Clinical effects of free bilateral overlength anterolateral femoral perforator flaps in repairing large area soft tissue defects of limbs by series or parallel connection of blood vessels

Objective: To explore the clinical effects of free bilateral overlength anterolateral femoral perforator flaps in repairing large area soft tissue defects of limbs by series or parallel connection of blood vessels. Methods: Form January 2017 to July 2019, 9 patients with large area soft tissue defects of limbs were admitted to the Departments of Hand Surgery and Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 8 males and 1 female, aged 36 to 63 years. The historical cohort study was conducted. The areas of wounds of patients after debridement were 20 cm×15 cm to 30 cm×25 cm, and were repaired with bilateral anterolateral femoral perforator flap whose blood vessel was connected in series or parallel. One main artery of 4 patients were injured, then the wounds were repaired with bilateral flap whose blood vessel was connected in series; Two main arteries of 4 patients were injured, then the wounds were repaired with bilateral flap whose blood vessel was connected in parallel. Eighteen flaps were excised and the area of single flaps ranged from 20 cm×8 cm to 46 cm×9 cm. Seventeen donor sites were sutured directly, and one donor site was repaired with free full-thickness skin graft from hypogastrium. Harvesting time and survival condition of flaps, wound healing time, flap observation at follow-up, two-point discrimination distance of flaps, functional recovery and appearance of recipient site, function of donor site were recorded. Results: In this group of 9 patients, the flap harvesting time was 1.0 to 4.5 hours, and all the 18 flaps survived. The wound healing time was 18 to 72 days after flap transplantation, the donor sites were all healed. They were followed up for 6 to 34 months. The shape of the recipient site was satisfactory, with no deep tissue infection such as osteomyelitis. The appearance of 4 flaps were slightly bloated in 2 cases which were thinned in 6 months after operation; 4 flaps of 2 cases had skin pigmentation on the edge of the flap; one case was scalded on the medial skin flap with patchy scars remained after healing. All the flaps of other cases were soft, elastic, good in blood supply with no pain. All the flaps were with protective feeling recovery, with only one point in two-point discrimination. Only linear scars remained in the 17 flap donor sites. All the limbs in distal end of donor sites had good blood supply, no restriction occurred in range of knee motion or quadriceps strength. Conclusions: The bilateral anterolateral femoral perforator flap whose blood vessel was connected in series or parallel has constant anatomy, reliable blood supply, and flexible combination, may be an ideal surgical method to repair large area soft tissue defects of limbs in one stage.