Commentary on ?Reconstruction of an extensive tibial soft tissue defect with multiple local muscle flaps for limb salvage when free tissue transfer was not an option?, by Thornton and Pu

ABSTRACT Introduction: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage. Materials and Methods: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. Observations and Results: Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. Conclusion: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.

Download Full-text

Evaluation of Free Tissue Transfer in The Reconstruction of Soft Tissue Defect in The Leg

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v1i4.81 ◽

1970 ◽

Vol 1 (4) ◽

Author(s):

Parintosa Atmodiwirdjo ◽

Fakhrul Hendra

Keyword(s):

Soft Tissue ◽

Blood Supply ◽

Arterial Thrombosis ◽

Large Diameter ◽

Perforator Flap ◽

Free Tissue Transfer ◽

Significant Degree ◽

Soft Tissue Defect ◽

Tissue Defect ◽

Alt Flap

Background: There are many possible reconstructive options for reconstruction of defects in the lower limb. These include:skin grafts, local flaps, distant flaps and free flaps.Patients and Methods: We present four cases with soft tissue defects in the legs who were admitted to the Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo Hospital, Jakarta, between February 2009 and February 2010. Result: In all four cases, the free anterolateral thigh (ALT) flaps have been performed for reconstruction of soft tissue defect in the upper third of the leg (3 patients) and lower third of the leg (1 patient). The cause of soft tissue defect was trauma in 3 patients and malignancy in 1 patient. All of the donor sites have similar size with the defect tissue with 15 to 20 cm in length and 10 to 15 cmin width. End-to-end microvascular anastomosis was performed in 2 cases while end-to-side anastomosis was done in the other 2 cases. Arterial thrombosis and infection were complications found in early post-operative period. Arterial thrombosis caused failure in 1 case of free ALT flap which were reconstructed further with free radial forearm flap. Summary: Free ALT flap is relatively easy to harvest once the technique of perforator flap dissection has been learnt. It has a reliable blood supply despite some anatomic variability, it is pliable and can be thinned to a significant degree without compromising blood supply, and can provide a long pedicle with large-diameter vessels.

Download Full-text