Effects of anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata in repairing destructive wounds and rebuilding function of hands or feet
Objective To investigate the effects of anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata in repairing destructive wounds and rebuilding function of hands or feet.Methods This study was a retrospective observational study.From January 2022 to March 2023,16 patients with destructive wounds in hands or feet combined with extensor tendon defects who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital,including 12 males and 4 females,aged 3 to 63 years.The wounds were located on the hands in 12 cases and on the feet in 4 cases.The number of defective extensor tendon ranged one to five,and the length of the defect ranged from 2.5 to 6.0 cm.The wound area was 11.0 cm×5.5 cm to 29.0 cm×9.5 cm after debridement.The wounds were repaired with anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata,and the flap area was 12.0 cm×6.5 cm to 30.0 cm× 11.0 cm.The fascia lata was used to repair the extensor tendon defects,and the harvesting area of fascia lata was 8.0 cm×3.0 cm to 12.0 cm×8.0 cm.The wounds in flap donor areas in 15 patients were sutured directly,and the wound in flap donor area in 1 patient was covered with medium-thickness skin graft from lower abdomen.The survival of flaps and the wound healing in donor and recipient areas of flaps were observed within 1 week after operation.The number of patients who underwent thinning and plastic surgery or tenolysis was recorded during postoperative follow-up.At the last follow-up,the recovery of sensory function of the transplanted flaps on hands or feet was evaluated,the efficacy of flap repair was evaluated according to the comprehensive flap evaluation scale,and the function of hands was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.The following two indexes were compared,including the measured total active motion of the injured fingers and the foot function assessed using Maryland foot function scale between before surgery and at the last follow-up.Results Arterial crisis occurred in flaps in 2 patients after operation,and the flaps survived after timely exploration;the flaps in the rest patients survived well after operation.No obvious scar hyperplasia or ulceration was observed in donor and recipient areas of flaps after operation.All patients were followed up for 8 to 16 months,of which 6 patients underwent flap thinning and plastic surgery 6 to 7 months after operation,and 4 patients underwent tenolysis 3 to 6 months after operation.At the last follow-up,the recovery of sensory function of flaps reached S1 level in 5 cases and S2 level in 11 cases,and the two-point discrimination only had 1 point.The efficacy of flap repair scored 80 to 91,which were evaluated as excellent in 5 cases,good in 9 cases,and acceptable in 2 cases.The hand function was evaluated as excellent in 5 cases,good in 5 cases,and acceptable in 2 cases.The active extension function of the injured finger/toe was reconstructed successfully,and the total active motion of the injured finger was(225±22)° at the last follow-up,which was significantly higher than(117±20)° before surgery(t=119.59,P＜0.05);the foot function score was 86±7 at the last follow-up,which was significantly higher than 29±7 before surgery(t=222.68,P＜0.05),and the foot function was evaluated as excellent in 2 cases,good in 1 case,and acceptable in 1 case.Conclusions The operation of harvesting the anterolateral femoral perforator flap pedicled with oblique branch of lateral circumflex femoral artery is relatively simple.After the wounds on hands or feet being repaired with the flaps,the appearance and function are good,with no obvious scar hyperplasia in donor and recipient areas of flaps.The fascia lata carried by the flap can repair the extensor tendon defect at the same time and improve the movement of the fiinger/toe.
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