ObjectiveTo compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. MethodAfter resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014 (chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010 (series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups (P>0.05) . The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. ResultsVascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group (P<0.05) , while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group (P<0.05) . The patients were followed up 1-5 years (mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh flap group were significantly better than those of the series-wound flaps group (P<0.05) , while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups (P>0.05) . ConclusionsUsing chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.
Objective To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities. Methods Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients’ mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly. Results All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction. Conclusion The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.
Objective To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects. Methods Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T2N1M0, 2 cases were T3N1M0, 1 case was T3N2M0, 2 cases were T4N1M0. After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm．The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm．The donor sites were closed directly in all cases. Results Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients. Conclusion Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions．
ObjectiveTo investigate the effectiveness of lateral circumflex femoral artery chimeric flap transplantation in repair of complex wounds of foot and ankle.MethodsA retrospective study was conducted to analyze the clinical data of 20 patients with complex wounds of foot and ankle treated with lateral circumflex femoral artery chimeric flap between June 2017 and June 2020. There were 14 males and 6 females with an average age of 42.8 years (range, 21-65 years). Among them, 8 cases had dorsalis pedis tendon defect with or without bone exposure, 4 cases had partial or total Achilles tendon defect without bone exposure, and 8 cases had deep cavity and bone exposure. The wound area ranged from 10 cm×6 cm to 21 cm×11 cm. The time from injury to operation ranged from 6 to 22 days, with an average of 9.4 days. The lateral femoral circumflex artery flap was used in 6 cases with fascia lata flap, 6 cases with rectus femoris aponeurosis flap, and 8 cases with lateral femoral muscle flap. The flap area ranged from 12.0 cm×6.5 cm to 35.0 cm×7.5 cm. All flap donor sites were sutured directly. The survival, appearance, texture, sensation of the flap, and complications of the donor site were observed. The foot and ankle function was evaluated by Kofoed score.ResultsAll patients were followed up 8-24 months (mean, 14.2 months). On the 3rd day after operation, 1 case had partial necrosis of 1 flap with fascia lata flap and healed after dressing change; 1 case of chimeric muscle flap developed venous crisis at 12 hours after operation; the chimeric flaps survived successfully in the other 18 patients and the wounds were primary healing. The color and texture of the flaps were good, the flaps recovered protective sensation. Only linear scar remained in the donor site of thigh. There was no sensory disturbance around the incision or walking disturbance. The Kofoed score of the foot and ankle function at last follow-up was 75-96, with an average of 89.8. Among them, 15 cases were excellent, 4 cases were good, and 1 case was qualified. The excellent and good rate was 95.0%.ConclusionThe application of lateral circumflex femoral artery chimeric flap can accurately and stereoscopically repair the complex wounds of foot and ankle and achieve satisfactory effectiveness.
Objective To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect. Methods The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October 2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years (range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect. The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm× 3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly. Results The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels. Perforating vessels mainly appeared in four places, which were (9.75±0.91), (13.21±0.74), (18.15±1.22), and (21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months (mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation, 2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score. ConclusionThe peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.