Arch Hand Microsurg.  2019 Jun;24(2):167-176. 10.12790/ahm.2019.24.2.167.

Usefulness of Anterolateral Thigh Flap for Severe Trauma Patients at the Regional Trauma Center

• Hong SM
• Kim YJ
• Kwak SH
• Kim DH
• Lee HJ
• Rhee SJ
• Ahn TY
• Lee SH

• KMID: 2448051
• DOI: http://doi.org/10.12790/ahm.2019.24.2.167

Abstract

PURPOSE
The purpose of the research is to identify the result of using anterolateral thigh (ALT) flap to multiple trauma patients with open fracture accompanying soft tissue injuries.
METHODS
The subjects were 18 patients who visited the regional trauma center with open fracture and treated with the ALT flap from February 2013 to September 2017. According to the injured body regions, there were 7 cases of foot injuries, 5 of lower extremity, 3 of ankle, 2 of hand, and 1 of forearm. The cause of injuries was car accidents in 10 cases including the pedestrian struck in 4 cases.
RESULTS
Except for one case that the patient's flap was lost due to the artery thrombosis, the rest of cases showed that the flap was survived. Average healing time to a bone union was 8.1 months.
CONCLUSION
During the surgery of the multiple trauma patients with open fracture, no change of patient position is required and no pressure to abdomen or chest was applied. Also, the ALT flap with relatively long pedicle seems to be more useful than other flap surgeries.

Keyword

Multiple traumas; Open fracture; Free flaps

MeSH Terms

Abdomen
Ankle
Arteries
Body Regions
Foot Injuries
Forearm
Fractures, Open
Free Tissue Flaps
Hand
Humans
Lower Extremity
Multiple Trauma
Soft Tissue Injuries
Thigh*
Thorax
Thrombosis
Trauma Centers*

Figure

• 

  Fig. 1. (A) A 38-year-old female patient visited the regional trauma center after falling from the 4-5th level of floor. By observation through the assessment of each part of body, intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hemorrhage, cardiac tamponade, right atrium rupture, sternum fracture, pneumothorax, multiple rib fracture, traumatic hemothorax, lung contusion, traumatic hemoperitoneum were found. Apart from them, sacral fracture and acetabular fracture were diagnosed at pelvic part, lumbar vertebral burst fracture at spine. (B) Both talus body fracture, both calcaneus open fracture and right distal tibiofibular fracture were diagnosed at the both ankles, and at the time of visit, the patient was in coma with injury severity score 66, Gustilo–Anderson classification type IIIb. (C) When the vital signs became stabilized after the emergency operation by neuro and thoracic surgery, the initial orthopedic surgery (anterolateral thigh flap) could be performed, which was after 26 days. The treatment for the spinal fracture and cerebral hemorrhage was not completed but the flap procedure could be done successfully. Although other simpler techniques such as sural flap can be done, the scar remained at the donor site was considered because the patient was a young female. (D) After 8 months, the patient achieved the bone union, and the defatting of the flap area and cement bead removal were performed.

• 

  Fig. 2. (A) A 51-year-old male patient was suspected of having a multiple trauma after a car accident and visited the regional trauma center, and he was diagnosed with traumatic hemothorax and lung contusion. (B) In orthopedic department he was diagnosed with left distal tibia open comminuted fracture and gastrocnemius muscle partial rupture. As an emergency surgery, the orthopedic surgeon performed the posterior decompression and fusion for the spine fracture, open reduction, irrigation and debridement, and external fixation for the left lower leg. (C) The inflammation at the left lower leg with skin loss showed an improvement, the anterolateral thigh flap was performed on the 8th day. The patient who had undergone a surgery for a spine fracture underwent the flap surgery but showed no complications. (D) After 6 months, he underwent a defatting and metal removal and at 7 months, the bone union was achieved.

• 

  Fig. 3. The authors used the Pearson correlation coefficient method to confirm the correlation between the timing of the flap and the time of union. The p-value of 0.0688 showed no significant statistical significance but a positive correlation.

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