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Chimeric Free Flaps Based on End-to-Side Anastomosis for Complex Lower Extremity Reconstruction
Yingluo Gu1, Yongyang Sun, Ke Xu
1From the Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Annals of Plastic Surgery
|December 27, 2024
Summary
Chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF) offer a reliable solution for complex lower extremity reconstruction. These flaps, used with arterial end-to-side anastomosis, show good functional and aesthetic outcomes with low complication rates.
Area of Science:
- Microsurgery
- Plastic Surgery
- Reconstructive Surgery
Background:
- Complex lower extremity defects pose significant reconstructive challenges, often necessitating multiple free tissue transfers.
- Chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF) have been developed for reconstruction using arterial end-to-side (ETS) anastomosis.
- This study evaluates the institutional experience with chimeric ALTF and PAPF for complex lower extremity reconstruction.
Purpose of the Study:
- To assess the institutional experience with chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF).
- To define the role of these chimeric flaps in complex lower extremity reconstruction.
- To evaluate the outcomes and complication profiles of reconstructions using these techniques.
Main Methods:
- A retrospective review of 27 patients with complex lower extremity defects reconstructed with chimeric ALTF or PAPF from July 2012 to March 2023.
- Flaps were utilized in retrograde fashion for tibia plateau fractures and antegrade for distal tibia defects.
- Data collected included demographic, clinical, and follow-up information, focusing on complication profiles over 6 to 60 months.
Main Results:
- The mean defect size was 121.1 cm², and flap size was 143.9 cm².
- One patient experienced initial flap loss but had a successful secondary reconstruction; three patients had partial flap loss, and three had minor complications, all managed successfully.
- Retrograde and antegrade flaps demonstrated comparable blood flow, with high patient satisfaction regarding functional and aesthetic results.
Conclusions:
- Chimeric ALTF and PAPF, employed with arterial ETS anastomosis, represent a reliable surgical option for complex lower extremity reconstruction.
- The technique, whether using retrograde or antegrade flow, demonstrates a favorable complication profile.
- These chimeric flaps provide effective solutions for challenging lower extremity defects, yielding satisfactory outcomes.
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