Blood Perfusion of the Free Anterolateral Thigh Perforator Flap: Its Beneficial Effect in the Reconstruction of Infected Wounds in the Lower Extremity

BackgroundIn a prospective study, we evaluated the blood perfusion and the blood flow of anterolateral thigh (ALT) flap by both near-infrared spectroscopy and color Doppler ultrasonography. Moreover, we assessed the ability of the perforator flap to reconstruct infected wounds of the lower extremity in 11 patients.MethodsNear-infrared spectroscopy showed excellent oxygen saturation, and Doppler ultrasonography documented excellent blood flow and decreased vascular resistance in the ALT flap postoperatively.ResultsAll flaps were successful and all wounds healed uneventfully within 2 weeks without any signs of recurrences or persistent infection. All patients achieved acceptable gait function after rehabilitation.ConclusionsApart from the mandatory role of thorough debridement, our results indicate that the ALT flap offers rich blood supply to the recipient area, thus contributing to the sterilization and healing of an infected wound within a short time period.

[1]  I. Koshima,et al.  Perforator flaps in lower extremity reconstruction. , 2002, Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V....

[2]  S. Mathes,et al.  Use of the Muscle Flap in Chronic Osteomyelitis: Experimental and Clinical Correlation , 1982, Plastic and reconstructive surgery.

[3]  Hung-Chi Chen,et al.  Anterolateral thigh flap: an ideal soft tissue flap. , 2003, Clinics in plastic surgery.

[4]  S. Mathes,et al.  Comparison of the Effect of Bacterial Inoculation in Musculocutaneous and Fasciocutaneous Flaps , 1986, Plastic and reconstructive surgery.

[5]  S. Suominen,et al.  Colour Doppler Ultrasound Evaluation of Haemodynamic Changes in Free Tram Flaps and Their Donor Sites , 2002, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[6]  Reimer Andresen,et al.  Investigation of TRAM Flap Oxygenation and Perfusion by Near-Infrared Reflection Spectroscopy and Color-Coded Duplex Sonography , 2004, Plastic and reconstructive surgery.

[7]  A. Gravvanis,et al.  Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: conservative or modern approach to the exposed knee joint? , 2005, Plastic and reconstructive surgery.

[8]  J. Jupiter,et al.  The parascapular flap for treatment of lower extremity disorders. , 1989, Plastic and reconstructive surgery.

[9]  Hung-Chi Chen,et al.  Have We Found an Ideal Soft‐Tissue Flap? An Experience with 672 Anterolateral Thigh Flaps , 2002, Plastic and reconstructive surgery.

[10]  S. Asko-Seljavaara,et al.  Postoperative changes in blood flow in free muscle flaps: A prospective study , 1999, Microsurgery.

[11]  R. Musharafieh,et al.  Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases. , 2001, Journal of reconstructive microsurgery.

[12]  A. Nather,et al.  The Posterior Neuromuscular Compartment of the Deltoid , 2005, Plastic and reconstructive surgery.

[13]  D. Wypij,et al.  Cerebral oxygen supply and utilization during infant cardiac surgery , 1995, Annals of neurology.

[14]  C. Rubino,et al.  Haemodynamic enhancement in perforator flaps: the inversion phenomenon and its clinical significance. A study of the relation of blood velocity and flow between pedicle and perforator vessels in perforator flaps. , 2006, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[15]  S. Asko-Seljavaara,et al.  Blood flow in free muscle flaps measured by color Doppler ultrasonography , 1995, Microsurgery.

[16]  S. Manek,et al.  Hemoglobin oxygenation kinetics and secondary ischemia in renal transplantation. , 1996, Transplantation.

[17]  J. Mader,et al.  A clinical staging system for adult Osteomyelitis : Proceedings of the musculoskeletal Infection Society 2002 , 2003 .

[18]  S. Suominen,et al.  Evaluation of blood flow in free microvascular flaps. , 2001, Journal of reconstructive microsurgery.

[19]  J. May,et al.  Microvascular transfer of free tissue for closure of bone wounds of the distal lower extremity. , 1982, The New England journal of medicine.

[20]  Taylor De,et al.  Use of near-infrared spectroscopy to monitor tissue oxygenation. , 1996 .

[21]  T. Chen,et al.  Free medial sural artery perforator flap for resurfacing distal limb defects. , 2005, The Journal of trauma.

[22]  S. Holland,et al.  Doppler US. Part I. Basic principles, instrumentation, and pitfalls. , 1990, Radiology.

[23]  Mark H. Gonzalez,et al.  Muscle flaps in the treatment of osteomyelitis of the lower extremity. , 2005, The Journal of trauma.

[24]  D. E. Taylor,et al.  Use of near-infrared spectroscopy to monitor tissue oxygenation. , 1996, New horizons.

[25]  M. Godina.  Early Microsurgical Reconstruction of Complex Trauma of the Extremities , 1986, Plastic and reconstructive surgery.

[26]  C. Green,et al.  Non-invasive measurement of cardiac oxygenation and haemodynamics during transient episodes of coronary artery occlusion and reperfusion in the pig. , 1994, Clinical science.

[27]  F. Wei,et al.  The Use of Anterolateral Thigh Perforator Flaps in Chronic Osteomyelitis of the Lower Extremity , 2005, Plastic and reconstructive surgery.

[28]  W. Lineaweaver,et al.  Treatment of chronic osteomyelitis of the lower extremities with debridement and microvascular muscle transfer. , 1992, Clinics in plastic surgery.

[29]  Frank Hölzle,et al.  Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. , 2006, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[30]  K. Kurachi,et al.  Preoperative Color Doppler Assessment in Planning of Anterolateral Thigh Flaps , 2004, Plastic and reconstructive surgery.

[31]  C. Attinger,et al.  Débridement. The key initial first step in wound healing. , 2001, Foot and ankle clinics.