Repair of soft tissue defect in extremities with anterolateral thigh perforator flap

Objective: To summarize the clinical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities.

Methods: From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of 28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsalis pedis in 5 cases, and plantae pedis in 4 cases. The defect area ranged from 9 cm x 6 cm to 15 cm x 13 cm. Nine cases complicated by bone defect and 1 case by radial nerve defect. The time from injury to hospitalization was 1 hour to 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterialized small saphenous vein in 1 case, and with fibular or ilium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm x 8 cm to 16 cm x 15 cm. Skin defects at donor site were repaired with split thickness skin graft or sutured directly.

Results: All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or ilium, the bony healing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site.

Conclusions: The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feeling recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.