Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Wound Healing, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China.
Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Injury. 2022 Nov;53(11):3843-3848. doi: 10.1016/j.injury.2022.08.068. Epub 2022 Aug 30.
Skin and soft-tissue defects around the foot and ankle remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh (ALT) flap and sural neurofasciocutaneous (NFC) flap are both used to reconstruct lower-extremity soft-tissue defects. The purpose of this study was to compare outcomes of the two flaps and attempt to provide an optimal strategy.
A retrospective study was conducted, reviewing data from 93 patients who underwent reconstruction of wounds around the foot and ankle with ALT flap (42 cases) or NFC flap (51 cases) from January 2014 to January 2020. Patients' demographics, characteristics of the defect, complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed.
There was no difference in gender and etiology; however, NFC flaps were more frequently used in elderly patients. Mean size of the flap in the ALT group was significantly larger in comparison with the NFC group. The ALT group had longer operation and hospitalization time than the NFC group (P < 0.05). The incidence of partial necrosis in ALT group was significantly lower than that in NFC group, while its general complications rate was higher. In long-term follow-up, esthetic appearance of the reconstructed site was comparable in both groups, the ALT group had a higher ratio of revision surgery. Moreover, the ALT group showed better overall esthetic outcomes in the donor site.
The study showed that anterolateral thigh flaps in wound coverage of foot and ankle achieved better outcomes than neurofasciocutaneous flaps in terms of recipient benefits and donor-site compromise with a special indication for larger and more distally located defects.
足部和踝关节周围的皮肤和软组织缺损仍然是骨科和整形外科医生面临的挑战。股前外侧皮瓣（ALT 皮瓣）和腓肠神经营养血管皮瓣（NFC 皮瓣）均可用于重建下肢软组织缺损。本研究旨在比较两种皮瓣的结果，并尝试提供一种最佳策略。
回顾性研究分析了 2014 年 1 月至 2020 年 1 月期间采用 ALT 皮瓣（42 例）或 NFC 皮瓣（51 例）修复足部和踝关节周围创面的 93 例患者的数据。分析了患者的人口统计学、缺损特征、并发症、美容外观和功能结果，并进行了统计学分析。
两组患者的性别和病因无差异，但 NFC 皮瓣更常用于老年患者。与 NFC 组相比，ALT 组的皮瓣平均尺寸明显更大。与 NFC 组相比，ALT 组的手术和住院时间更长（P<0.05）。ALT 组的部分坏死发生率明显低于 NFC 组，而其总体并发症发生率较高。长期随访时，两组重建部位的美容外观相似，ALT 组的修复手术比例更高。此外，ALT 组供区的整体美容效果更好。
该研究表明，在足部和踝关节创面覆盖方面，股前外侧皮瓣的效果优于 NFC 皮瓣，前者在受区获益和供区损伤方面具有优势，尤其适用于较大和更偏远部位的缺损。
