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Objective To evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle. Methods Clinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm × 10 cm to 35 cm × 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep‐tissue injury of the soft‐tissue defects. The skin flap and muscle flap were fanned out on the wound, and single‐ or two‐staged split‐thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post‐operationally. Complications at both recipient site and donor site were carefully recorded. Results The mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post‐traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6–8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12–36 months post‐operational follow‐up. Conclusion The chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space., Large area of deep wound in the foot and ankle with bone and tendon exposed. Harvested chimeric anterolateral thigh perforator flappedicled with descending branch of lateral circumflex femoral artery. Place the chimeric anterolateral thigh perforator flap near the wound of the foot and ankle. The chimeric flap was used to fan out on the wound, the muscle flap covers the bone exposed wound. All wounds were reconstructed by the flap and the skin grafting on the muscle flap or on the residual local wound.

Objective To investigate the clinical application of chimeric anterolateral thigh perforator flap in the treatment of complex wounds complicated with deep dead space of the extremities. Methods From January 2014 to December 2018, 56 cases (38 males and 18 females) with wounds complicated with deep dead space received treatment of chimeric anterolateral thigh perforator flap. The average age was 33.4 years, ranged from 3 to 72 years. Causes of injury: 34 cases of vehicle or motorcycle bruise injuries, 12 cases of falling related injuries, and 10 cases of heavy objects crush injuries. All of these patients were experiencing severe limb injuries accompanied with varying levels of tissue necrosis, tissue infection and deep tissue exposure. Residual deep dead space was observed after debridement, including 41 cases of dead space caused by tendon and muscle exposure, 29 cases formed by bone and joint exposure, as well as 5 cases induced by exposure of internal fixators such as plates. The wound sized were from 8 cm×6 cm to 30 cm×15 cm. Forty-one cases were complicated with the ipsilateral fractures, and 21 cases were complicated with fractures in other bone parts or systematic injuries. Following thorough debridement and treatment with vacuum sealing drainage, the granulation tissues of the wound surface grew well with well-controlled infection, and then we used the chimeric anterolateral thigh perforator flap to obliterate the deep dead space and repair the wounds. The postoperative flap survival and infection condition were evaluated.Results Among 56 patients, 2 cases developed vascular crisis, which was alleviated with timely vascular exploration. One case had excessive bleeding after flap grafting, which was resolved with surgical exploration. Three patients experienced partial necrosis of the flaps, leaving residual local wound, which were completely eliminated by secondary skin grafting in one case and by proactive dressing changes in the other 2 cases. Overall, the infection was effectively controlled, without persistent exudation or sinus tract formation after wound healing. While 5 cases lost to follow-up, the remaining 51 patients were followed up until 15 months, ranged from 9-24 months. Generally, the affected extremities recovered satisfactorily with normal appearances and texture of the flaps, along with normal functions. Importantly, no recurrence of infection was observed.Conclusion During the grafting of chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery and lateral thigh muscle flap, the muscle flap is recommended to obliterate the deep dead space while the skin flap being used to cover the wound surface. The combination of these two methods performed well in the repair and reconstruction of the complex wounds of the extremities, possessing potential for broader clinical application.