Limb Salvage of Gustilo Type Fracture with Composite Anterolateral Thigh Perforator Flap in Primary Surgery

Introduction: To investigate the surgical techniques and clinical effects of limb salvage surgery for Gustilo type fracture with free composite anterolateral thigh perforator flap (ALTP) in primary surgery.

Methodology and Material: From August 2007 to December 2012， 9 patients on the verge of amputation received free composite ALTP transfer in primary surgery to salvage their limbs. All their limbs were injured in traffic accidents, including 3 upper limbs and 6 lower legs. In this series, 5 fractures were performed ORIF primarily, and the other 4 with bone defect were fixed with external fixation temporarily which were replaced with internal fixation at the same time of second bone graft surgery. These composite flaps consisted of flow-through ALTPs in 4 cases, chimeric ALTPs in 2 case, flow-through-chimeric ALTPs in 2 cases, flow-through-chimeric- polyfoliate flap ALTP in 1 case. The size of flaps ranged from 10cm × 6 cm;22cm × 9 cm, and the donor sites were all closed primarily.;

Results: All patients were followed up for 5 -36 months, and all limbs were salvaged successfully; 6 flaps survived uneventfully, another 3 with tension blisters survived eventually after stitches removing and blood-letting. All patients achieved bone union in 4.5∼8 months (6.25 months on average).

Conclusions: The free composite ALTP in primary surgery cannot only salvage the limb with Gustilo type; C fracture, but also reduce the patients' recovery time and surgery complications, and contribute to the early regain of limb function.