Applied anatomic study and clinical application of anterolateral thigh perforator flap

Abstract

Abstract: PURPOSE : To provide anatomic evidence for clinical application of anterolateral thigh flap, this study compared the appearance and function of donor site and recipient site pre- and post-operatively in order to investigate the clinical value in reconstruction of oral and maxillofacial defects. METHODS : Six lower limbs of Chinese adult cadavers were microsurgically dissected and the number of perforators was recorded based on anterolateral thigh perforator flap, the external diameters, pedicle lengths, and locations were measured. Nine clinical cases of anterolateral thigh perforator flap were selected from May 2011 to May 2014, the flap size ranged from 5 cm×6 cm to 6 cm×12 cm. The patients were evaluated during postoperative follow-up including flap survival number, contour and function of recipient and donor site, and their swallowing and speech function after reconstruction of the tongue and/or floor of mouth. RESULTS : Totally 21 anterolateral thigh perforaters(each leg on average 3.5) were found in 6 legs. Nearly all perforaters of the anterolateral thigh were located in a 6 cm diameter circle, the center of the circle was located 1 cm horizontally and 2 cm vertically to the middle line between the anterior superior iliac spine and the patellar lateral edge. The external diameter of vessel pedicle was (2.99±0.48) mm and the pedicle length was (15.83±3.52)cm. Among the 9 anterolateral thigh perforator flaps, 1 flap had partial necrosis, 1 case was lost for follow up. All the cases were followed up for 10-47 months (mean 24 months). Anterolateral thigh flap was favourable in survival rate, donor or recipient site complications, swallowing and speech function. CONCLUSIONS : Anterolateral thigh flap has constant perforator, longer pedicle and suitable diameter. Clinically, anterolateral thigh flap has fewer complications, moderate size and pleasing contour, which satisfy the need for reconstruction of oral and maxillofacial defects.

Key words: Perforator flap, Applied anatomy, Anterolateral thigh perforator flap

CLC Number:

R782.2

XU Lei, GAO Peng-fei, XU Wan-Lin, CHENG Jie, LI Huai-qi, WU Yu-nong, YE Jin-hai.. Applied anatomic study and clinical application of anterolateral thigh perforator flap[J]. China Journal of Oral and Maxillofacial Surgery, 2015, 13(6): 502-507.

References

[1] Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle [J]. Br J Plast Surg, 1989, 42(6): 645-648.
[2] Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap [J]. Ann Plast Surg, 2001, 47(5): 517-522.
[3] 徐达传, 钟世镇, 刘牧之, 等. 股前外侧穿支皮瓣的解剖学 [J]. 临床应用解剖学杂志, 1984, 2(3):158-160.
[4] Lalovi N, Cvijanovi R, Malis M, et al. Surgical anatomy of the initial segment of the lateral circumflex femoral artery [J]. Med Pregl, 2013, 66(7-8): 326-330.
[5] Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review [J]. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
[6] Lee YC, Chen WC, Chou TM , et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications [J]. Plast Reconstr Surg, 2015,135(4): 1097-1107.
[7] 陈奇鸣, 杨福周, 罗景辉, 等. 股前外侧穿支皮瓣穿支血管变异形态及临床应用对策[J]. 中华整形外科杂志,2013,29(1):59-61.
[8] 单振锋, 周晓, 李赞, 等. 应用股前外侧游离组织瓣修复头颈部肿瘤术后缺损临床分析 [J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(21): 1685-1687.
[9] Gong ZJ, Wang K, Tan HY, et al. Application of thinned anterolateral thigh Flap for the reconstruction of head and neck defects [J]. J Oral Maxillofac Surg, 2015, 73(7): 1410-1419.
[10] Cigna E, Minni A, Barbaro M, et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction [J]. Eur Rev Med Pharmacol Sci, 2012, 16(8): 1095-1101.
[11] Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications [J]. Ann Plast Surg, 2014, 72(2): 246-252.
[12] 刘杰, 张彬, 李德志, 等. 应用周边穿支皮瓣作为股前外侧皮瓣皮穿支血管缺失时的替代方案研究 [J].中华耳鼻咽喉头颈外科杂志, 2013, 48(6): 486-489.