Tear drop-free anterolateral thigh flap, a versatile design for lower limb reconstruction after trauma

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

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ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

Journal of Medicine and Pharmacy ◽

10.34071/10.34071/jmp.2019.3.6 ◽

2019 ◽

pp. 44-48

Author(s):

Hong Phuc Le ◽

Thiet Son Tran ◽

Nghi Thanh Nhan Le

Keyword(s):

Lower Limb ◽

Free Flaps ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Fasciocutaneous Flaps ◽

Limb Reconstruction ◽

Anterolateral Thigh ◽

Lower Limb Reconstruction ◽

Alt Flap ◽

Tissue Defects

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

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Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606559 ◽

2017 ◽

Vol 33 (S 01) ◽

pp. S27-S33 ◽

Cited By ~ 5

Author(s):

Martina Corno ◽

Salvatore D'Arpa ◽

Pietro Di Summa ◽

Igor Pellegatta ◽

Luigi Valdatta ◽

...

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Donor Site ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Muscle Flaps ◽

Limb Reconstruction ◽

Lower Limb Reconstruction ◽

Tissue Defects

AbstractSoft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge in perforator anatomy and their mapping, a new era of lower limb reconstruction has begun. Propeller flap could be raised on any suitable perforator vessel and, without the aid of microsurgical anastomosis, used to restore small- to middle-sized soft tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous free flaps and the applicability of the propeller flaps in lower limb reconstruction.

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Free Flaps in Complex Lower Limb Reconstruction - 2-Year Experience

Journal of Reconstructive Microsurgery ◽

10.1055/s-0034-1374005 ◽

2014 ◽

Vol 30 (S 01) ◽

Author(s):

Horácio Zenha ◽

Carla Diogo ◽

Sara Ramos ◽

Susana Pinheiro ◽

Ricardo Carvalho ◽

...

Keyword(s):

Lower Limb ◽

Free Flaps ◽

Limb Reconstruction ◽

Lower Limb Reconstruction

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Canadian Trends in Free Flap Management for Microsurgical Lower Limb Reconstruction

Plastic Surgery ◽

10.1177/22925503211019602 ◽

2021 ◽

pp. 229255032110196

Author(s):

Michelle Bonapace-Potvin ◽

Alexander Govshievich ◽

Laurent Tessier ◽

Mihiran Karunanayake ◽

Dominique Tremblay ◽

...

Keyword(s):

Lower Limb ◽

Free Flaps ◽

Online Questionnaire ◽

Limb Reconstruction ◽

Changing Practice ◽

Current State ◽

Lower Limb Reconstruction ◽

Tumor Extirpation ◽

Based Medicine ◽

Previous Training

Introduction: Free tissue transfers have become a mainstay in lower limb salvage, allowing safe and reliable reconstruction after trauma, tumor extirpation, and complex wounds. The optimal perioperative (PO) management of these flaps remains controversial. This study aims to assess the current state of practice among Canadian microsurgeons. Methods: Sixty-four Canadian microsurgeons were approached to complete an online questionnaire regarding their PO management of fasciocutaneous free flaps used for lower limb reconstruction. Trends in dangling timing and duration, use of venous couplers, compressive garments, thromboprophylaxis, and surgeons’ satisfaction with their protocol were assessed. Results: Twenty-eight surgeons responded. Fifty-seven percent did not have a specific mobilization protocol. Dangling was mainly initiated on postoperative days 5 to 6 (44%). The most common protocol duration was 5 to 6 days (43%). The concern for prolonged venous pooling was the main reason for delay of dangling (71%). Compressive garments were placed routinely by 12 surgeons (43%) with 20% starting before dangling, 46% with dangling, and 33% after dangling. Venous couplers were routinely used by 24 surgeons (85.7%). Trends in management were influenced by previous training in 53.6% of cases (vs evidence-based medicine 7.1%). Although 89.3% were satisfied with their approach, 92.8% would consider changing practice if higher-level evidence was available. Conclusions: The majority of Canadian microsurgeons initiate dangling early and utilize venous couplers. However, the use of compressive garments is limited. Trends in management are largely based on personal experience. Nearly all surgeons would consider changing their practice if higher-level evidence was available.

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Lower limb reconstruction with bone free flaps: experience of 25 cases

European Journal of Plastic Surgery ◽

10.1007/s00238-011-0654-2 ◽

2011 ◽

Vol 35 (5) ◽

pp. 359-364

Author(s):

Luís Azevedo ◽

Horácio Zenha ◽

Leonor Rios ◽

Hugo Sequeira ◽

Gustavo Coelho ◽

...

Keyword(s):

Lower Limb ◽

Free Flaps ◽

Limb Reconstruction ◽

Lower Limb Reconstruction

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Islanded Posterior Tibial Artery Perforator Flap for Lower Limb Reconstruction: Review of Lower Leg Anatomy

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e318200ad06 ◽

2011 ◽

Vol 127 (2) ◽

pp. 1014-1015 ◽

Cited By ~ 3

Author(s):

Megan C. Jack ◽

Martin I. Newman ◽

Yoav Barnavon

Keyword(s):

Lower Limb ◽

Perforator Flap ◽

Lower Leg ◽

Posterior Tibial Artery ◽

Limb Reconstruction ◽

Posterior Tibial ◽

Tibial Artery ◽

Lower Limb Reconstruction ◽

Artery Perforator

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Modified Recipient Blood Flow-Preserved Cross-Leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

10.21203/rs.3.rs-411666/v2 ◽

2021 ◽

Author(s):

Hong-Xiang Zhou ◽

Liang He ◽

Dong Yin ◽

Yang Niu ◽

Zhe Jin ◽

...

Keyword(s):

Blood Flow ◽

Lower Limb ◽

Posterior Tibial Artery ◽

Anterolateral Thigh Flap ◽

Posterior Tibial ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Flap Procedure ◽

Tissue Defects

Abstract Background Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy. Methods Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up. Results All 22 flaps survived. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed in a single fashion, and four flaps were bilobed. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries was confirmed during follow-up. All flaps recovered sensation at the final follow-up. The postoperative follow-up ranged from 18 to 84 months, and no long-term complications were observed. Conclusions The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing the major artery of the uninjured lower limb.

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