Clinical effects of anterolateral femoral or anteromedial femoral perforator flaps in repairing skin and soft tissue defects after resection of cutaneous squamous cell carcinoma
Objective To explore the clinical effects of anterolateral femoral or anteromedial femoral perforator flaps in repairing skin and soft tissue defects after resection of cutaneous squamous cell carcinoma(CSCC).Methods This study was a retrospective observational study.From July 2015 to July 2022,21 patients with CSCC were treated in the Department of Burns and Plastic Surgery of Guizhou Provincial People's Hospital,including 15 males and 6 females,aged from 27 to 74 years.The area of skin and soft tissue defects after extended resection of CSCC was 7.5 cm×4.0 cm to 23.0 cm×8.5 cm.The wounds in 18 patients were repaired with anterolateral femoral perforator flaps;variations of perforating branch of the descending branch of lateral circumflex femoral artery were observed in 3 patients during the operation,and the wounds were repaired with anteromedial femoral perforator flaps.The flap areas were 8.0 cm× 5.0 cm to 25.0 cm×10.0 cm.The wounds in the donor areas were sutured directly in 19 patients,and the wounds in the donor areas were repaired with thin and medium-thickness skin grafts in the contralateral thigh in 2 patients.The postoperative survival of flaps and the occurrence of vascular crisis were observed.The length of operation and the hospitalization day were recorded.The recurrence of tumor,the appearances of the donor and recipient areas of flaps,the function of the flap donor area were followed up.At the last follow-up,the satisfaction degree of patients for the curative effects was evaluated.Results The flaps survived in 20 patients,while the vascular crisis occurred in 1 patient within 48 hours after operation,and the flap survived after immediate emergency operation.The length of operation was 4 to 5 hours,and the hospitalization day was 15 to 38 days.The patients were followed up for 1 to 6 years after operation,there was no local tumor recurrence,the color and texture of the flaps were with no obvious differences to those of the surrounding tissue,and the elasticity and appearance were good.The skin grafts in the flap donor areas of 2 patients survived well with local pigmentation.There was only linear scar in the flap donor areas of all patients,and there were no significant effects on sensory and motor functions.At the last follow-up,fifteen patients were satisfied with the curative effect,and 6 patients were generally satisfied with the curative effect.Conclusions For skin and soft tissue defects after CSCC resection,the anterolateral femoral perforator flaps can be used preferentially.In the case of variation of the perforating branch of descending branch of the lateral circumflex femoral artery,the anteromedial femoral perforator flap is selected.The areas of the two flaps are large and can be adjusted according to the amount of defect tissue,thus accurately and effectively repairing skin and soft tissue defects after CSCC resection.The postoperative appearance and function are good.
Wounds and injuriesPerforator flapCarcinomaCutaneous squamous cell carcinomaVascular variationWound repair
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