Gu Yingluo, Sun Yongyang, Xu Ke, Yi Nan, Qin Jianzhong, Zhang Yong, Zhao Jiaju, Jiang Bo
From the Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Ann Plast Surg. 2025 Feb 1;94(2):185-191. doi: 10.1097/SAP.0000000000004180. Epub 2024 Dec 26.
Complex lower extremity defects are difficult to cover and often require multiple free tissue transfers. Chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF) have been designed specifically as an alternative for reconstruction with arterial end-to-side (ETS) anastomosis. We aimed to assess our institutional experience with this technique and to define its role in complex lower extremity reconstruction.
From July 2012 to March 2023, 27 patients with complex lower extremity defects underwent reconstruction with chimeric ALTF or PAPF. Patients were performed with retrograde flaps for repairing refractory wounds of tibia plateau fracture and antegrade flaps for distal 2/3 tibia and beyond. Demographic, clinical, and follow-up data on the patients were recorded with a special focus on complication profiles during a follow-up of 6 to 60 months.
The mean defect size measured 121.1 ± 215.1 cm 2 , and the chimeric ALTF or PAPF flaps measured 143.9 ± 177.8 cm 2 . One patient lost the first free flap but successfully had a chimeric PAPF then. Three patients suffered partial free flap loss, and another 3 had minor complications. All 6 survived after an additional exploration, wound dressing, or antibiotics treatment. The retrograde flaps achieved similar blood flow to the antegrade flaps. Patients are all satisfied with functional and aesthetic outcomes.
Given the incidence of complications, utilizing chimeric ALTF and PAPF either with retrograde or antegrade flow based on arterial ETS anastomosis is a reliable surgical option for complex lower extremity reconstructions.
复杂的下肢缺损难以覆盖，通常需要多次游离组织移植。嵌合型股前外侧游离皮瓣（ALTF）和腓动脉穿支游离皮瓣（PAPF）已被专门设计作为动脉端侧（ETS）吻合重建的替代方案。我们旨在评估我们机构在该技术方面的经验，并确定其在复杂下肢重建中的作用。
2012年7月至2023年3月，27例复杂下肢缺损患者接受了嵌合型ALTF或PAPF重建。患者采用逆行皮瓣修复胫骨平台骨折难治性创面，采用顺行皮瓣修复胫骨远端2/3及更远端创面。记录患者的人口统计学、临床和随访数据，特别关注6至60个月随访期间的并发症情况。
平均缺损面积为121.1±215.1平方厘米，嵌合型ALTF或PAPF皮瓣面积为143.9±177.8平方厘米。1例患者首次游离皮瓣失败，但随后成功采用了嵌合型PAPF。3例患者出现部分游离皮瓣丢失，另外3例出现轻微并发症。经再次探查、伤口换药或抗生素治疗后，所有6例均存活。逆行皮瓣的血流与顺行皮瓣相似。患者对功能和美学效果均满意。
鉴于并发症的发生率，基于动脉ETS吻合采用逆行或顺行血流的嵌合型ALTF和PAPF是复杂下肢重建的可靠手术选择。
