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Extensive calcific myonecrosis of the lower leg treated with free tissue transfer. Arch Plast Surg 2021; 48:329-332. [PMID: 33657779 PMCID: PMC8143952 DOI: 10.5999/aps.2020.01200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/23/2020] [Indexed: 01/28/2023] Open
Abstract
Calcific myonecrosis is a rare condition in which hypoperfusion due to compartment syndrome causes soft tissue and muscle to become calcified. As calcific myonecrosis gradually deteriorates, secretions steadily accumulate inside the affected area, forming a cavity that is vulnerable to infection. Most such cases progress to chronic wounds that are unlikely to heal spontaneously. After removing the calcified tissue, the wound can be treated by primary closure, flap coverage, or a skin graft. In this case, a 72-year-old man had extensive calcific myonecrosis on his left lower leg, and experienced swelling and increasing tenderness. After removing the muscle calcification, we combined two anterolateral thigh free flaps, which were harvested from the patient's right and left thigh, respectively, to reconstruct the wound with a dead-space filler and skin-defect cover at the same time. The patient recovered without revision surgery or major complications.
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Yu J, Luo Z, Wu P, Tang J. Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three-Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children. Orthop Surg 2021; 13:216-224. [PMID: 33448701 PMCID: PMC7862167 DOI: 10.1111/os.12887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of the present study was to report a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP) to achieve dead space filling, Achilles tendon bridging, and skin resurfacing simultaneously with minimal donor‐site morbidity. Methods From September 2012 to May 2016, a retrospective study was carried out on six pediatric patients with composite soft tissue defects of the heel that were repaired with the chimeric DIEP flap. The chimeric flap design included a flap of the anterior sheath of the rectus, a block of rectus muscle, and a large skin paddle. All the parts were supplied by a common artery. After harvesting the flap, all element parts were inserted at the corresponding sites in a tension‐free manner. With one set of vessel anastomoses at the recipient site, accurate repair with tendon reconstruction, dead space elimination, and wound covering were accomplished. The donor site incisions were closed initially. Data on patient age, medical history, injury severity, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow‐up were collected and reviewed. Results Five of the six chimeric DIEP flaps survived without complications. The remaining one case experienced partial necrosis of the skin paddle caused by venous congestion, which healed after routine dressing changes. Primary donor site closure was accomplished in all cases. The mean follow‐up was 18.6 months (range, 10–36 months). Five patients had satisfactory aesthetic and functional outcomes; one patient needed a secondary debulking procedure. Compared to the unaffected side, the affected side showed no obvious difference for ankle movement, tiptoe function, and patient gait during the follow‐up period. Good ankle function was observed in all patients. There was no donor site breakdown, with only a slightly noticeable linear scar. Conclusion The chimeric DIEP flap reduced the operative time, solved the problem of deficiency of recipient vessels, and attained satisfactory functional and aesthetic outcomes with low donor site morbidity. Therefore, it is a promising option for three‐dimensional reconstruction of composite defects with dead space and Achilles tendon defects as well as skin loss in children.
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Affiliation(s)
- Junyi Yu
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Luo
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Khajehahmadi S, Rahpeyma A. Biologic Basis of De-Epithelialized Transverse Platysma Flap for Oral Cavity Reconstruction. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2019; 31:343-347. [PMID: 31857978 PMCID: PMC6914321 DOI: 10.22038/ijorl.2019.26361.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction The inferiorly and laterally based platysma myocutaneous flap contains hair in some ethnics; therefore, it is required to change the myocutaneous flap to myofascial flap to prevent the hair growth after its transfer to the oral cavity. Materials and Methods Five male mongrel dogs were selected for this study. De-epithelialized laterally based platysma flap, muscle part facing the oral cavity, was used for buccal reconstruction. The clinical healing process was photographed every week. After 40 days, biopsy specimens were obtained from the transferred flap. Results According to the results, all flaps survived. At the end of the first week, the flap was covered with fibrinous exudate. On the third week, only the center of the transferred flap was not covered with mucosa. Within 40 days, the flap was distinguishable clinically from the adjacent buccal mucosa just by hypopigmentation. Hematoxylin and eosin staining of the biopsy specimens taken on day 40 showed thin stratified squamous epithelium covered with a tiny parakeratin layer. Conclusion Myofascial platysma flap, muscle part faced oral cavity, survives and undergoes mucosalization after adaptation to the recipient oral tissue.
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Affiliation(s)
| | - Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Oh TS, Kwon JG, Jeong WS, Nam SY, Choi SH, Choi JW. A flag-shaped anterolateral thigh free flap for complete circumferential hypopharyngeal reconstruction with dead space obliteration and monitoring flap inset. J Plast Reconstr Aesthet Surg 2019; 72:1785-1794. [DOI: 10.1016/j.bjps.2019.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 04/09/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
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Squamous cell carcinoma following multiple revision breast surgeries with massive chest wall reconstruction via flow-through double ALT free flaps. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ischemic Time in Free-Flap Surgery With Arteriovenous Bundle Interposition Graft: Comparison of Two Anastomosis Sequences. J Craniofac Surg 2019; 30:493-496. [PMID: 30688815 DOI: 10.1097/scs.0000000000005193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During free-tissue transfer for scalp reconstruction, pedicle lengthening may be required when finding a recipient vessel is difficult because of defects from previous surgery. Arteriovenous (AV) bundle interposition grafting is a good option. This study compared 2 sequences of AV bundle interposition grafting when flap pedicle lengthening is needed. METHODS Two anastomosis methods were used. In the recipient lengthening type (R type), the flap was harvested and the AV bundle was harvested from a donor vessel for lengthening. In the flap lengthening type (F type), the flap was harvested first. Next, in contrast to that in the R type method, the authors performed anastomosis with a flap pedicle and bundle before the AV bundle was harvested. RESULTS The mean flap pedicle length was 8.75 cm (range, 5-11 cm). The AV bundle had a mean length of 9.25 cm (range, 6-13 cm), meaning that 13 cm of additional pedicle length can be added. The mean length of the extended vascular pedicle was 18 cm (range, 14-23 cm). CONCLUSION This study compared the results of F type and R type AV bundle interposition grafting. The F type allowed easy monitoring of the anastomosis of the flap pedicle and ensured flap stability by reducing continuous ischemic time. Finally, this study confirmed the efficacy and safety of the AV bundle interposition graft in scalp reconstruction.
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Zhu S, Zang M, Yu S, Xu B, Liu Y. Distally based anteromedial thigh flaps pedicled on the rectus femoris branch of the lateral circumflex femoral artery for reconstruction of soft-tissue defect of the knee. J Plast Reconstr Aesthet Surg 2018; 71:743-749. [PMID: 29428585 DOI: 10.1016/j.bjps.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/05/2017] [Accepted: 01/21/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anteromedial thigh flaps are far less clinically appealing than their anterolateral counterparts, and are occasionally considered as an alternative to the anterolateral thigh flap. Herein, we report the study of soft-tissue defects reconstruction in the knee using a distally based anteromedial thigh flap pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery. PATIENTS AND METHODS Between July 2008 and September 2016, a distally based anteromedial thigh flap was used to reconstruct soft-tissue defects of the knee in 5 patients (3 males, 2 females; age range at surgery 4-55 years old). The perforating vessels supplying anteromedial thigh were derived from the rectus femoris branch of the lateral circumflex femoral artery. The rectus femoris branch shared a common trunk with the descending branches of the lateral circumflex femoral artery. Defect etiologies included malignant neoplasms in 2 cases and post-burn scar contracture in the remaining 3 cases. RESULTS The average flap size was 19.6 × 9.2 cm (range: 15-24 × 6-12 cm). There was no flap loss. Postoperative muscle weakness occurred in one case. The average follow-up time was 17.8 months (range: 5-36 months). No recurrence of tumor or scar contracture was noted. CONCLUSIONS Distally based anteromedial thigh flaps pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery may serve as an alternative option to the distally based anterolateral thigh flap for soft-tissue defect reconstruction of the knee.
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Affiliation(s)
- Shan Zhu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China
| | - Mengqing Zang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China
| | - Shengji Yu
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences, 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Boyang Xu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China
| | - Yuanbo Liu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China.
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Choi JW, Kim YC, Oh TS, Koh KS, Jeong WS. The versatile use of revisited de-epithelialization concept in superficial circumflex iliac and anterolateral thigh perforator free flap for head and neck reconstructions. J Craniomaxillofac Surg 2017; 45:872-880. [DOI: 10.1016/j.jcms.2017.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/22/2016] [Accepted: 02/13/2017] [Indexed: 11/29/2022] Open
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Lee SH, An SJ, Kim NR, Kim UJ, Kim JI. Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap. Clin Orthop Surg 2016; 8:444-451. [PMID: 27904728 PMCID: PMC5114258 DOI: 10.4055/cios.2016.8.4.444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/03/2016] [Indexed: 11/06/2022] Open
Abstract
Background Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. Methods Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. Results All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. Conclusions The ALT flap may be considered ideal for the treatment of severe forefoot deformity.
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Affiliation(s)
- Sang Hyun Lee
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Jin An
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nu Ri Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Um Ji Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeung Il Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Han HH, Choi EJ, Oh DY, Moon SH. The usefulness of microsurgical pedicle lengthening in free anterolateral thigh flaps. Microsurgery 2016; 36:559-566. [DOI: 10.1002/micr.30042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Eun Jeong Choi
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Suk Ho Moon
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
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A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases. Int J Oral Maxillofac Surg 2015; 44:1088-94. [DOI: 10.1016/j.ijom.2015.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/09/2015] [Accepted: 06/15/2015] [Indexed: 11/18/2022]
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Sofiadellis F, Grinsell D. Refinements and restoring contour in head and neck reconstruction. ANZ J Surg 2015; 86:675-80. [PMID: 25904390 DOI: 10.1111/ans.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date head and neck reconstructions of oncological defects have concentrated on primarily filling the defect to achieve primary wound healing, secondly restore function and lastly cosmesis. This paper describes a refinement of existing free tissue transfer techniques for improvement of contour, function and aesthetics. METHODS A retrospective review of 38 patients operated on by one surgeon at St Vincent's, Royal Melbourne and Western Hospitals over a 3-year period was conducted. Data were collected on patient demographics, tumour details, nature of the defect, type of reconstructive procedure, nature of additional tissue used, radiotherapy, complications and outcome. RESULTS We present refinements in using de-epithelialized skin paddles, flexor hallucis longus, and rectus and vastus lateralis muscle in order to achieve optimal reconstruction. Free tissue transfer refinements are discussed in anterolateral thigh, fibula, rectus and anteromedial thigh free flaps. The average defect size and volume of neck dissection prior to reconstruction is presented. A variation of radical, modified radical and selective neck dissections were required for oncological staging and clearance. Rare and minor associated complications are discussed. Post-operative radiotherapy treatment was used in the majority of patients with preoperative adjuvant therapy required in some salvage cases. All patients achieved primary wound healing post-operatively with no salivary leaks, flap failures or exposure of neck vessels. CONCLUSIONS Supplementary microsurgical tissue transfer of de-epithelialized skin, vastus lateralis, flexor hallucis longus and rectus muscles is a valuable option for restoring contour, aesthetics and vessel protection post-radiotherapy.
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Affiliation(s)
- Foti Sofiadellis
- Department of Plastics and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Damien Grinsell
- Department of Plastics and Reconstructive Surgery, St Vincent's Hospital, The Western Hospital, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Wang WH, Deng JY, Xu B, Zhu J, Xia B, Zhang BJ. Double anterior (anterolateral and anteromedial) thigh flap for oral perforated defect reconstruction. J Craniomaxillofac Surg 2014; 42:2041-4. [PMID: 25458346 DOI: 10.1016/j.jcms.2014.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/19/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the therapeutic efficacy of oral perforated defect reconstruction with a double anterior (anterolateral and anteromedial) thigh flap through the modified lateral lip-submandibular approach. MATERIALS AND METHODS From July 2010 to August 2013, eight patients with oral perforated defects secondary to oral cancer ablation involving the superior partial mandible or the posterior partial maxilla, with immediate reconstruction by double anterior (anterolateral and anteromedial) thigh flaps, were retrospectively enrolled into this study. RESULTS All double anterior flaps were musculocutaneous flaps. Seven double flaps resulted in good functional and aesthetic outcomes with complete flap survival. One patient required operative exploration in the postoperative period due to thrombosis in the external jugular vein. After the salvage, one of the double flaps in the intraoral region resulted in partial failure of the superficial skin of the flap. No functional impairment at the donor sites occurred in any of the cases. CONCLUSION The double anterior (anterolateral and anteromedial) thigh flap is a feasible and acceptable technique for reconstruction of an oral perforated defect involving the mandible or the maxilla through the modified lateral lip-submandibular approach. It presents a very acceptable aesthetic and functional result with the additional advantage of low morbidity at the donor site.
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Affiliation(s)
- W H Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China.
| | - J Y Deng
- Department of Computer Tomography, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - B Xu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
| | - J Zhu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
| | - B Xia
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
| | - B J Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
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Visconti G, Salgarello M, Visconti E, Cipriani A, Cina A, Bonomo L. Anatomy of anteromedial thigh perforators: CT-angiography study. Microsurgery 2014; 35:196-203. [PMID: 25043682 DOI: 10.1002/micr.22292] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 11/09/2022]
Abstract
The anatomy of perforator for anteromedial thigh (AMT) flap is a very much-debated issue. In this article, we report AMT perforator vascular anatomy by CT-Angiography (CTA) evaluation of 68 consecutive healthy thighs. Perforators emergence, caliber, length, course, and source vessel in the central three fifth of the thigh were studied by a virtual coordinate system. A mean 4.94 ± 1.75 perforators per thigh (average length, 2.6 ± 0.99 cm) from superficial femoral artery (SFA) were found, emerging medial and lateral to sartorius muscle. A mean 0.4 ± 0.74 perforators per thigh (average length, 2.45 ± 0.97 cm) branched from rectus femoris artery, of which 80% were emerging lateral to sartorius muscle. A mean 0.62 ± 0.91 perforators per thigh (average length, 3.1 ± 1.23 cm) branched from an unnamed branch of SFA, of which 88% were emerging lateral to the sartorius muscle. Perforators' calibre was inferior to 1-5 mm in 177 perforators (51.6%), between 1.5 and 2 mm in 159 (46.7%), and over 2 mm in 7 (2%). The findings from this study show that AMT region is plenty of reliable perforators with overlapping fascial emergence but branching from three different source arteries.
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Affiliation(s)
- Giuseppe Visconti
- Department of Plastic and Reconstructive Surgery, Università Cattolica del "Sacro Cuore", University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
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Xu ZF, Sun CF, Duan WY, Zhang EJ, Dai W, Zheng XJ, Liu FY, Tan XX. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck. Br J Oral Maxillofac Surg 2013; 51:725-30. [DOI: 10.1016/j.bjoms.2011.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 11/17/2011] [Indexed: 10/14/2022]
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Riva FM, Tan NC, Liu KW, Hsieh CH, Jeng SF. Anteromedial thigh perforator free flap: Report of 41 consecutive flaps and donor-site morbidity evaluation. J Plast Reconstr Aesthet Surg 2013; 66:1405-14. [DOI: 10.1016/j.bjps.2013.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 04/14/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
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Use of Anteromedial Thigh Flaps as an Alternative to Anterolateral Thigh Flaps for Reconstruction of Head and Neck Defects in Cancer Patients. Ann Plast Surg 2013; 71:375-9. [DOI: 10.1097/sap.0b013e31824f20bb] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Ferri T, Sesenna E. The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: One surgeon's experience in 92 cases. Microsurgery 2012; 32:87-95. [DOI: 10.1002/micr.20952] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 08/01/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Bernardo Bianchi
- Maxillo‐Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
| | - Andrea Ferri
- Maxillo‐Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
| | - Silvano Ferrari
- Maxillo‐Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
| | - Chiara Copelli
- Maxillo‐Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
| | - Pietro Boni
- Maxillo‐Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
| | - Teore Ferri
- Otolaryngology Head Neck Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
| | - Enrico Sesenna
- Maxillo‐Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia
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Tan PWW, Wong CH, Koong HN, Tan BK. Chest wall reconstruction using a combined musculocutaneous anterolateral-anteromedial thigh flap. Indian J Plast Surg 2011; 43:88-91. [PMID: 20924459 PMCID: PMC2938634 DOI: 10.4103/0970-0358.63966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We present a massive 25 cm × 20 cm chest wall defect resulting from resection of recurrent cystosarcoma phyllodes of the breast along with six ribs exposing pleura. The chest wall was reconstructed with a Prolene mesh–methylmethacrylate cement sandwich while soft tissue reconstruction was carried out using a combined free anterolateral–anteromedial thigh musculocutaneous flap with two separate pedicles, anastomosed to the thoracodorsal and thoracoacromial vessels respectively. We explain our rationale for and the advantages of combining the musculocutaneous anterolateral thigh flap with the anteromedial-rectus femoris thigh flap.
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Affiliation(s)
- Pearlie W W Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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Hong JP, Kim EK, Kim H, Shin HW, Hwang CH, Lee MY. Alternative Regional Flaps When Anterolateral Thigh Flap Perforator is not Feasible. J Hand Microsurg 2010; 2:51-7. [PMID: 22282668 PMCID: PMC3122710 DOI: 10.1007/s12593-010-0014-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 05/25/2010] [Indexed: 11/26/2022] Open
Abstract
This paper presents the scheme to select alternative flaps limited to the region of the ipsilateral thigh when the perforator of the anterolateral thigh flap is not feasible. Total of 564 consecutive microsurgery cases using anterolateral thigh perforator flap was reviewed from March of 2001 to January of 2009. Total of 12 cases used a contingent flap due to anatomical and technical complications of the anterolateral thigh perforator. The alternatives were skin perforator flaps adjacent to the initial flap (3 cases of upper anterolateral thigh flap, 4 cases of anteromedial thigh flap), vastus lateralis muscle flap with skin graft (2 cases), and anterolateral thigh flap as septocutaneous flap without a prominent perforator on the septum (3 cases). All flaps survived and provided coverage as planned but one case using septocutaneous flap without a prominent perforator was noted with partial necrosis. Adjacent flaps around the anterolateral thigh perforator flap may provide useful alternative flaps in cases of failed elevation. Limiting the contingent secondary flap to this region may reduce further donor site morbidity and still provide an adequate flap for reconstruction.
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Affiliation(s)
- Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul, Korea 138-736
| | - Eun Key Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul, Korea 138-736
| | - Hoon Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul, Korea 138-736
| | - Hyun Woo Shin
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul, Korea 138-736
| | - Chang Hun Hwang
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul, Korea 138-736
| | - Moo Young Lee
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul, Korea 138-736
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22
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Abstract
In the last two decades, the anterolateral thigh flap has emerged as one of the most popular reconstructive options for multiple body sites. Based on a perforator flap harvest concept, the flap encompasses the advantages of versatility, pliability, and potential for composite tissue replacement. Although numerous anatomical variations exist, these are well-described, and flap safety remains uncompromised if certain anatomical boundaries are respected. Careful preoperative planning and identification of perforators remain the cornerstone of successful flap harvest. Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom-made flaps tailored to fit almost any defect. A suprafascial dissection allows for "ultra-thin" flaps ideal for folding, tubing, or packing purposes. The versatility of the lateral circumflex femoral artery branches can be exploited to include muscle, iliac bone, tendon, fascia, or nerve in extended designs. The anterolateral thigh flap is currently the frontline choice for head and neck reconstruction, including intraoral, mandibular-maxillary, tongue, and facial defects, and is gaining popularity in abdominal and pelvis reconstruction. It can also be used as a pedicled flap in phallus or perineum reconstruction. More recently, the flap has proved to be extremely useful in skin resurfacing and even functional reconstruction in traumatic wounds. This review summarizes the anatomy, planning, flap harvest, donor morbidity, and clinical applications of the anterolateral thigh flap. An algorithm is proposed that facilitates a clear, problem-based approach for the use of this versatile reconstructive option.
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Hsieh CH, Yang JCS, Chen CC, Kuo YR, Jeng SF. Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available. Head Neck 2009; 31:571-5. [PMID: 19132721 DOI: 10.1002/hed.20995] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ching-Hua Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung Hsien, Taiwan.
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24
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Yano T, Sakuraba M, Asano T, Sarukawa S. Head and neck reconstruction with the deep inferior epigastric perforator flap: A report of two cases. Microsurgery 2009; 29:287-92. [DOI: 10.1002/micr.20617] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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Ng RW, Chan JY, Mok V, Li GK. Clinical use of a pedicled anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2008; 61:158-64. [DOI: 10.1016/j.bjps.2007.10.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 10/08/2007] [Indexed: 11/28/2022]
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26
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Park JE, Rodriguez ED, Bluebond-Langer R, Bochicchio G, Christy MR, Bochicchio K, Scalea TM. The Anterolateral Thigh Flap is Highly Effective for Reconstruction of Complex Lower Extremity Trauma. ACTA ACUST UNITED AC 2007; 62:162-5. [PMID: 17215749 DOI: 10.1097/01.ta.0000250599.84033.1f] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and requires recruitment of vascularized tissues from distant sites. The objective of this study was to evaluate the utility of the anterolateral thigh (ALT) flap for reconstruction of the traumatically injured lower extremity. METHODS Prospective data were collected on all patients who underwent lower extremity reconstruction with an ALT flap during a 3.5-year period at a primary adult resource center (PARC). Demographics captured included age, gender, Injury Severity Score, mechanism of injury, and size of defect and complications. RESULTS Fifty-six patients underwent a total of 59 ALT flap harvests during the study period. The majority of patients were male (75%) and sustained blunt injury (95%). The mean age was 37 +/- 14 years with a mean Injury Severity Score of 17.9 +/- 8. The mean flap size was 20.7 x 8.4 cm, with 64% harvested from the injured limb. Total flap success rate was 91.5%, with four total (6.7%) and one partial flap failure (1.7%). CONCLUSION The ALT flap is a useful tool for trauma reconstruction in lower extremity salvage. We have shown that the ALT flap can be performed successfully in the traumatically injured patient even when harvested from the ipsilateral lower extremity.
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Affiliation(s)
- Julie E Park
- Division of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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27
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Gaggl A, Bürger H, Lesnik G, Müller E, Chiari F. [Anterolateral thigh perforator flaps for facial reconstruction after tumour surgery]. ACTA ACUST UNITED AC 2006; 10:315-23. [PMID: 16944084 DOI: 10.1007/s10006-006-0019-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individual flap design and minor donor site morbidity are main criteria in the treatment of facial defects after tumour surgery. Microvascular perforator flaps seem to follow these criteria well. In the following study our experiences with microvascular anterolateral thigh perforator flaps (ALTPF) in reconstruction of the face following ablative tumour surgery are described and discussed in comparison to the present literature. PATIENTS AND METHODS In 19 patients with squamous cell carcinomas of the floor of the mouth (8), the cheek (6) or the mandible (5) of stadium T3 or T4 ablative tumour surgery followed by reconstruction was performed. For covering the soft tissue defects 19 ALTPF were used. In the five patients with carcinomas of the mandible a microvascular iliac crest transplant was combined with the anterolateral thigh perforator flap for complete chin reconstruction. RESULTS In one patient an intraoperative dissection of the perforator vessels happened. In all other patients surgery and postoperative period was free of complications. Five patients had minor second surgery for aesthetic of functional reasons. At the end there were good aesthetic and functional results in every patient. CONCLUSIONS The anterolateral thigh perforator flap is of great advantage in reconstruction of the face after tumour surgery. Individual designing, central and save perfusion, easy to be controlled, and a low incidence of donor site morbidity are their main advantages.
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Affiliation(s)
- Alexander Gaggl
- Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Landeskrankenhaus Klagenfurt, St. Veiterstrasse 47, A-9020, Klagenfurt, Osterreich.
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28
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Wolff KD, Kesting M, Thurmüller P, Böckmann R, Hölzle F. The anterolateral thigh as a universal donor site for soft tissue reconstruction in maxillofacial surgery. J Craniomaxillofac Surg 2006; 34:323-31. [PMID: 16860992 DOI: 10.1016/j.jcms.2006.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 04/12/2006] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The experience with 191 flaps from the anterolateral thigh is described with special regard to variations of vascular anatomy and possible flap designs. PATIENTS Since 1992, 191 flaps from the anterolateral thigh donor site were used in 187 patients. The size of the defects varied from 3 x 5 cm to 21 x 10 cm, being located in nearly all areas of the head and neck region including the skull base. METHODS The functional and aesthetic outcome was routinely evaluated during follow-up of the patients. All complications and secondary procedures were documented during the whole follow-up period ranging from 4 weeks to 11.2 years. RESULTS Six different patterns of variations were observed concerning the flap pedicle, but none of these resulted in failure of flap raising except for two patients, in whom no perforators could be found. Poor functional results were observed in 17 patients, and debulking procedures or scar revisions were carried out in 58 of the 187 patients. Nine flap types reaching from voluminous and large myocutaneous flaps to ultra-thin cutaneous perforator flaps were used, enabling closure of virtually any type of soft tissue defect. Twelve flaps were lost, resulting in a success rate of 93.7%. CONCLUSION Due to the combined advantages of minimal donor site morbidity, the option of simultaneous flaps and the satisfying results, the anterolateral thigh can be considered a universal donor site which is ideally suited for soft tissue reconstruction in cranio-maxillofacial surgery.
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Affiliation(s)
- Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Plastic Surgery (Chair: Prof. Dr. Dr. K.-D. Wolff), Ruhr-University, Bochum, Germany.
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29
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Spyriounis PK. The Extended Approach to the Vascular Pedicle of the Anterolateral Thigh Perforator Flap: Anatomical and Clinical Study. Plast Reconstr Surg 2006; 117:997-1001; discussion 1002-3. [PMID: 16525298 DOI: 10.1097/01.prs.0000200616.63843.a7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The anterolateral thigh perforator flap is a well-described and versatile flap that has specific advantages. However, the variable anatomy makes flap elevation challenging. Furthermore, the dissection of the proximal part of the pedicle that runs underneath the rectus femoris muscle demands continuous pull by an assistant and is inconvenient and tiring for the surgeon. A technique that facilitates dissection of the proximal pedicle part is suggested. It is useful in both pedicled and free flap transfer, when maximum pedicle length is crucial. METHODS Five anterolateral thigh perforator flaps were dissected using the extended technique. Four were transferred as free flaps and one as an island pedicled flap. In addition, anatomical cadaver studies were performed bilaterally in five fresh cadavers to further clarify the relevant anatomy. RESULTS All flaps survived well. One patient suffered from donor-site infection caused by inadequate drainage. Conservative treatment with daily dressing changes resulted in satisfactory healing. Two patients suffered from hypesthesia of part of the lateral thigh area. No patient experienced any difficulty in daily activities and none suffered from knee extension lag. CONCLUSIONS An extended approach for dissection of the anterolateral thigh perforator flap is described that is useful in both pedicled and free flap transfers. Cautious tunnel creation is a prerequisite for avoidance of complications.
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30
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Chen CM, Chen CH, Lai CS, Lin SD, Huang IY, Shieh TY. Anterolateral Thigh Flaps for Reconstruction of Head and Neck Defects. J Oral Maxillofac Surg 2005; 63:948-52. [PMID: 16003620 DOI: 10.1016/j.joms.2005.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This article presents our clinical experience with head and neck reconstruction using a free anterolateral thigh (ALT) flap and describes the morbidity of the donor site. MATERIALS AND METHODS From October 2001 to October 2003, 20 free ALT flaps were transferred for reconstructing soft tissue defects of the head and neck. The age and gender of the patients, the site of the primary tumor, tumor stage, previous operative condition, types of associated operation, results of flap transfer, donor site morbidity, and clinical course were analyzed. RESULTS Of 20 cases, 19 free flaps were successfully performed. The success rate was 95%. The size of the ALT flaps ranged from 6 to 10 cm in width and 9 to 20 cm in length (54 to 200 cm2 in area). Sixteen of the 20 donor sites were closed primarily, whereas 4 cases required a split-thickness skin graft to cover the donor site. Complications and morbidity of the donor site were minimal. CONCLUSION The ALT flap has some advantages over other free flaps, including a long pedicle with a suitable diameter for anastomoses, the availability of different tissues with large amounts of skin, the ease of closing the donor site, and the ability for 2 teams to simultaneously perform the operation.
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Affiliation(s)
- Chun-Ming Chen
- Department of Oral and Maxillofacial Surgery, Kaohsiung University, Kaohsiung, Taiwan.
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31
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Ribuffo D, Cigna E, Gargano F, Spalvieri C, Scuderi N. The Innervated Anterolateral Thigh Flap: Anatomical Study and Clinical Implications. Plast Reconstr Surg 2005; 115:464-70. [PMID: 15692351 DOI: 10.1097/01.prs.0000149481.73952.f3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the past 20 years, the neural anatomy of many flaps has been investigated, although no extensive studies have been reported yet on the anterolateral thigh flap. The goal of this study was to describe the sensory territories of the nerves supplying the anterolateral thigh flap with dissections on fresh cadavers and with local anesthetic injections in living subjects. The sensate anterolateral thigh flap is typically described as innervated by the lateral cutaneous femoral nerve. Two other well-known nerves, the superior perforator nerve and the median perforator nerve, which enter the flap at its medial border, might have a role in anterolateral thigh flap innervation. Twenty-nine anterolateral thigh flaps were elevated in 15 cadavers, and the lateral cutaneous femoral nerve, the superior perforator nerve, and median perforator nerve were dissected. In the injection study, the lateral cutaneous femoral nerve, superior perforator nerve, and median perforator nerve in 16 thighs of eight subjects were sequentially blocked. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked anterolateral thigh flap territory. The study shows that the sensate anterolateral thigh flap is basically innervated by all three nerves. The lateral cutaneous femoral nerve was present in 29 of 29 thighs, whereas the superior perforator nerve was present in 25 of 29 and the median perforator nerve in 24 of 29 thighs. Furthermore, in the proximal half of the flap, the lateral cutaneous femoral nerve lies deep, whereas the superior perforator nerve and median perforator nerve lie more superficially. Whereas the lateral cutaneous femoral nerve innervates the entire flap, the superior perforator nerve innervates 25 percent of the flap and the median perforator nerve innervates 60 percent of the flap. Clinically, a small anterolateral thigh flap (7 x 5 cm) can be raised sparing the lateral cutaneous femoral nerve and using only the selective areas innervated by the superior perforator and median perforator nerves. Alternatively, a large anterolateral thigh flap can be raised with this multiple innervation. This can be helpful if one wants to harvest the flap under local anesthesia. Sensate bilobed flaps can be harvested when dual innervated flaps are required.
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Affiliation(s)
- Diego Ribuffo
- Division of Plastic Surgery, University of Rome La Sapienza, Rome, Italy.
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32
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Tiguemounine J, Picard A, Fassio E, Goga D, Ballon G. Le lambeau antérolatéral de cuisse. Étude rétrospective. ANN CHIR PLAST ESTH 2005; 50:62-70. [PMID: 15695012 DOI: 10.1016/j.anplas.2004.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Accepted: 10/21/2004] [Indexed: 11/29/2022]
Abstract
The anterolateral thigh flap is a cutaneous or fasciocutaneous perforator flap, extensively used in China, Japan, Taiwan (Demirkan et al., 2000; Kimata et al., 1997; Koshima et al., 1993; Luo et al., 1999) but infrequently in Europe, probably because of variations in origin and course of the cutaneous perforators rending its use apparently less reliable. This study is about 13 anterolateral thigh flaps performed between November 1, 1998, and December 30, 2002, on 13 patients, four women, nine men. Among these 13 flaps, 11 were free flaps, two were pedicled flaps. The surgical procedure was decided because of loss of soft tissue localised in: floor of the mouth (2 flaps), limb (9 flaps), inguinal-illiac region (2 flaps). The mean age of patients was 47.7 years (ext. 23 years and 69 years). The quality of the result was evaluated by the surgeon as good or very good, fair or bad. The function of the donor site was evaluated by questionnaire of the patient and physical examination of knee extension. Three free flaps were re-explored because of venous thrombosis, one of them necrosed. No functional impairment was found. The result was evaluated by the surgeon as good or very good in 11 cases, fair for one case, "bad" in the case were the flap was lost. The results of the reconstructive procedure using the anterolateral thigh flap are satisfying. This flap is reliable if the surgical technique is strictly applied.
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Affiliation(s)
- J Tiguemounine
- Service de chirurgie plastique reconstructrice et esthétique, centre hospitalier universitaire de Tours, 37044 Tours cedex 1, France.
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33
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Huemer GM, Bauer T, Wechselberger G, Schoeller T. Gracilis muscle flap for aesthetic reconstruction in the head and neck region. Microsurgery 2005; 25:196-202. [PMID: 15744721 DOI: 10.1002/micr.20105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Microsurgical tissue transfer has constantly improved the therapeutic options for reconstruction in the head and neck region, but the ideal flap has yet to be found. The purpose of this study is to discuss the aesthetic potential of the free gracilis muscle flap in difficult head and neck reconstruction. We report our experience with the free gracilis muscle flap in seven patients who underwent reconstruction in the head and neck region for a variety of indications. In all seven patients, the transplanted muscle flaps healed well, with no flap loss. Postoperative complications consisted of skin-graft loss in one patient requiring a second split-thickness skin graft. Donor-site morbidity was minimal in all patients. For difficult reconstruction in the head and neck region, the free gracilis muscle flap offers a number of advantages, including reliable vascular anatomy, relatively great plasticity, and a concealed donor area. Thus this type of flap offers a valuable option whenever an aesthetically pleasing result is sought.
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Affiliation(s)
- Georg M Huemer
- Clinical Department of Plastic and Reconstructive Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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34
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Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. ACTA ACUST UNITED AC 2004; 57:603-9. [PMID: 15380693 DOI: 10.1016/j.bjps.2004.05.032] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 05/27/2004] [Indexed: 11/18/2022]
Affiliation(s)
- Jagdeep S Chana
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei 10591, Taiwan, ROC
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35
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Mäkitie AA, Beasley NJP, Neligan PC, Lipa J, Gullane PJ, Gilbert RW. Head and neck reconstruction with anterolateral thigh flap. Otolaryngol Head Neck Surg 2004; 129:547-55. [PMID: 14595278 DOI: 10.1016/s0194-59980301393-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our goal was to present our experience with the free anterolateral thigh flap for reconstruction of various cutaneous and mucosal defects of the head and neck. STUDY DESIGN We conducted a retrospective review of 37 patients who underwent reconstruction between 1994 and 2002. Outcome measures included ethnicity, flap harvest technique, vascular anatomy, flap success, general surgical complications, and donor site morbidity. RESULTS The majority of our patients were white (n = 33). The size of the 39 free anterolateral thigh flaps varied from 24 to 252 cm(2). There was 1 arterial failure and flap loss (2.6%) and 2 venous occlusions that were both salvaged. The donor site was closed primarily in 37 cases and with a split-thickness skin graft in 2 cases. CONCLUSIONS This is the first report on using the free anterolateral thigh flap in whites. This free transfer has proved to be a versatile and reliable flap for reconstruction of the head and neck.
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Affiliation(s)
- Antti A Mäkitie
- Wharton Head and Neck Centre, Princess Margaret Hospital, University Health Network, Toronto, Ontario, USA
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36
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Schoeller T, Huemer GM, Shafighi M, Gurunluoglu R, Wechselberger G, Piza-Katzer H. Free anteromedial thigh flap: Clinical application and review of literature. Microsurgery 2003; 24:43-8. [PMID: 14748024 DOI: 10.1002/micr.10194] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The anteromedial thigh (AMT) flap is reviewed in terms of its vascular anatomy and previous clinical reports in the literature. Our own series of 5 patients treated with this flap for defects in the head and neck region and lower extremity is presented. Although several authors controversially discussed vasculature, we constantly found the pedicle as an emerging septocutaneous perforator at a point where the medial border of the rectus femoris muscle is crossed by the sartorius muscle. In all 5 patients, the AMT flap provided stable coverage with no flap loss. Based on our findings, we conclude that the anteromedial thigh flap offers all the advantages of fasciocutaneous flaps. Therefore, we recommend this flap as an alternative for defects requiring coverages of thin to moderate skin thickness. However, it should be remembered that variations in vascular anatomy are possible.
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Affiliation(s)
- Thomas Schoeller
- Department of Plastic and Reconstructive Surgery and Ludwig-Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery, Leopold-Franzens University, Innsbruck, Austria
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37
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Iida H, Ohashi I, Kishimoto S, Umeda T, Hata Y. Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry. BRITISH JOURNAL OF PLASTIC SURGERY 2003; 56:21-5. [PMID: 12706145 DOI: 10.1016/s0007-1226(03)00018-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An anterolateral thigh flap is very useful in head and neck reconstruction because of its long and large-caliber vascular pedicle, large skin territory and elevation simultaneous with tumour resection. However, the number and locations of cutaneous perforators vary individually, and thus, it is not widely used because flap elevation is often complicated and time-consuming owing to unexpected anatomical variations. To overcome this disadvantage, we assessed the number and locations of cutaneous perforators preoperatively by colour Doppler flowmetry. These data were compared with the intraoperative anatomical findings and their reliability evaluated. A total of 48 cutaneous perforators were found by preoperative colour Doppler flowmetry scanning of 17 anterolateral thigh flaps. All the perforators except two were found intraoperatively. Doppler scanning failed to detect four perforators. Colour Doppler flowmetry assessment therefore has a 92% true-positive rate and a 95.8% positive predictive value. All the flaps except one included multiple perforators, and sufficient blood circulation was observed in all cases. No flaps were unexpectedly changed to anteromedial thigh flaps or contralateral anterolateral thigh flaps because of inappropriate cutaneous perforators or the absence of perforators. Though this investigation is relatively time-consuming (30-40 min) and requires skill, it is very useful for preoperative flap planning and increases the reliability and safety of elevating an anterolateral thigh flap.
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Affiliation(s)
- H Iida
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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38
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Jeng SF, Kuo YR, Wei FC, An PC, Su CY, Chien CY. Free radial forearm flap with adipofascial tissue extension for reconstruction of oral cancer defect. Ann Plast Surg 2002; 49:151-5. [PMID: 12187342 DOI: 10.1097/00000637-200208000-00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The radial forearm flap has been one of the most popular flaps used to reconstruct defects after oral cancer ablation. However, it sometimes may not provide sufficient soft tissue to obliterate the dead space after tumor excision and lymph node dissection, which can result in deep wound infection of the neck or even orocervical fistula. The authors modified the radial forearm flap with a sheet of adipofascial tissue extension to prevent such postoperative complications. From January 1997 to December 2000, 52 patients who underwent ablative oral cancer surgery were studied. A total of 29 patients (group I) underwent reconstruction with the traditional radial forearm flap retrospectively, and 23 patients (group II) underwent reconstruction with the radial forearm flap along with a sheet of adipofascial tissue extension. The radial forearm flap was designed on the axis of the radial artery, was 8 x 4 to 12 x 10 cm in size, and was sufficient to resurface the intraoral defect. In group II, the radial forearm skin flap along with a sheet of adipofascial tissue 8 x 8 to 12 x 10 cm was used to obliterate the dead space of the oral floor and neck. The donor site of both groups was resurfaced with a split-thickness skin graft. In group II, the skin flap of the adipofascial tissue was resutured to its original site. Two flaps in group I failed because of arterial occlusion and required other skin flaps for reconstruction. Postoperative hematoma, which required surgical treatment for drainage, developed in five patients in group I. None of the patients in group II had hematoma formation. Nine patients in group I had a neck wound infection compared with only 2 patients in group II (a significant difference). The average volume of drainage and days of hospitalization were similar in both groups. The morbidity of the donor site of both groups was not significant. The advantages of this modification include 1) suitable soft tissue available for dead space obliteration to decrease the chance of postoperative hematoma; 2) the important vessels in the neck can be protected; 3) there is a decrease in neck wound infections; and 4) donor site morbidity is similar to the traditional group.
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Affiliation(s)
- Seng-Feng Jeng
- Departments of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Chang Gung University, Taiwan
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39
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Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Hau SP, Liao CT. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:30-6. [PMID: 10657446 DOI: 10.1054/bjps.1999.3250] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In search of an alternative soft tissue free flap donor site to radial forearm flap and rectus abdominis flap in head and neck reconstruction, we used the anterolateral thigh flap for reconstruction of various defects in the head and neck in 59 patients. The aim was to demonstrate the versatility of this donor site and propose a new approach to achieve a safer flap dissection. With the exception of three cases, all defects resulted from excision of malignant tumours. The defects were categorised as full thickness defects of the mandible (33.9%), full thickness defects of the cheek (52.5%) and others (13.6%). During the flap dissection a direct septocutaneous pedicle was observed in 12% of the cases. In the remaining cases there were only musculocutaneous perforators and the flaps were raised either as a split vastus lateralis musculocutaneous flap (72%) or as a perforator flap (16%), depending on the required thickness. Total flap survival was 96.7% with one total and one partial failure and two re-explorations (3.3%). The mean follow-up time was 7.1 months (range: 1-12 months). In conclusion, the anterolateral thigh flap is a versatile and dependable flap that can be adapted to any type of defect by modifying the flap design and composition. It should be considered to be a musculocutaneous flap of the vastus lateralis muscle that can also be raised as a perforator flap. When harvested and used in this context, the flap dissection becomes very safe and consistent, nullifying the only major disadvantage associated with this donor site.
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Affiliation(s)
- F Demirkan
- Department of Plastic and Reconstructive Surgery and, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taipei, Taiwan
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