Identification and management strategies of the"descending branch trap"in anterior lateral thigh flap surgery
Objective To explore the identification method of"descending branch trap"in the operation of anterolateral thigh flap,and the clinical effect of the"perforator layer-by-layer stripping method"in the treatment of"descending branch trap".Methods Ret-rospective analysis from April 2021 to June 2022,245 patients with skin and soft tissue defects repaired with anterolateral thigh flap were treated at Suzhou Ruihua Orthopedic Hospital.There were 41 cases of"descending branch trap"counted,including 29 male and 12 female aged between 20 and 86 years.The cut area of the flap ranged from 11.0 cm×4.0 cm～40.0 cm×10.0 cm.Before surgery,a color ultra-sound was routinely performed to locate the perforators of the lateral thigh.During surgery,the"perforator layer-by-layer stripping method"with the perforator as the center was used to carefully dissect the musculocutaneous perforator,and the frequency of"descending branch trap",the caliber and position of the perforator,the length of the vascular pedicle,and the cutting time of the flap were recorded,and the survival of the flap after surgery was counted.Results All patients was followed up for 4 to 10 months.The occurrence rate of"descending branch trap"in this group was 16.7%,the caliber of perforators were 0.3～1.0 mm,with an average of 0.58 mm,the length of the vascular pedicle was measured during operation,the length of vascular pedicle was the 5.0～22.0 cm,the average length of the vascular pedicle was 11.5 cm,and the time of skin flap cutting was 13～93 min,with an average of 41.2 min.The flaps were removed successfully in 41 cases.After the operation,1 patient had an arterial crisis and 1 patient had a venous crisis,which survived after timely exploration.The other flaps survived smoothly.The donor area of the thigh healed in the first stage,and the wound healing time from the skin flap to the recipient area was 10～45 days.At the last follow-up,the color and texture of the flap were good and the sensation was partially recovered.All the donor areas were linear scars,with no discomfort such as scar contracture and pain,and no other serious complications.The skin flap comprehen-sive evaluation scale was used to evaluate,the total score was 100 points,and the score was 76～92 points,of which 15 cases were excellent,21 cases were good,5 cases were fair,and the excellent and good rate was 87.8%.Conclusion To identify and treat the"descending branch trap"during the operation of the anterolateral thigh flap,to improve the understanding of the"descending branch trap",and to use the"perforator layer-by-layer stripping method"to identify and dissect the source artery of the musculocutaneous perforator.It can effec-tively deal with the"descending branch trap"and improve the success rate of skin flap extraction.
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