APPLICATION OF DIGITAL TECHNOLOGY IN ANTEROLATERAL THIGH FLAP FOR REPAIRING WOUNDS OF HAND AND FOOT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DUANJiazhang ¹ , HEXiaoqing ² ,  XUYongqing ² , FANXinyu ² , LUOHaotian ² , WANGTeng ² , DONGKaixuan ² , YUKaifu ¹

1. Brigade of Postgraduate Management, Third Military Medical University, Chongqing, 400038, P. R. China;
2. Department of Orthopedics, Kunming General Hospital of Chengdu Military Region;

Corresponding author：

XUYongqing, Email: xuyongqingkm@163.net

Keywords：

Anterolateral thigh flap; Digital technology; CT angiography; Hand and foot wounds

DOI：

10.7507/1002-1892.20150175

Video：

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Objective To investigate the effectiveness of digital technology in repairing wounds of the hand and foot with anterolateral thigh flap. Methods Between September 2013 and September 2014, 16 cases of wounds of the hand and foot were treated with the anterolateral thigh flap. There were 10 males and 6 females, with an average age of 31 years (range, 20-52 years). The causes included traffic accident injury in 8 cases, crushing injury by machine in 6 cases, burning injury in 1 case, and animal biting injury in 1 case. The locations of soft tissue defect were the dorsum of the foot in 5 cases, the ankle in 4 cases, the planta pedis in 1 case, and the hand and forearm in 6 cases. The time was 2 hours to 45 days from injury to hospitalization (mean, 14.3 days). All defects were associated with exposure of bone and tendon. The size of wound was from 9.0 cm×4.0 cm to 29.0 cm×8.5 cm. CT angiography (CTA) was performed before operation, and the appropriate perforator as well as the donor site was selected. Then the Mimics15.0 software was used to reconstruct the data of CTA so as to locate the main perforators, design the three-dimensional models of the anterolateral thigh flap, and simulate operation. The flap was obtained according to preoperative plan during operation. The size of flaps varied from 11 cm×5 cm to 31 cm×10 cm. The donor sites were sutured directly in 14 cases and were repaired by free skin graft in 2 cases. Results The lateral femoral circumflex artery identified by Mimics15.0 software before operation, as well as the starting position of its descending branch, the blood vessel diameter at start site, vascular distribution, the maximum cutting length of the vascular pedicle were consistent with the actual observation during operation. All flaps were harvested and were used to repair defect smoothly. Vascular crisis occurred in 1 flap after operation, and the other flaps survived successfully. The wounds and the incisions obtained healing by first intention, and grafted skin survived completely. All cases were followed up 6-17 months (mean, 9 months). Fifteen flaps had good shape;but a second-stage operation was performed to make the flap thinner in 1 case. At last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case according to total active motion (TAM) in 6 cases of hand and forearm injury;the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) in 10 cases of foot injury. The total excellent and good rate was 81.25%. Conclusion The preoperative individualization design of the flap can be realized through CTA digital technology and Mimics15.0 software;it can reduce the operation risk.

Citation： DUANJiazhang, HEXiaoqing, XUYongqing, FANXinyu, LUOHaotian, WANGTeng, DONGKaixuan, YUKaifu. APPLICATION OF DIGITAL TECHNOLOGY IN ANTEROLATERAL THIGH FLAP FOR REPAIRING WOUNDS OF HAND AND FOOT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 807-811. doi: 10.7507/1002-1892.20150175 Copy

1.	刘君,刘兴邦,陶圣祥,等.游离股前外侧皮瓣在手掌背侧毁损伤修复中的应用.中华显微外科杂志,2014,37(1):91-92.
2.	Liu L,Cao X,Zou L,et al.Extended anterolateral thigh flaps for reconstruction of extensive defects of the foot and ankle.PLoS One,2013,8(12):e83696.
3.	Satish C,Baliarsing A.Variations in perforators of anterolateral thigh flap.Eur J Plast Surg,2012,35(1):77-79.
4.	Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications.Plast Reconstr Surg,2015,135(4):1097-1107.
5.	张元智,陆声,温树正,等.数字化技术在隐动脉皮瓣血供的可视化及其临床初步应用.中华创伤骨科杂志,2013,15(1):32-35.
6.	Tang M,Yin Z,Morris SF.A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers.Plast Reconstr Surg,2008,122(2):429-437.
7.	Wong CH,Wei FC,Fu B,et al.Alternative vascular pedicle of the anterolateral thigh flap:the oblique branch of the lateral circumflex femoral artery.Plast Reconstr Surg,2009,123(2):571-577.
8.	Miyamoto S,Fujiki M,Nakatani F,et al.Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery.Microsurgery,2015.[Epub ahead of print].
9.	徐永清,朱跃良,范新宇,等.万古霉素硫酸钙或万古霉素骨水泥治疗胫骨开放性骨折术后并发骨髓炎.中华创伤骨科杂志,2014,16(11):925-929.
10.	潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3):130-135.
11.	Lin SJ,Rabie A,Yu P.Designing the anterolateral thigh flap without preoperative Doppler or imaging.J Reconstr Microsurg,2010,26(1):67-72.
12.	Zhang Q,Qiao Q,Gould LJ,et al.Study of the neural and vascular anatomy of the anterolateral thigh flap.J Plast Reconstr Aesthet Surg,2010,63(2):365-371.
13.	Choi SW,Park JY,Hur MS,et al.An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap.J Craniofac Surg,2007,18(4):866-871.
14.	Zhang Q,Qiao Q,Yang X,et al.Clinical application of the anterolateral thigh flap for soft tissue reconstruction.J Reconstr Microsurg,2010,26(2):87-94.
15.	Garvey PB,Selber JC,Madewell JE,et al.A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps.Plast Reconstr Surg,2011,127(4):1505-1514.
16.	Chen SY,Lin WC,Deng SC,et al.Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction.Eur J Surg Oncol,2010,36(10):1004-1011.
17.	Zhou H,Tan Q,Liu S,et al.Improved location technology of perforators of anterolateral thigh flap for Chinese patients.J Reconstr Microsurg,2013,29(5):317-324.
18.	Cheng HT,Lin FY,Chang SC.Evaluation of diagnostic accuracy using preoperative handheld Doppler in identifying the cutaneous perforators in the anterolateral thigh flap:a systematic review.Plast Reconstr Surg,2012,129(4):769e-770e.
19.	肖海涛,时莹瑜,王怀胜,等.高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用.中国修复重建外科杂志,2013,27(2):178-181.
20.	Eder M,Raith S,Jalali J,et al.Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging.Int J Comput Assist Radiol Surg,2014,9(4):541-549.
21.	卿黎明,胡懿郃,唐举玉,等.基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究.中国修复重建外科杂志,2014,28(6):697-700.

1. 刘君,刘兴邦,陶圣祥,等.游离股前外侧皮瓣在手掌背侧毁损伤修复中的应用.中华显微外科杂志,2014,37(1):91-92.
2. Liu L,Cao X,Zou L,et al.Extended anterolateral thigh flaps for reconstruction of extensive defects of the foot and ankle.PLoS One,2013,8(12):e83696.
3. Satish C,Baliarsing A.Variations in perforators of anterolateral thigh flap.Eur J Plast Surg,2012,35(1):77-79.
4. Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications.Plast Reconstr Surg,2015,135(4):1097-1107.
5. 张元智,陆声,温树正,等.数字化技术在隐动脉皮瓣血供的可视化及其临床初步应用.中华创伤骨科杂志,2013,15(1):32-35.
6. Tang M,Yin Z,Morris SF.A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers.Plast Reconstr Surg,2008,122(2):429-437.
7. Wong CH,Wei FC,Fu B,et al.Alternative vascular pedicle of the anterolateral thigh flap:the oblique branch of the lateral circumflex femoral artery.Plast Reconstr Surg,2009,123(2):571-577.
8. Miyamoto S,Fujiki M,Nakatani F,et al.Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery.Microsurgery,2015.[Epub ahead of print].
9. 徐永清,朱跃良,范新宇,等.万古霉素硫酸钙或万古霉素骨水泥治疗胫骨开放性骨折术后并发骨髓炎.中华创伤骨科杂志,2014,16(11):925-929.
10. 潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3):130-135.
11. Lin SJ,Rabie A,Yu P.Designing the anterolateral thigh flap without preoperative Doppler or imaging.J Reconstr Microsurg,2010,26(1):67-72.
12. Zhang Q,Qiao Q,Gould LJ,et al.Study of the neural and vascular anatomy of the anterolateral thigh flap.J Plast Reconstr Aesthet Surg,2010,63(2):365-371.
13. Choi SW,Park JY,Hur MS,et al.An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap.J Craniofac Surg,2007,18(4):866-871.
14. Zhang Q,Qiao Q,Yang X,et al.Clinical application of the anterolateral thigh flap for soft tissue reconstruction.J Reconstr Microsurg,2010,26(2):87-94.
15. Garvey PB,Selber JC,Madewell JE,et al.A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps.Plast Reconstr Surg,2011,127(4):1505-1514.
16. Chen SY,Lin WC,Deng SC,et al.Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction.Eur J Surg Oncol,2010,36(10):1004-1011.
17. Zhou H,Tan Q,Liu S,et al.Improved location technology of perforators of anterolateral thigh flap for Chinese patients.J Reconstr Microsurg,2013,29(5):317-324.
18. Cheng HT,Lin FY,Chang SC.Evaluation of diagnostic accuracy using preoperative handheld Doppler in identifying the cutaneous perforators in the anterolateral thigh flap:a systematic review.Plast Reconstr Surg,2012,129(4):769e-770e.
19. 肖海涛,时莹瑜,王怀胜,等.高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用.中国修复重建外科杂志,2013,27(2):178-181.
20. Eder M,Raith S,Jalali J,et al.Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging.Int J Comput Assist Radiol Surg,2014,9(4):541-549.
21. 卿黎明,胡懿郃,唐举玉,等.基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究.中国修复重建外科杂志,2014,28(6):697-700.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF DIGITAL TECHNOLOGY IN ANTEROLATERAL THIGH FLAP FOR REPAIRING WOUNDS OF HAND AND FOOT

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