目的 探讨分叶股前外侧穿支皮瓣（ALTPF）修复踝关节周围大面积软组织缺损的可行性及临床效果。 方法 2019年6月至2022年10月，南昌大学第一附属医院骨科采用分叶ALTPF修复踝关节周围大面积软组织缺损11例，其中交通伤所致8例，重物砸伤3例。所有创面均宽大（15。0 cm×14。0 cm~30。0 cm×20。0 cm）且合并不同程度的感染。术中切取大小为16。0 cm×14。5 cm~23。0 cm×18。5 cm的分叶ALTPF修复缺损，深部死腔用抗生素骨水泥填充，供区直接缝合或植皮修复。分别于术后1、3、6个月及之后每半年通过门诊、电话等方式进行随访，记录皮瓣的外形、颜色及供区愈合情况，并根据美国足踝关节协会（AOFAS）踝-后足评分量表评价足踝部运动功能恢复情况。 结果 11例皮瓣全部成活，受区术后未出现血肿和继发感染，供区一期愈合；1例分叶皮瓣远端发生静脉回流障碍，予以远端静脉放血1周后皮瓣完全成活。术后随访6~24（15。27±5。21）个月，所有皮瓣血运良好，外形满意，无明显臃肿，色泽、质地与受区相近，皮瓣无溃疡形成；皮瓣供区仅留线形瘢痕或少量片状植皮伤口，位置隐蔽；AOFAS踝-后足评分为（88。36±10。21）分，结果优6例，良4例，可1例。 结论 分叶ALTPF可将皮瓣长度转变成皮瓣宽度，是踝关节周围大面积软组织缺损修复的一种良好方法。 Objective To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle。 Methods From June 2019 to October 2022， large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University。 The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients。 All wounds were large defects (15。0 cm×14。0 cm-30。0 cm×20。0 cm) and combined with various degrees of infection。 Intraoperatively， polyfoliate ALTPFs sized 16。0 cm×14。5 cm-23。0 cm×18。5 cm were used in reconstruction of the defects。 Deep dead spaces were filled with antibiotic bone cement， and direct suture was performed to close the donor sites or by skin grafting repair。 Postoperative follow-ups were scheduled at 1， 3 and 6 months， and 6 monthly thereafter at outpatient clinics and via telephone interviews。 The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS)。 Results All flaps survived。 No haematoma or secondary infection occurred at the recipient site after surgery。 All donor sites healed primarily。 One patient had venous occlusion at the distal end of the polyfoliate ALTPF。 The flap survived completely at 1 week after distal venous bloodletting。 Postoperative follow-ups lasted 6-24 (15。27±5。21) months。 All flaps had good blood supply with satisfactory appearance， similar colour and texture to the recipient sites， and without obvious bloat nor ulceration。 Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations。 The mean AOFAS ankle-hindfoot score was (88。36±10。21) point。 There were 6 cases of excellent， 4 cases of good， and 1 case of fair。 Conclusion A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width。
Polyfoliate anterolateral thigh perforator flap in reconstruction of large soft tissue defects around ankle: a study on 11 cases
Objective To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle. Methods From June 2019 to October 2022, large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University. The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients. All wounds were large defects (15.0 cm×14.0 cm-30.0 cm×20.0 cm) and combined with various degrees of infection. Intraoperatively, polyfoliate ALTPFs sized 16.0 cm×14.5 cm-23.0 cm×18.5 cm were used in reconstruction of the defects. Deep dead spaces were filled with antibiotic bone cement, and direct suture was performed to close the donor sites or by skin grafting repair. Postoperative follow-ups were scheduled at 1, 3 and 6 months, and 6 monthly thereafter at outpatient clinics and via telephone interviews. The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS). Results All flaps survived. No haematoma or secondary infection occurred at the recipient site after surgery. All donor sites healed primarily. One patient had venous occlusion at the distal end of the polyfoliate ALTPF. The flap survived completely at 1 week after distal venous bloodletting. Postoperative follow-ups lasted 6-24 (15.27±5.21) months. All flaps had good blood supply with satisfactory appearance, similar colour and texture to the recipient sites, and without obvious bloat nor ulceration. Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations. The mean AOFAS ankle-hindfoot score was (88.36±10.21) point. There were 6 cases of excellent, 4 cases of good, and 1 case of fair. Conclusion A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width.
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