performed every 3-6 months to review flap survival. Results All flaps of 29 cases survived. Venous congestion occurred in 2 flaps within 48 h after the operation, among which, 1 was overcomed after released the dressing and sutures, and the other underwent surgical exploration. The venous end-to-side anastomotic stomas were unobstructed, and hematoma was formed. After the hematoma compression was removed, circulation was recovered and the flap survived. With followed-up for 6 months to 2.5 years, both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder. Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable. Key words: Anterolateral thigh perforator flaps; Vascular anastomosis; End-to-side anastomosis; Repair; Microsurgical technique