Reconstruction of lower extremity complex wounds with combined free tissue transfer using the anterolateral thigh flap as a link

Microsurgery ◽  
2012 ◽  
Vol 32 (7) ◽  
pp. 575-579 ◽  
Author(s):  
Tae-Gon Kim ◽  
Il-Kug Kim ◽  
Yong-Ha Kim ◽  
Jun-Ho Lee
Keyword(s):  
Lower Extremity ◽  
Free Tissue Transfer ◽  
Anterolateral Thigh Flap ◽  
Tissue Transfer ◽  
Anterolateral Thigh ◽  
Complex Wounds

scholarly journals Short-term augmentation of venous drainage with extra-corporeal shunt and simultaneous auto-transfusion, for salvaging a congested free flap

2013 ◽  
Vol 46 (03) ◽  
pp. 572-576 ◽  
Author(s):  
Rahul K. Patil ◽  
Kiran Jayaprasad ◽  
Saurabh Sharma ◽  
Mohit Sharma ◽  
Jimmy Mathew
Keyword(s):  
Tibial Fracture ◽  
Venous Blood ◽  
Free Tissue Transfer ◽  
Venous Drainage ◽  
Anterolateral Thigh Flap ◽  
Short Term ◽  
Critical Part ◽  
Tissue Transfer ◽  
Anterolateral Thigh ◽  
Potential Applications

ABSTRACTAdequate drainage of venous blood is the most critical part of successful free tissue transfer. We report a case of anterolateral thigh flap used for covering open communited tibial fracture. The flap was salvaged with short term augmentation of venous drainage with external shunt. The drainage was continued for six days. It was confirmed that there is no more congestion after blocking the catheter and then the drainage was discontinued on seventh day. The flap was successfully salvaged. This method has potential applications in multiple situations for successful salvage of free tissue transfer.

scholarly journals Free Tissue Transfer Penile Reconstruction

2019 ◽  
Vol 33 (01) ◽  
pp. 024-029 ◽  
Author(s):  
Jason Cohn ◽  
Weitao Wang ◽  
Mofiyinfolu Sokoya ◽  
Yadranko Ducic ◽  
Bradley Kropp
Keyword(s):  
Free Tissue Transfer ◽  
Anterolateral Thigh Flap ◽  
Complete Excision ◽  
Advantages And Disadvantages ◽  
Tissue Transfer ◽  
Anterolateral Thigh ◽  
Gender Affirmation ◽  
Scapular Flap ◽  
Radial Forearm ◽  
And Gender

AbstractPhalloplasty can be a challenging plastic surgery procedure associated with complications and unsatisfactory results. Phalloplasty has become an important procedure in the setting of trauma, partial or complete excision of the penis, and gender affirmation. Advances in microsurgery has expanded penile reconstruction through free tissue transfer techniques which include the radial forearm free flap, fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular flap, and abdominal flaps. Each procedure has advantages and disadvantages; most of the procedures achieve adequate cosmetic results with high patient satisfaction. Most of the surgical complications are related to the reconstruction of the urethra or creating rigidity for intercourse. The main goals of reconstruction are to create a cosmetically appealing phallus with satisfactory sexual function.

Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap

2021 ◽  
pp. 153473462098223
Author(s):  
Jong-Ho Kim ◽  
Hyokyung Yoo ◽  
Seokchan Eun
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Distal Portion ◽  
Outcome Data ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Flap Viability ◽  
Anterolateral Thigh ◽  
Large Skin ◽  
Tissue Defects

The anterolateral thigh flap is a classic flap used for various reconstruction defects. However, the flap viability of extended large skin paddles (ie, 240 cm2) was doubted by many surgeons. This study reports successful experience of reconstructing extensive soft tissue defects of lower extremity using extended large skin paddles. Twelve consecutive patients who had undergone reconstruction of defects using an extended anterolateral thigh flap were identified. Patient characteristics (age, sex, defect location, injured structures, and type of flap) and outcome data were analyzed retrospectively. One artery and 2 accompanying veins were anastomosed to vascularize each flap. Follow-up periods ranged from 10 to 91 months postoperatively. The average size of the flaps was 268.75 cm2 (range = 220-391 cm2). All flaps were perforator flaps with one perforator except that 2 perforators were used in 3 patients. Two patients suffered partial flap necrosis of the distal portion with delayed healing. In conclusion, the extended anterolateral thigh flap is a considerable option for massive defects requiring composite tissue coverage. This flap is advantageous for reconstructing various complex defects in the lower extremities, providing a pliable and vascularized tissue to cover exposed extensive defects including tendons, nerves, and bones.

scholarly journals Risk Factors for Amputation Following Lower Extremity Free Tissue Transfer in a Chronic Wound Population

2019 ◽  
Vol 7 ◽  
pp. 84-85
Author(s):  
Peter Wirth ◽  
Jonathan A. Schwitzer ◽  
Vikas S. Kotha ◽  
Elliot T. Walters ◽  
Karen Kim Evans
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Chronic Wound ◽  
Free Tissue Transfer ◽  
Tissue Transfer

Cross-Leg Flaps for Lower Extremity Salvage: A Scoping Review

2019 ◽  
Vol 35 (07) ◽  
pp. 505-515
Author(s):  
Melody Scheefer Van Boerum ◽  
Thomas Wright ◽  
Mary McFarland ◽  
Michelle Fiander ◽  
Christopher J. Pannucci
Keyword(s):  
Lower Extremity ◽  
Scoping Review ◽  
Free Tissue Transfer ◽  
The United States ◽  
Posterior Tibial Artery ◽  
Tissue Loss ◽  
Peroneal Artery ◽  
Tissue Transfer ◽  
Reconstructive Option ◽  
Soft Tissue Loss

Abstract Background Lower extremity trauma with soft tissue loss presents a challenge to the reconstructive surgeon. Cross-leg flaps, first described by Hamilton in 1854, are still used to salvage traumatized lower extremities in patients not suitable for free tissue transfer, or those who are receiving care in locations with limited resources. Methods A scoping review methodology was used to examine the evidence supporting the use of cross-leg flaps in modern healthcare. Results There have been 409 cases of cross-leg flaps reported in the modern literature, with the majority of flap cases occurring outside the United States in Turkey, India, and Japan. The most common indication was trauma, mentioned in 93.2% of patients (n = 353 of 379), and anatomic limitation, including inadequate vasculature, was the main reason for not performing free tissue transfer (52.8% of patients; n = 170 of 322). The majority are cross-leg fasciocutaneous flaps (85.8%, n = 273 of 318), based off the posterior tibial artery (27.5%, n = 50 of 182) and peroneal artery (26.9%, n =  49 of 182) and, covering defects of the distal third of the leg (55.5%, n = 151 of 272), or the foot (27.9%, n = 76 of 272). The pedicles are typically divided at 3 weeks (mean 20.9 days) after external fixation is used as the immobilization method (57.7%, n = 184 of 319). Flap survival was 100% across all publications except one (n = 349 of 350 patients), making cross-leg flaps a robust and reliable reconstructive option. Conclusion In resource-limited environments or in patients who are unsuitable for microvascular free tissue transfer, the cross-leg flap remains an impactful and reliable option for limb salvage.

The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review

2020 ◽  
Vol 36 (09) ◽  
pp. 634-644
Author(s):  
Carol E. Soteropulos ◽  
Nikita O. Shulzhenko ◽  
Harry S. Nayar ◽  
Samuel O. Poore
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Complication Rate ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Cochrane Central Register ◽  
Fasciocutaneous Flaps ◽  
Tissue Transfer ◽  
Individual Participant ◽  
The Impact

Abstract Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls of microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined the impact of perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and impact of pedicle skeletonization on perforator-based fasciocutaneous flaps of the lower extremity. Methods PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were reviewed for literature examining perforator-based fasciocutaneous flaps from knee to ankle, from January 2000 through November 2018. The Preferred Reporting Items for Systematic Reviews-Individual Participant Data (PRISMA-IPD) structure was used. Results Thirty-six articles were included for quantitative analysis. Of 586 flaps, 365 were skeletonized (60.1%) with 58 major (9.9%) and 19 minor complications (3.2%). With skeletonization, overall reoperative rate was higher (odds ratio [OR]: 9.71, p = 0.004), specifically in propeller (OR: 12.50, p = 0.004) and rotational flaps (OR: 18.87, p = 0.004). The complication rate of rotational flaps also increased (OR: 2.60, p = 0.04). Notably, skeletonization reduced complications in flaps rotated 90 degrees or more (OR: 0.21, p = 0.02). Reoperative rate of distal third defects (OR: 14.08, p = 0.02), flaps over 48 cm2 (OR: 33.33, p = 0.01), and length to width ratios over 1.75 (OR: 7.52, p = 0.03) was increased with skeletonization. Skeletonization increased complications in traumatic defects (OR: 2.87, p = 0.04) and reduced complications in malignant defects (OR: 0.10, p = 0.01). Conclusion Pedicled, perforator-based flaps can provide a reliable locoregional alternative to free tissue transfer for lower extremity defects. Though skeletonization increased the overall reoperative rate, the complication rate for flaps with 90 degrees or more of rotation was significantly reduced. This suggests skeletonization should be considered when large rotational movements are anticipated to reduce complications that can arise from pedicle compression and venous congestion.

Sign in / Sign up

Export Citation Format

Share Document