Modified Recipient Blood Flow-preserved Cross-leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

Abstract

Background: Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. We here introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy.Methods: Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent the modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were stubborn ulcers, and 1 case was degloving injury. The arterial pedicle of flap was prepared as Y-shaped fashion and microanastomosed to contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed as single or bilobed fashions according to the shape of defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up.Results: All of 22 flaps survived. The flap sizes ranged from to 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed as single fashion, and four flaps were bilobed fashion. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision were performed in 16 cases, while additional full-thickness skin grafting were performed in remaining 6 cases. Further bone transport procedure was performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries were all confirmed during follow-up. The postoperative follow-up ranged 18 to 84 months, and no long-term complications were observed.Conclusions: The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing major artery of uninjured lower limb.