Sensorial anterolateral thigh flap with end-to-side anastomotic non-primary source vessels for foot and ankle soft tissue defects

He Jianlin; Zhu Biqing; Zhang Binbin; Wang Xiaoxiao; Zhong Junbo

doi:10.3969/j.issn.1009-4237.2025.03.008

Abstract：Objective To explore the application of anterolateral thigh flap(ALTF)with sensory perforator in the repair of soft tissue defects at the foot and ankle,by end-to-side anastomosis of non-primary source vessels,and to observe the sensory reconstruction and flap revascularization.Methods This prospective study was conduc-ted on 104 patients(55 males and 49 females aged 19-53 years,mean 36.1 years)with foot and ankle soft tissue de-fects and managed in our department from Jan.2019 to Apr.2023.Patients were divided into two groups using a random number table method,with 52 cases in each group.Genranl data and injury severity showed no significant difference between two groups.The intervention group was repaired with a sensory ALTF using end-to-side anasto-mosis of non-primary source vessels,while the control group was repaired with a conventional subdermal perforator flap of the inferior epigastric artery.The two groups were compared for repair surgery prodecures and outcome pa-rameters of two-point discrimination,tactile sensation,and function by American Orthopaedic Foot&Ankle Society(AOFAS)ankle hindfoot score at 1 and 3 months postoperatively.Postoperative complications and aesthetics were also recorded.Results There was no statistically significant difference in the preparation time of skin flaps,first-stage healing rate,and survival rate of skin flaps between the two groups(all P>0.05).The wound healing time(d)in the observation group was 20.89±5.10,much shorter than that in the control group of 24.00±4.85(P<0.05).At 1 and 3 months after surgery,the two-point discrimination distances(mm)in the observation group were 8.32±1.47 and 7.06±1.24,respectively,shorter than those in the control group(9.64±1.20 and 8.33±1.36,both P<0.05);while the excellent and good rates of tactile sensation were 71.2%and 96.2%,respectively,much higher than those in the control group(51.9%and 80.8%,both P<0.05).The excellent and good rates by AOFAS ankle hindfoot score showed no significant difference between the two groups at 1 and 3 months after surgery(both P>0.05).The incidence of postoperative complications in the observation group was 3.9%,much lower than that in the control group(17.3%,P<0.05).At 3 months after surgery,the observation group showed significantly lower scores for surgical site thickness(2.62±0.31 vs.3.58±0.57),compliance(2.13±0.36 vs.2.78±0.42),and softness(2.64±0.59 vs.3.43±0.74),respectively(all P<0.05).The appearance and pain were close between two groups.Conclusion Sensorial ALTF with end-to-side anastomosis of non-primary source vessels to repair soft tissue defects at the foot and ankle has sound effects.It promotes wound healing,improves sensory functional recov-ery,enhances aesthetic outcomes,and is safe.