Objective: To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects.
Methods: The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation ( P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society's functional evaluation standard for replantation of amputated limbs. Weber's quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups.
Results: No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group ( P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) ( χ 2=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation ( P>0.05).
Conclusion: Flow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.
目的: 探讨Flow-through桥式股前外侧皮瓣修复复杂小腿软组织缺损的疗效。.
方法: 回顾分析2008年1月—2022年1月采用Flow-through桥式股前外侧皮瓣（研究组，23例）或单纯桥式股前外侧皮瓣（对照组，23例）治疗的复杂小腿软组织缺损患者临床资料。所有患者缺损均为外伤或骨髓炎所致，小腿仅存1根主要血管或者没有与移植皮瓣吻合的血管。两组患者性别、年龄、致伤原因、小腿软组织缺损范围及受伤至手术时间等一般资料比较差异均无统计学意义（ P>0.05）。术后采用下肢功能评价量表（LEFS）评价两组患者患侧下肢功能，参照中华医学会手外科学会断肢再植功能评定试用标准评价健侧下肢末梢血液循环状态，采用Weber定量法检测静态两点辨别觉（static 2-point discrimination，S2PD）评价健侧下肢末梢感觉，并比较两组患者健侧腘动脉血液流速、趾甲毛细血管充盈时间、足部温度、足趾血氧饱和度及并发症发生情况。.
结果: 术中未发生血管及神经损伤。两组各发生1例皮瓣部分坏死，经游离植皮后愈合；其余皮瓣完全成活。46例患者均获随访，随访时间6个月～8年，中位时间26个月。两组患者患侧肢体功能恢复满意，皮瓣血运良好、质地柔软、外观尚可；供区切口仅留一线性瘢痕，植皮区色泽与周围正常皮肤相近，取皮处可见一长方形瘢痕，外观满意。健侧远端肢体血运良好，色泽及皮温未见明显异常，活动时肢体血液供应无异常。术后1个月断蒂后研究组健侧腘动脉血液流速快于对照组，足部温度、足趾血氧饱和度、S2PD、趾甲毛细血管充盈时间、末梢血液循环评分均优于对照组（ P<0.05）。术后对照组发生健侧足部冰凉8例、麻木2例，研究组仅发生3例足部冰凉，研究组并发症发生率（13.04%）明显低于对照组（43.47%）（ χ 2=3.860， P=0.049）。术后6个月两组患侧LEFS评分比较差异无统计学意义（ P>0.05）。.
结论: Flow-through桥式股前外侧皮瓣可减少术后健足并发症，降低手术对健足血运及感觉的影响，是一种有效修复复杂性小腿软组织缺损的方法。.
Keywords: Bridge flap; Flow-through technique; anterolateral thigh flap; complex calf soft tissue defect.