Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ , LI Zan ¹ , ZHOU Xiao ¹ ,  XIE Songlin ²

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Hand Surgical Centre, Nanhua Hospital, Nanhua University, Hengyang Hunan, 421001, P.R.China;

Corresponding author：

XIE Songlin, Email: xiesonglinpro@163.com

Keywords：

Anterolateral thigh perforator flap; thinned flap; wrap-around flap; donor site; wound repair

DOI：

10.7507/1002-1892.201703122

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Objective To explore the feasibility of harvesting free thinned innervated anterolateral thigh (ALT) perforator flap for repairing the donor defect after wrap-around flap transfer. Methods Between May 2011 and December 2013, free thinned innervated ALT perforator flap was used to repair the donor defects after wrap-around flap transfer in 9 patients. There were 8 males and 1 female, with a mean age of 31.2 years (range, 19-42 years). The interval time between injury and admission was 3-12 hours (mean, 6.5 hours). Injury causes included machine crush injury (4 cases), traffic accident injury (3 cases), and twisting injury (2 cases). The wrap-around flaps were transferred to reconstruct thumb defects. And the size of donor site defect ranged from 3 cm×2 cm to 8 cm×5 cm. A branch of the lateral femoral cutaneous nerve was carried to make innervated ALT perforator flap for donor site repair. The size of innervated ALT perforator flap ranged from 3.0 cm×2.0 cm to 8.5 cm×5.0 cm. The thickness of innervated ALT perforator flap before defatting ranged from 2.0 to 4.5 cm (mean, 3.2 cm); the thickness after defatting ranged from 0.4 to 0.6 cm (mean, 0.5 cm). The defect at the anterolateral thigh was primarily closed in all cases. Results All reconstructed thumbs and ALT perforator flaps survived. All patients were followed up 6-30 months (mean, 15.8 months). The ALT perforator flaps had good appearance and color, with no further flap revision or defatting procedures. The static two-point discrimination was 8-15 mm (mean, 10.5 mm). All patients could walk and run normally without postoperative skin erosions or ulcerations. Conclusion The free thinned innervated ALT perforator flap is pliable and thin. It is suitable for repairing the donor site defects after wrap-around flap transfer for thumb reconstruction.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, XIE Songlin. Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 987-991. doi: 10.7507/1002-1892.201703122 Copy

1.	Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg (Am), 1980, 5(6): 575-583.
2.	Pan YW, Zhang L, Tian W, et al. Donor foot morbidity following modified wraparound flap for thumb reconstruction: a follow-up of 69 cases. J Hand Surg (Am), 2011, 36(3): 493-501.
3.	Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg, 2005, 21(4): 225-229.
4.	Hashimoto F, Nomura S, Yamauchi S, et al. Free peroneal flap coverage of the great toe defect resulting from a wrap-around flap transfer. Microsurgery, 1986, 7(4): 199-202.
5.	Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
6.	唐举玉, 李康华, 任家伍, 等. 股外侧皮神经的形态特点与临床意义. 中南大学学报(医学版), 2012, 37(12): 1255-1259.
7.	Kimura N, Satoh K, Hasumi T, et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg, 2001, 108(5): 1197-1210.
8.	Rajacic N, Gang RK, Krishnan J, et al. Thin anterolateral thigh free flap. Ann Plast Surg, 2002, 48(3): 252-257.
9.	Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg, 1996, 97(5): 985-992.
10.	Koshima I, Moriguchi T, Fukuda H, et al. Free, thinned, paraumbilical perforator-based flaps. J Reconstr Microsurg, 1991, 7(4): 313-316.
11.	Kim JT, Koo BS, Kim SK. The thin latissimus dorsi perforator-based free flap for resurfacing. Plast Reconstr Surg, 2001, 107(2): 374-382.
12.	Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg, 2003, 112(7): 1875-1885.
13.	Barca F, Santi A, Tartoni PL, et al. Gait analysis of the donor foot in microsurgical reconstruction of the thumb. Foot Ankle Int, 1995, 16(4): 201-206.
14.	Lipton HA, May JW Jr, Simon SR. Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer. J Hand Surg Am, 1987, 12(1): 66-69.
15.	Wong CH, Wei FC. Anterolateral thigh flap. Head Neck, 2010, 32(4): 529-540.
16.	Koshima I, Moriguchi T, Soeda S, et al. Free thin paraumbilical perforator-based flaps. Ann Plast Surg, 1992, 29(1): 12-17.
17.	Thomas CV. Thin flaps. Plast Reconstr Surg, 1980, 65(6): 747-752.
18.	Nojima K, Brown SA, Acikel C, et al. Defining vascular supply and territory of thinned perforator flaps: Part II. Superior gluteal artery perforator flap. Plast Reconstr Surg, 2006, 118(6): 1338-1348.
19.	Kimura N, Saitoh M. Free microdissected thin groin flap design with an extended vascular pedicle. Plast Reconstr Surg, 2006, 117(3): 986-992.
20.	Yang WG, Chiang YC, Wei FC, et al. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
21.	Inoue G, Maeda N, Suzuki K. Closure of big toe defects after wrap-around flap transfer using the arterialized venous flap. J Reconstr Microsurg, 1991, 7(1): 1-8.
22.	St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg Am, 1997, 22(5): 913-917.

1. Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg (Am), 1980, 5(6): 575-583.
2. Pan YW, Zhang L, Tian W, et al. Donor foot morbidity following modified wraparound flap for thumb reconstruction: a follow-up of 69 cases. J Hand Surg (Am), 2011, 36(3): 493-501.
3. Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg, 2005, 21(4): 225-229.
4. Hashimoto F, Nomura S, Yamauchi S, et al. Free peroneal flap coverage of the great toe defect resulting from a wrap-around flap transfer. Microsurgery, 1986, 7(4): 199-202.
5. Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
6. 唐举玉, 李康华, 任家伍, 等. 股外侧皮神经的形态特点与临床意义. 中南大学学报(医学版), 2012, 37(12): 1255-1259.
7. Kimura N, Satoh K, Hasumi T, et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg, 2001, 108(5): 1197-1210.
8. Rajacic N, Gang RK, Krishnan J, et al. Thin anterolateral thigh free flap. Ann Plast Surg, 2002, 48(3): 252-257.
9. Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg, 1996, 97(5): 985-992.
10. Koshima I, Moriguchi T, Fukuda H, et al. Free, thinned, paraumbilical perforator-based flaps. J Reconstr Microsurg, 1991, 7(4): 313-316.
11. Kim JT, Koo BS, Kim SK. The thin latissimus dorsi perforator-based free flap for resurfacing. Plast Reconstr Surg, 2001, 107(2): 374-382.
12. Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg, 2003, 112(7): 1875-1885.
13. Barca F, Santi A, Tartoni PL, et al. Gait analysis of the donor foot in microsurgical reconstruction of the thumb. Foot Ankle Int, 1995, 16(4): 201-206.
14. Lipton HA, May JW Jr, Simon SR. Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer. J Hand Surg Am, 1987, 12(1): 66-69.
15. Wong CH, Wei FC. Anterolateral thigh flap. Head Neck, 2010, 32(4): 529-540.
16. Koshima I, Moriguchi T, Soeda S, et al. Free thin paraumbilical perforator-based flaps. Ann Plast Surg, 1992, 29(1): 12-17.
17. Thomas CV. Thin flaps. Plast Reconstr Surg, 1980, 65(6): 747-752.
18. Nojima K, Brown SA, Acikel C, et al. Defining vascular supply and territory of thinned perforator flaps: Part II. Superior gluteal artery perforator flap. Plast Reconstr Surg, 2006, 118(6): 1338-1348.
19. Kimura N, Saitoh M. Free microdissected thin groin flap design with an extended vascular pedicle. Plast Reconstr Surg, 2006, 117(3): 986-992.
20. Yang WG, Chiang YC, Wei FC, et al. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
21. Inoue G, Maeda N, Suzuki K. Closure of big toe defects after wrap-around flap transfer using the arterialized venous flap. J Reconstr Microsurg, 1991, 7(1): 1-8.
22. St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg Am, 1997, 22(5): 913-917.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap

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