Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

AbstractReconstruction of complex penile defects is always challenging, as some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded in complex wounds. We present a case of a 63-year-old otherwise healthy man, who underwent transurethral resection of the prostate for benign prostatic hyperplasia. After the procedure, he developed panurethral necrosis with consequent stricture. Three urethroplasties for reconstruction of the bulbar and distal urethra using buccal mucosa grafts, a preputial flap, and penile skin were performed by urology team in different institutions, but serious urinary fistulization and carbapenemase-producing Klebsiella pneumoniae (KPC) infection translated in a chronic wound, urethra necrosis, and near-total penile amputation. A composite anterolateral thigh flap and vascularized fascia lata were used with success together with a perineal urethroplasty in different stages, improving the ischemic wound condition. The extended segment of fascia lata was used for Buck's fascia replacement and circumferential reinforcement to cover the erectile bodies of the penis. The postoperative period was uneventful and after 12 months, there were no signs of recurrence or wound dehiscence. He was able and easily adapted to void in a seated position through the perineal urethrostomy that was made. To the best of our knowledge, this procedure has not been reported previously as a salvage procedure in a fistulizated and KPC infected penis, but it may be considered to avoid penile amputation in chronic infected and intractable wounds.

Download Full-text

Reconstruction of the Achilles Tendon and Overlying Soft Tissue by Free Composite Anterolateral Thigh Flap with Vascularized Fascia Lata

Journal of Reconstructive Microsurgery ◽

10.1055/s-0032-1306367 ◽

2012 ◽

Vol 28 (03) ◽

pp. 205-210 ◽

Cited By ~ 16

Author(s):

Philippe Houtmeyers ◽

Dries Opsomer ◽

Koenraad Van Landuyt ◽

Stanislas Monstrey

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Fascia Lata ◽

Anterolateral Thigh Flap ◽

Anterolateral Thigh

Download Full-text

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740958 ◽

2021 ◽

Author(s):

Reece Moore ◽

Donna Mullner ◽

Georgina Nichols ◽

Isis Scomacao ◽

Fernando Herrera

Keyword(s):

Computed Tomography ◽

Doppler Ultrasound ◽

Computed Tomography Angiography ◽

False Positive ◽

Color Doppler ◽

Color Doppler Ultrasound ◽

Preoperative Imaging ◽

Anterolateral Thigh Flap ◽

Anterolateral Thigh ◽

Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

Download Full-text

Pedicled anterolateral thigh flap for contralateral groin composite defect

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699415 ◽

2010 ◽

Vol 43 (01) ◽

pp. 103-105

Author(s):

S. P. Bharath ◽

G. Madhusudan ◽

Suraj Manjunath

Keyword(s):

Free Flaps ◽

Anterior Superior Iliac Spine ◽

Anterolateral Thigh Flap ◽

Wide Resection ◽

Vascular Pedicle ◽

Anterolateral Thigh ◽

Vascular Compromise ◽

Femoral Vessels ◽

Alt Flap ◽

Composite Defect

ABSTRACTPedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.

Download Full-text

Anterolateral thigh flap fascia lata suspension in oral floor reconstruction

The Laryngoscope ◽

10.1002/lary.21336 ◽

2010 ◽

Vol 121 (3) ◽

pp. 555-557 ◽

Cited By ~ 3

Author(s):

Wan Jing Zhang ◽

Ardalan Ebrahimi ◽

Michael D. Kernohan ◽

Jonathan R. Clark

Keyword(s):

Fascia Lata ◽

Anterolateral Thigh Flap ◽

Anterolateral Thigh

Download Full-text

Early mobilizing and dangling of the lower leg after one-stage reconstruction of Achilles tendon and overlying tissue defect using an anterolateral thigh flap with vascularized fascia lata

Case Reports in Plastic Surgery and Hand Surgery ◽

10.1080/23320885.2017.1396902 ◽

2017 ◽

Vol 4 (1) ◽

pp. 89-95 ◽

Cited By ~ 1

Author(s):

Masayuki Okochi ◽

Masanori Momiyama ◽

Hiromi Okochi ◽

Kazuki Ueda

Keyword(s):

Achilles Tendon ◽

Lower Leg ◽

Fascia Lata ◽

Anterolateral Thigh Flap ◽

Tissue Defect ◽

One Stage ◽

Anterolateral Thigh ◽

One Stage Reconstruction

Download Full-text

Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

Plastic Surgery International ◽

10.1155/2014/489012 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Carlos Alberto Torres-Ortíz Zermeño ◽

Javier López Mendoza

Keyword(s):

Upper Extremity ◽

Free Flaps ◽

Sensory Function ◽

Anterolateral Thigh Flap ◽

Level Of Evidence ◽

Average Percentage ◽

Aesthetic Result ◽

Anterolateral Thigh ◽

Good Cosmetic ◽

Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

Download Full-text

A neglected problem in the utilization of free anterolateral thigh flap toward reconstructing complicated wounds of extremities: the obliteration of deep dead space

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01914-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Gao-hong Ren ◽

Da-yong Xiang ◽

Xiao-hu Wu ◽

Yun-biao Chen ◽

Runguang Li

Keyword(s):

Clinical Application ◽

Dead Space ◽

Skin Flap ◽

Perforator Flap ◽

Muscle Flap ◽

Sinus Tract ◽

Thigh Muscle ◽

Anterolateral Thigh Flap ◽

Anterolateral Thigh ◽

Complex Wounds

Abstract Background Deep dead space may be thought as an independent risk factor of the poor infection control after flap reconstruction in complex limb wounds. But it can be easily neglected. The conventional skin flap and musculocutaneous flap are difficult to obliterate the deep dead space in irregular shape effectively. It was investigated that the clinical application of chimeric anterolateral thigh perforator flap in the treatment of complex wounds complicated with deep dead space of the extremities in the paper. Methods Fifty-six cases complicated with deep dead space wounds were registered in group. Following thorough debridement and treatment with VSD, the granulation tissues grew with well-controlled infection. And then the chimeric anterolateral thigh perforator flap was used to obliterate the deep dead space and repair the wounds. The postoperative flap survival and infection conditions were evaluated. Results Overall, the infection was effectively controlled, without persistent exudation or sinus tract formation after wound healing. While 5 cases lost to follow-up, the remaining 51 cases were followed up until 15 months on average. Generally, the affected extremities recovered satisfactorily with normal appearances and texture of the flaps, along with normal functions. Importantly, no recurrence of infection was observed. Conclusion During the grafting of chimeric perforator flap pedicled with lateral thigh muscle flap, the muscle flap is recommended to obliterate the deep dead space while the skin flap is being used to cover the wound. The combination of these two technologies performed well in the repair and reconstruction of the complex wounds of the extremities, possessing potential for broader clinical application.

Download Full-text

Achilles Tendon Region Defects: Delayed Composite Anterolateral Thigh Flap With Stripping of Fascia Lata: A Case Series

Wound Management & Prevention ◽

10.25270/wmp.2020.12.1322 ◽

2020 ◽

Vol 66 (12) ◽

pp. 13-22

Author(s):

Cesare Tiengo ◽

Regina Sonda ◽

Andrea Monticelli ◽

Francesco Messana ◽

Alberto Crema ◽

...

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Short Form ◽

Case Series ◽

Fascia Lata ◽

Anterolateral Thigh Flap ◽

Soft Tissue Reconstruction ◽

Medical Outcomes ◽

Anterolateral Thigh ◽

Tissue Reconstruction

Defects of the Achilles tendon that include the surrounding soft tissue represent a challenge due to complex functionality and biomechanics. PURPOSE: The purpose of this study was to evaluate the functional and physical functioning score outcomes of patients following microsurgical reconstruction of the yarrow region, using a combination of objective, subjective, and semi-subjective measurements. METHODS: Between 2007 and 2018, 15 patients underwent delayed Achilles tendon region reconstruction with different anterolateral thigh flap types. Seven (7) patients underwent tendon and soft tissue reconstruction with a chimeric anterolateral thigh flap (ALT) and rolled-up fascia lata, and 8 patients underwent soft tissue reconstruction and only tendon coverage with fascia lata. Follow-up assessments included maximal range of motion (MROM) (plantarflexion and dorsiflexion), the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale score, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning subscore. RESULTS: A total of 15 patients (11 males and 4 females with a mean age of 39.86 years) were evaluated during a mean follow-up time of 23 months (SD = 7.12). The MROM for plantarflexion and dorsiflexion was 42.71 degrees (SD = 2.9) and 24.8 degrees (SD = 4.29), respectively, in patients who underwent composite ALT with a rolled-up fascia lata. The MROM for plantarflexion and dorsiflexion was 43 degrees (SD = 5.37) and 27.37 degrees (SD = 3.2), respectively, in patients who underwent fasciocutaneous ALT. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 82 for the first group and 86.87 for the second, whereas the mean Medical Outcomes Study 36-item Short-Form Health Survey scores were 82.57 and 81.5, respectively, for the 2 groups. Statistical analysis showed no significant difference between the 2 groups. CONCLUSIONS: The results of this case series suggest that the single-stage composite reconstruction with a fasciocutaneous flap with or without a strip of fascia lata is a safe and reliable strategy for composite reconstruction of the Achilles tendon region. Additional studies to evaluate these outcomes and instruments to evaluate functioning are necessary.

Download Full-text