Feasibility of a bone and soft tissue chimeric anterolateral thigh free flap? Anatomic study and report of two cases for oral cavity reconstruction

2018 ◽  
Vol 71 (5) ◽  
pp. 729-735 ◽  
Author(s):  
J.A. LoGiudice ◽  
J.G. Yan ◽  
B.L. Massey ◽  
J. Neilson ◽  
N. Flugstad ◽  
...  
2014 ◽  
Vol 29 (1) ◽  
pp. 26-29
Author(s):  
Jefferson A. Alamani ◽  
Samantha S. Castañeda ◽  
Adrian F. Fernando

Objective: To present our application of a double anterolateral thigh (ALT) free flap in reconstruction of a large full thickness defect of the oral cavity, cheek and cervical area. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 77-year-old male with a 20 x 25 cm full thickness soft tissue defect on the facial and cervical area contiguous with a 6 x 6 cm buccal defect resulting from wide tumor ablation of a Stage IVA (T4aN2bM0) squamous cell carcinoma of the buccal mucosa underwent reconstruction using two ALT free flaps. An ALT flap was designed to cover the intraoral and cheek defect, while another ALT flap was used for external coverage of the cervical defect. The first ALT flap measured approximately 8 x 22 cm while the second ALT flap measured 6 x 22 cm harvested from the left and right thigh respectively. Temporary venous congestion was observed on the inferiorly placed ALT flap due to neck edema that spontaneously resolved on the 2nd post-operative day. Minimal donor site complications observed were linear scars, and a 1 x 4 cm dehiscence on the right thigh that healed spontaneously by secondary intention.   Conclusion: The utilization of a double anterolateral thigh free flap allowed single-stage reconstruction of the large soft tissue head and neck defect with little donor site morbidity, shorter operating time and shorter hospital stay.   Keywords: anterolateral thigh free flap (ALT flap), double ALT flap, full-thickness buccal defect


2020 ◽  
pp. 85-91
Author(s):  
Phuc Le Hong ◽  
Son Tran Thiet ◽  
Thuy Nguyen Xuan

Background: In recent years, the composite anterolateral thigh free flap with tensor fasciae latae or vastus lateralis has been a new-applied type of flap that can provide very good reconstruction materials in complex defects of lower leg and foot. The study purpose is to evaluate the systematically complications of donor site, related factors to results of the donor area, in order to apply the result to improve the treatment, which have not been much reported in literature. Materials and Methods: Systematic donor site morbilidy evaluation in a prospective, uncontrolled clinical descriptive study of 33 composite anterolateral thigh free flaps in various forms to reconstruct anatomical structures or to resconstruct deep defects combined with covering the surfaces for complex soft tissue defects in lower extremities for 32 patients due to different causes in lower leg and foot area from 2014-2019 at Hue University of Medicine and Pharmacy. Examining and evaluating aesthetic and functional result of donor-site 3 months and 6 months up to 2 year after surgery; evaluating the correlation between the width and the type of the flaps and donor site closure methods. Result: In 33 composite flaps used, flap width to thigh circumference less than 20% in 27 cases (81.8%), more than 20% in 6 cases (18.20% ); There were 28 cases in which the donor site was directly closed, 5 cases required skin graft; All direct closed cases had flap width/ thigh circumference index below 20%; On the contrary, in cases having this index greater than 20%, the donor site required skin graft with p < 0.01. There are 11/33 (33.33%) of cases reported complications in donor site ; lateral thigh paresthesia is the most complicated complication with 8/33 cases (24.24%), followed by bad scarring 3/33 cases (9.09%). Conclusion: Long term follow up donor site morbility after composite anterior thigh free flap present 11/33 cases (33.33%): mostly complications of the donor site are thigh paresthesia with 8/33 cases (24.24%), and bad scarring 3/33 cases (9,09%), which improve time by time. Keywords: Composite anterior thigh free flap, lower extremities soft tissue defect, donor site morbidity


Oral Oncology ◽  
2016 ◽  
Vol 55 ◽  
pp. e11-e12 ◽  
Author(s):  
Chung-Kan Tsao ◽  
Joaquim Megias Barrera ◽  
Charles Yuen Yung Loh

2018 ◽  
Vol 18 (1) ◽  
pp. 89-93
Author(s):  
Joonho Lim ◽  
Heeyeon Kwon ◽  
Kyoung Min Lee ◽  
Changsik Pak

In a severely injured leg with acute limb ischemia, both immediate revascularization of an endangered part and coverage of soft tissue defect are crucial to limb salvage. In this article, we report a case of an anterolateral thigh free flap with interposition graft of descending branches of the lateral circumflex femoral vessels. A 18-cm-long graft was harvested and used to replace the injured anterior tibial vessels. One month later, a duplex sonogram revealed intact circulation to both the interposition graft and the flap. Despite anatomic inconstancy, the anterolateral thigh free flap is commonly utilized in reconstructive surgeries. When descending branches of the lateral femoral circumflex vessels were included sufficiently, its pedicle can be used to bridge a vascular defect in the extremity while covering soft tissue defect.


2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Nikolas Higa Benites ◽  
Guilherme Leipner Margatho ◽  
Fernanda Ruiz de Andrade ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Amanda Favaro Cagnolati ◽  
...  

Introdução: Com a evolução da microcirurgia ao longo dos anos o Retalho Anterolateral da Coxa vem se tornando uma das principais opções para reconstruções na cabeça, pescoço, tronco e extremidades devido sua versatilidade e confiabilidade. Objetivo: Descrever dados de um hospital terciário referência em trauma na reconstrução de extremidades com o Retalho Anterolateral da Coxa. Método: Este é um estudo retrospectivo de 18 retalhos Anterolateral da Coxa microcirúrgicos realizados entre Março de 2016 e Outubro de 2019 em pacientes de todas as idades, na reconstrução de membros, onde se observou dados referentes ao paciente: idade, sexo, membro acometido, tempo entre a lesão e a confecção do retalho; ao intraoperatório: anatomia dos vasos perfurantes, tempo cirúrgico total, vasos receptores utilizados; e informações do pós-operatório: número de cirurgias relacionadas ao retalho, necessidade de reabordagem e número de perdas. Foram excluídos pacientes que perderam seguimento ou que apresentaram dados do prontuário incompletos. Realizou-se estatística descritiva e cruzamento de algumas variáveis utilizando o teste t-Student. Resultados: Nas reconstruções houve predomínio de pacientes do sexo masculino (72%), em idade produtiva, de etiologia traumática e nos membros inferiores. O tempo médio até a reconstrução foi de 21 dias e o tempo cirúrgico foi de 384 minutos. O paciente permaneceu, em média, 39 dias internado. Dos 18 retalhos, 3 evoluíram com necrose, 2 por trombose arterial e 1 por infecção. 6 retalhos necessitaram de reaborgadem de emergência, 3 por sangramento, 2 por congestão e 1 por infecção. Foram realizadas uma média de 3 cirurgias até a alta. Foram identificadas 15 perfurantes miocutâneas (83%) e 3 septocutâneas (17%). A análise do sucesso do retalho em relação ao tempo cirúrgico e dos dias até a cirurgia não mostrou significância estatística, assim como a necessidade de reabordagem em relação ao tempo cirúrgico. Conclusão: O retalho Anterolateral da Coxa mostrou-se confiável, além de apresentar diversas vantagens como: por ser retirado com uma grande ilha de pele, apresentar pedículo longo, vasos de bom calibre, não necessitar de mudança de decúbito e apresentar baixa morbidade da área doadora.Descritores: Retalho Miocutâneo; Microcirurgia; Hospitais Especializados.ReferênciasDaniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg. 1973;52(2):111-17.Ninkovic M, Voigt S, Dornseifer U, Lorenz S, Ninkovic M. Microsurgical advances in extremity salvage. Clin Plast Surg. 2012;39(4):491-505.Tamimy MS, Rashid M, Ehtesham-ul-Haq, Aman S, Aslam A, Ahmed RS. Has the anterolateral thigh flap replaced the latissimus dorsi flap as the workhorse for lower limb reconstructions? J Pak Med Assoc. 2010; 60(2):76-81.Spyropoulou A, Jeng SF. Microsurgical coverage reconstruction in upper and lower extremities. Semin Plast Surg. 2010;24(1):34-42.Xiong L, Gazyakan E, Kremer T, Hernekamp FJ, Harhaus L, Saint-Cyr M et al. Free flaps for reconstruction of soft tissue defects in lower extremity: a meta-analysis on microsurgical outcome and safety. Microsurgery. 2016; 36(6):511-24.Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concepted based on the septocutaneous artery. Br J Plast Surg. 1984; 37(2):149-59.Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219-26Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variation and technical problems of the anterolateral thigh flap: A report of 74 cases. Plast Reconstr Surg. 1998; 102(5):1517-23Spindler N, Al-Benna S, Ring A, Homann H, Steinsträsser L, Steinau HU et al. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction. GMS Interdiscip Plast Reconstr Surg DGPW. 2015;4:Doc05.Kimura N, Satoh K, Hasumi T, Ostuka T. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg. 2001;108(5):1197-210.Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg. 2012;20(1):17-23.Kuo YR, Jeng SF, Kuo MH, Huang MN, Liu YT, Chiang YC et al. Free anterolateral thigh flap for extremity reconstruction: Clinical experience and functional assessment of donor site. Plast Reconstr Surg. 2001;107(7):1766-71Novak CB, Lipa JE, Noria S, Allison K, Neligan PC, Gilbert RW. Comparison of anterolateral thigh and radial forearm free flap donor site morbidity. Microsurgery. 2007;27(8):651-54.Pagano M, Gauvreau K. Princípios de Bioestatística. São Paulo: Pioneira Thomson Learning; 2004.SAS Institute Inc., SAS/STAT® User’s Guide. Version 9.4. Cary, NC: SAS Institute Inc.Arruda LRP, Silva MAC, Malerba FG, Turíbio FM, Fernandes MC, Matsumoto MH. Fraturas expostas: estudo epidemiológico e prospectivo. Acta ortop bras. 2009;17(6):326-30.Cunha FM, Braga GF, Drumond Jr SN, Figueiredo CTO. Epidemiologia de 1.212 fraturas expostas. Rev Bras Ortop. 1998;33(6):451-56.Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29(7):529-34.Shabtai M, Rosin D, Zmora O, Munz Y, Scarlat A, Shabtai EL et al. The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident’s laparoscopic skills. Surg Endosc. 2004;18(9):1328-30.Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg.1986;78:285-292Smit JM, Acosta R, Zeebregts CJ, Liss AG, Anniko M, Hartman EH. Early reintervention of compromised free flaps improves success rate. Microsurgery. 2007;27(7):612-16.


2010 ◽  
Vol 43 (01) ◽  
pp. 079-080 ◽  
Author(s):  
Prabha S. Yadav ◽  
Quazi G. Ahmad ◽  
Vinay K. Shankhdhar ◽  
G. I. Nambi

ABSTRACTIn head and neck reconstructions when a free flap is used intra orally to provide the lining its vascular pedicle has to be transferred to the neck for anastomosis. This has to be performed in such a way that the pedicle does not get kinked or twisted. The pedicle is enrolled in a split open glove from its point of entry into the flap till its proximal most part. In order to prevent twisting of the vessels and to maintain orientation, the glove is wrapped in such a way that the imprint on the glove is on the visualized surface. The glove wrapped pedicle is passed from inside the oral cavity while an artery clamp passed from the neck wound through the submandibular or subcutaneous tunnel holds the tip of the glove component and guides it safely to the neck without exerting any traction on the flap or the pedicle vessels.


2020 ◽  
Author(s):  
Axel Sahovaler ◽  
Ilyes Berania ◽  
Marco Ferrari ◽  
Hedyeh Ziai ◽  
Ashok Jethwa ◽  
...  

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