Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps

Abstract Background Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction. Methods We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications. Results Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months). Conclusions Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites. Level of evidence: Level IV, therapeutic study.

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Complex Soft Tissue Defects in Operative Urology: Pedicled Perforator Flaps of the Anterior Lateral Thigh for Tissue Reconstruction of the Lower Trunk

Urologia Internationalis ◽

10.1159/000512057 ◽

2021 ◽

pp. 1-6

Author(s):

Rafael Jakubietz ◽

Michael Jakubietz ◽

Adrian Vater ◽

Arkadius Kocot ◽

Hubert Kübler ◽

...

Keyword(s):

Soft Tissue ◽

Interdisciplinary Approach ◽

Soft Tissue Reconstruction ◽

Soft Tissue Defects ◽

Lower Abdomen ◽

Perforator Flaps ◽

Urologic Surgery ◽

Tissue Reconstruction ◽

Alt Flap ◽

Tissue Defects

Background: Complex soft tissue defects involving the lower abdomen, perineum, and groin (LAPG) represent reconstructive challenges following urologic surgery. Consequently, these often require an interdisciplinary approach involving plastic surgery. While pedicled flaps from the lower abdomen are a reliable option, previous placement of colostomies and urinary urostomies renders these flap types unavailable. Here, the pedicled anterolateral thigh perforator (ALT) flap represents a reliable pedicled alternative which can harvest from the thigh. Materials and Methods: A retrospective data analysis of pedicled perforator flaps harvested from the thigh to reconstruct soft tissue defects was conducted. Seven patients treated in the urology department with soft tissue defects following tumor resection, infection, and dehiscence were included. Results: In all patients, the ALT flap was utilized successfully to reconstruct soft tissue defects up to 450 cm2 in size. All flaps survived. In 1 case, prolonged wound healing was observed. All defects were adequately addressed with no recurrence of dehiscence or fistula formation. Conclusions: Pedicled perforator flaps represent a valid option for the soft tissue reconstruction of the lower abdomen and perineum when a pedicled rectus abdominis flap is no longer available. This flap is, therefore, a good option in an interdisciplinary approach to soft tissue reconstruction, especially following urologic surgery, which is predominantly performed in the LAPG region.

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Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

Foot & Ankle International ◽

10.1177/107110070502600302 ◽

2005 ◽

Vol 26 (3) ◽

pp. 191-197 ◽

Cited By ~ 15

Author(s):

Frederick J. Duffy ◽

James W. Brodsky ◽

Christian T. Royer

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Donor Site Morbidity ◽

Tissue Loss ◽

Soft Tissue Reconstruction ◽

Foot And Ankle ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Microsurgical Reconstruction ◽

Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

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Free Peroneal Artery Perforator-Based Flap for Soft Tissue Reconstruction of the Finger

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0037-1608670 ◽

2017 ◽

Vol 02 (02) ◽

pp. e136-e139

Author(s):

Kenji Kawamura ◽

Hiroshi Yajima ◽

Shohei Omokawa ◽

Takamasa Shimizu ◽

Satoshi Hayashi ◽

...

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Peroneal Artery ◽

Soft Tissue Reconstruction ◽

Digital Artery ◽

Soft Tissue Defects ◽

Tissue Reconstruction ◽

Perforator Vessels ◽

Artery Perforator ◽

Tissue Defects

Background The peroneal artery perforator-based flap has been widely used as a pedicled propeller flap for soft tissue reconstruction in the lower extremity; however, its application as a free flap has been rarely reported. We report on the utility of the free peroneal artery perforator-based flap for finger soft tissue reconstruction. Methods Twelve patients underwent reconstructions of soft tissue defects of the finger with free peroneal artery perforator-based flaps. The soft tissue defects were located either dorsally and/or laterally on the fingers. The size of the flaps ranged from 5 × 2 to 8 × 3 cm. The length of the vascular pedicles ranged from 4 to 5 cm. The artery and vein of the perforator vessels were anastomosed in the finger to the digital artery and subcutaneous vein, respectively. Results All twelve flaps survived completely, and the donor site in the lower leg was closed primarily in all cases. Secondary defatting was performed in six cases, while in the remaining cases, thinning of the flap was performed when the flap was transferred. Conclusion The advantages of the free peroneal artery perforator-based flap for finger soft tissue reconstruction include the following: the flap is flexible and can be thinned to match the texture of the finger; elevation of the flap is easy; the donor site can be closed primarily; there is no need to sacrifice any main arteries in the lower leg; and the diameter of the perforator vessels is suitable for anastomosis to the digital artery and subcutaneous vein in the finger.

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Clinical Study of the Lateral Supramalleolar Flap in the Soft Tissue Reconstruction around the Ankle Region

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-3402354 ◽

2020 ◽

Vol 53 (01) ◽

pp. 083-089 ◽

Cited By ~ 1

Author(s):

G. I. Nambi ◽

T. K. Arudra Varanambigai

Keyword(s):

Clinical Study ◽

Soft Tissue ◽

Soft Tissue Reconstruction ◽

Soft Tissue Defects ◽

Split Skin Graft ◽

Tissue Reconstruction ◽

Split Skin ◽

Tissue Defects ◽

Ankle And Foot

Abstract Objective The purpose of this study is to present the efficiency of the lateral supramalleolar flap which is a very useful and yet underutilized in the soft tissue reconstruction of the regions extending from the distal leg, ankle, and foot. Methods Over a period of 3 years, 20 flaps were used in the reconstruction of soft tissue defects in the region extending from the distal leg, ankle, and foot. The location of the defects, the etiology, possible alternative flaps, outcome, and the complications were studied and presented. Results The follow-up period of the cases was from 1 month to 18 months after surgery. Seventeen flaps survived and three were lost. All the three lost flaps were those used over the tendocalcaneal region. The lost flaps were later replaced with split skin graft after the wound was debrided and was later covered with granulation tissue. Conclusion The lateral supramalleolar flap is a very useful flap in the regional soft tissue reconstruction around the ankle except in the tendocalcaneal region.

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Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_19_17 ◽

2018 ◽

Vol 51 (02) ◽

pp. 216-221 ◽

Cited By ~ 4

Author(s):

Deepak Nanda ◽

Shamendra Anand Sahu ◽

Durga Karki ◽

Sanjay Kumar ◽

Amrita Mandal

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Donor Site ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Tibial Artery ◽

Split Skin ◽

Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

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Minimally invasive soft tissue reconstruction with free peroneal artery perforator flap

Internal Medicine Review ◽

10.18103/imr.v2i8.173 ◽

2016 ◽

Vol 2 (8) ◽

Author(s):

Kenji Kawamura ◽

Hiroshi Yajima ◽

Shohei Omokawa ◽

Takamasa Shimizu ◽

Naoki Maegawa ◽

...

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Donor Site ◽

Perforator Flap ◽

Peroneal Artery ◽

Soft Tissue Reconstruction ◽

Perforator Flaps ◽

Major Vessel ◽

Tissue Reconstruction ◽

Artery Perforator

The development of a concept of perforator flap has dramatically changed the soft tissue reconstructive surgery. The surgery with perforator flaps enables to minimize donor-site morbidity by preserving important tissues including the muscle and the major vessel. The peroneal artery perforator flap is one of perforator flaps that can be harvested from the lower leg. The peroneal artery perforator flap has been widely used as a local flap for soft tissue reconstruction in the lower extremity; however, the free peroneal artery perforator flap transfer has been little reported. Utilities of the free peroneal artery perforator flap for soft tissue reconstruction of the extremities are reported, and minimally invasive flap surgery with perforator flaps is reviewed.

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Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1601422 ◽

2017 ◽

Vol 33 (07) ◽

pp. 466-473 ◽

Cited By ~ 18

Author(s):

Akhil Seth ◽

Matthew Iorio

Keyword(s):

Soft Tissue ◽

Soft Tissue Reconstruction ◽

Flap Reconstruction ◽

Venous Anastomosis ◽

Distal Extremity ◽

Anterolateral Thigh ◽

Effective Option ◽

Tissue Reconstruction ◽

Extremity Reconstruction ◽

Alt Flap

Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial (n = 14) or super-thin (n = 11) ALT flap reconstruction for primarily lower extremity wounds (n = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m2, respectively. Follow-up was 6.3 months. Comorbidities included smoking (n = 7), diabetes (n = 8), peripheral vascular disease (n = 6), and hypertension (n = 8). The presence of hardware (n = 9), trauma (n = 10), and chronic infection (n = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n = 16) taken on one perforator. Forty-eight percent (n = 12) were end-to-side anastomoses and 62% (n = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n = 6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.

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Free Thoracodorsal Artery Polyfoliate Perforator Flaps for Repairing Multiple Soft Tissue Defects in the Hand

10.21203/rs.3.rs-461312/v1 ◽

2021 ◽

Author(s):

Wenquan Ding ◽

Jianbo Xue ◽

Yingling Zhou ◽

Lingfeng He ◽

Xiaofeng Wang

Keyword(s):

Soft Tissue ◽

Evaluation System ◽

Operative Time ◽

Donor Site ◽

Active Movement ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Short Operative Time ◽

Thoracodorsal Artery ◽

Tissue Defects

Abstract Background: Hand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.To confirm the feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand. Methods: Fifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated. Results: The flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12-26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Obvious scar hyperplasia was noted in three patients. A puffed appearance in the recipient area was noted in four patients.To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs. Conclusion: Free thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

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