Use of Anteromedial Thigh Flaps as an Alternative to Anterolateral Thigh Flaps for Reconstruction of Head and Neck Defects in Cancer Patients

Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity-score-matched patient cohorts

BACKGROUND

The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction.

METHODS

A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications.

RESULTS

Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well-balanced pairs of propensity-score-matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026).

CONCLUSION

This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity-score-matched cohorts.

Perforator navigation using color Doppler ultrasound and three-dimensional reconstruction for preoperative planning of optimal lateral circumflex femoral artery system perforator flaps in head and neck reconstruction

BACKGROUND

The authors introduce an algorithm for preoperative planning of optimal lateral circumflex femoral artery system perforator flap (LCFAPF) supplied by the best quality and the easiest dissection of the perforators and the source vessels for simplified and customized strategies in head and neck reconstruction with perforator navigation using color Doppler ultrasound and three-dimensional reconstruction (3D-CDUS PN).

METHODS

Between June 2011 and September 2015, a prospective cohort study was performed with an algorithm based on defect site, perforator type, and pedicle length using 3D-CDUS PN to select optimal perforators arising from the different branches of LCFA in 108 patients. The optimal perforator and flap were determined by perforator caliber and quality, difficulty in flap dissection, and length of the source vessels. Cause and classification of the defect, flap choice, recipient vessels, postoperative course, and complications were analyzed.

RESULTS

The source vessels of the perforators were lateral descending branch in 73 cases and oblique branch in 17 cases with ALTPFs, medial descending branch in 12 cases with AMTPFs, and ascending branch in 6 cases with TFLPFs. Straightforward dissection of flaps with septocutaneous (n = 40) and semi-septocutaneous (n = 17) perforators was performed in 52.8% cases. Successful exploration rate and overall flap survival rate were both 100%. Satisfactory functional and esthetic results in both recipient and donor sites with no serious complications were observed in all patients.

CONCLUSIONS

Our algorithm using 3D-CDUS PN facilitates selection of optimal flap with better caliber and quality of the perforators and sufficient pedicle length for easy dissection.

Salvage of planned ALT flap with rectus femoris free flap for pediatric lower extremity reconstruction: A demonstrative case report

INTRODUCTION

Free tissue transfer in children represents a good option for reconstruction in skilled hands despite the technical difficulties, and represent a significant challenge in microsurgery. With Anteriorlateral thigh flap is a popular option even in pediatric age group.

PRESENTATION OF CASE

We report here a case of 9 year old girl that sustained a lower extremity trauma with exposed ankle joint secondary to Motor Vehicle Crash, That was planned for (ALT) Anterior Lateral Thigh flap reconstruction, and was not completed and salvaged by rectus femoris flap as an alternative option on table to complete the reconstruction.

DISCUSSION

Such case was successfully reconstructed by rectus femoris muscle free flap when ALT (Anterior lateral thigh) flap could not be completed as planned although it's the workhorse flap in majority of cases, due to absence of perforator utilizing the same vascular anatomical blood supply with no significant donor site morbidity.

CONCLUSION

Based on this case report the rectus femoris flap was successfully performed, and we believe it's an effective and reliable backup option to reconstruct complex lower extremity wound even in pediatric age group.

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

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.

Double anterior (anterolateral and anteromedial) thigh flap for oral perforated defect reconstruction

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.

Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

Objective

Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction.

Study Design

Case series and chart review.

Setting

Tertiary care teaching hospital.

Subjects and Methods

Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed.

Results

The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%.

Conclusion

This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

Functional reconstruction of a combined tendocutaneous defect of the achilles using a segmental rectus femoris myofascial construct: a viable alternative

The composite anterolateral thigh flap with vascularized fascia lata has emerged as a workhorse at our institution for complex Achilles defects requiring both tendon and soft tissue reconstruction. Safe elevation of this flap, however, is occasionally challenged by absent or inadequate perforators supplying the anterolateral thigh. When discovered intraoperatively, alternative options derived from the same vascular network can be pursued. We present the case of a 74-year-old male who underwent composite Achilles defect reconstruction using a segmental rectus femoris myofascial free flap. Following graduated rehabilitation, postoperatively, the patient resumed full activity and was able to ambulate on his tip-toes. At 1-year follow-up, active total range of motion of the reconstructed ankle exceeded 85% of the unaffected side, and donor site morbidity was negligible. American Orthopaedic Foot and Ankle Society and Short Form-36 scores improved by 78.8% and 28.8%, respectively, compared to preoperative baseline assessments. Based on our findings, we advocate for use of the combined rectus femoris myofascial free flap as a rescue option for reconstructing composite Achilles tendon/posterior leg defects in the setting of inadequate anterolateral thigh perforators. To our knowledge, this is the first report to describe use of this flap for such an indication.