[Clinical application effects of the "novel three-longitude and five-transverse method" for perforator localization...

Objective: To evaluate the clinical application effects of the "novel three-longitude and five-transverse method" for perforator localization in anterolateral thigh chimeric flaps. Methods: This study was a retrospective study of case series. From June 2021 to June 2023, 15 patients with destructive limb wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University. The wounds were located on the upper limbs in 5 cases and the lower limbs in 10 cases, with a post-debridement area ranging from 12 cm×5 cm to 22 cm×7 cm. The "novel three-longitude and five-transverse method" was employed. The anterior superior iliac spine was defined as Point P, the superolateral border of patella was defined as Point A, and the lateral femoral epicondyle was defined as Point B. Point P was connected with Points A and B to form Lines PA and PB. The Point P was connected to the midpoint of the line connecting Points A and B (Point C) to form Line PC. A perpendicular line was drawn from the midpoint of Line PA as Line E. Line E was translated 5 cm proximally to form Line D, while Lines F, G, and H were drawn 5, 10, and 15 cm distally, respectively. The intersections of Lines PA and PB with Lines D, E, F, G, and H were defined as Zones Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. Using Line PC as the flap axis, anterolateral thigh chimeric flaps were designed and harvested within the areas to repair the wounds. The area of harvested flap ranged from 13.0 cm×6.0 cm to 23.0 cm×8.0 cm. The donor site wounds were sutured with tension reduction. During surgery, the number and origin of perforators observed in each zone, as well as the vertical distance from the skin entry point of the perforator to Line PC were recorded. After surgery, flap survival was observed. During follow-up, the color, texture, appearance, and occurrence of complications of flaps, as well as the occurrence of hyperplastic scar formation and muscle herniation in donor sites were observed. Results: During surgery, a total of 75 perforators was identified. Of those perforators, 18 were located in Zone Ⅰ (three originating from the oblique branch of lateral circumflex femoral artery and 15 originating from the descending branch of lateral circumflex femoral artery), 17 were located in Zone Ⅱ (all originating from the descending branch of lateral circumflex femoral artery), 21 were located in Zone Ⅲ (all originating from the descending branch of lateral circumflex femoral artery), and 19 were located in Zone Ⅳ (12 originating from the descending branch of lateral circumflex femoral artery and 7 originating from the peripheral vessels in distal thigh). The skin entry points of 24 perforators were located directly on Line PC, while the skin entry points of the other 51 perforators were located adjacent to it, with the vertical distances to Line PC all less than 1.0 cm. After surgery, one patient developed distal flap bruising, and two patients had minor exudation at the flap margin, which all healed after dressing changes. The flaps in the remaining patients survived smoothly. During the follow-up period of 6 to 40 months, all flaps demonstrated favorable color, texture, and appearance, with no complications observed; the scars in donor sites were mild, with no muscle herniation. Conclusions: The "novel three-longitude and five-transverse method" can effectively locate anterolateral thigh chimeric flap perforators. The method is simple and reliable. The anterolateral thigh chimeric flaps designed and harvested based on this method have good clinical effect in repairing destructive limb wounds, which is worthy of promotion.