Clinical application of anterolateral thigh perforator flap for the reconstruction of severe tibia exposure

Exposure of tibia can result from severe traumatic wounds, such as injuries due to traffic accidents, crush injuries (machine) and amputation wounds. The free anterolateral thigh perforator flap is increasingly being used for trauma reconstruction. Here we report our case load with this surgical intervention.

We reviewed 27 patients who underwent free anterolateral thigh flap reconstruction for tibia exposure in the proximal-middle part. The flap size ranged from 64 cm2 to 270 cm2 (mean, 35 cm2). The recipient artery was the anterior tibial artery (3 cases), the posterior tibial artery (8 cases), the dorsal pedal artery (8 cases) and the contralateral posterior tibial vessels (8 cases).

Among the flaps, 20 successfully survived (74%), and the others suffered from partial skin necrosis at flap edge (5 cases, 18.5%) and flap loss was caused by venous or arterial thrombosis (2 cases, 7.4%). The lost flap was reconstructed with a split-thickness skin graft or a cross-leg soleus muscle flap coverage. The follow-up period ranged from 3 to 30 months. Three patients had sinus formation and healed in one year with the repeated debridement and drainage. Among the 27 cases, only one case presented reinfection at the sixth postoperative month, due to the plate fixation and was healed in one month by the removal of steel plate and thorough debridement and drainage.

Our results suggest that free anterolateral thigh flap would be an alternative choice for reconstruction of severe tibia exposure, and careful selection of the location and number of perforators as well as the proper selection of recipient artery are of great importance.