Designing Anterolateral Thigh Flap Using Ultrasound

2021 ◽  
Author(s):  
Giuseppe Visconti ◽  
Alessandro Bianchi ◽  
Akitatsu Hayashi ◽  
Marzia Salgarello
Keyword(s):  
Subcutaneous Tissue ◽  
Preoperative Evaluation ◽  
Donor Site ◽  
Perforator Flap ◽  
The Body ◽  
Anterolateral Thigh Flap ◽  
Perforator Flaps ◽  
Anterolateral Thigh ◽  
Ultrasound Technology ◽  
The Given

Abstract Background Preoperative knowledge of themicrovascular anatomy of a patientmay improve safetyand efficacy and reduce morbidity. Today, with the advancement in technology, ultrasound can provide minute details of the structures within the body, which makes this technology very helpful in preoperative evaluation of the traditional perforator flaps as well as thin, superthin, and pure skin perforator flaps. Methods In this article, we will describe the design of one of the most popular perforator flaps, the anterolateral thigh (ALT) flap, using high-frequency and ultrahigh-frequency ultrasound technology. Results Ultrasound technology allows to study preoperatively the ALT donor-site and its microvascular anatomy by using different US modalities in order to provide a virtual surgical plan to the operating surgeon. Conclusion Ultrasound technology allow to expand preoperative knowledge of flap microvascular anatomy and its course within the subcutaneous tissue up to and within the dermis, allowing to select the best perforator for the given reconstruction and the plane of elevation for thin, superthin and pure skin perforator flap.

Perforator flap breast reconstruction in thin patients.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 242-242
Author(s):  
C. M. Chen ◽  
C. Ahn ◽  
J. Levine
Keyword(s):  
Breast Reconstruction ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Perforator Flap ◽  
Preoperative Imaging ◽  
Perforator Flaps ◽  
Autologous Tissue ◽  
New Techniques ◽  
Medial Thigh ◽  
Abdominal Flaps

242 Background: Perforator flap breast reconstruction has strong appeal for many women seeking breast reconstruction, but the procedure requires adequate donor site tissue to produce realistic breasts. Thin women requesting perforator flaps are often advised that they lack sufficient donor site tissue for autologous tissue breast reconstruction, and that implants are their only option. We have expanded the reconstructive options for thin women who seek an alternative to implants with innovative new techniques. Methods: A retrospective review was done of 223 patients who underwent 293 consecutive perforator flap breast reconstructions from April 2007-May 2011. Preoperative imaging allowed visualization of the microvascular anatomy and subcutaneous tissue. Donor sites evaluated included the abdomen, medial thigh, buttocks, and back. Complications included flap loss, hematoma, seroma, takeback, and fat necrosis. No patients were turned away for perforator flap breast reconstruction due to insufficient donor site tissue. Results: Out of 293 perforator flap breast reconstructions, 45 perforator flap breast reconstructions (15.4%) were reported in 26 thin women with a BMI < 23 (mean BMI 20.7, range BMI 18.2-22.7). Out of 45 perforator flap breast reconstructions in thin women, donor sites included 35 hemi-abdominal flaps (77.8%), 4 medial thigh flaps (8.9%), 7 buttock flaps (15.6%), and 2 back flaps (4.4%). Of the 35 hemi-abdominal flaps, 8 hemi-abdominal flaps were combined to create 4 stacked DIEP flaps (22.9%) while the remaining 27 hemi-abdominal flaps were regular DIEP flaps (77.1%). There was one seroma (2.2%) and one takeback for postoperative pain (2.2%); there were no flap losses. Conclusions: Even in thin women, perforator flap breast reconstruction is a safe, reliable, and consistent technique for recreating new breasts. While implant-based breast reconstruction may be acceptable to many women, there is a growing subgroup of patients who prefer autologous tissue breast reconstruction. By challenging common conceptions about the amount of donor site tissue required, we have been able to expand reconstructive options in thin women by using perforator flaps to construct natural, aesthetic breasts.

scholarly journals Free anteromedial thigh perforator flap: Complementing and completing the anterolateral thigh flap

2017 ◽  
Vol 50 (01) ◽  
pp. 016-020 ◽  
Author(s):  
Dushyant Jaiswal ◽  
Amol Ghalme ◽  
Prabha Yadav ◽  
Vinaykant Shankhdhar ◽  
Akshay Deshpande
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Perforator Flap ◽  
Anterolateral Thigh Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Circumflex Femoral Artery ◽  
First Choice ◽  
Anterolateral Thigh ◽  
Alt Flap

ABSTRACT Objective: Theobjective of this study was to determine the indications, utility, advantages and surgical approach for the anteromedial thigh (AMT) flap. Materials and Methods: We reviewed the records of the patients in whom the AMT flap was used for head and neck reconstruction. We use an anterior approach to harvest the anterolateral thigh (ALT) flap with a non-committal straight line incision. This preserves both ALT and AMT flap territories intact, and further decision is based on the intraoperative anatomy of perforator and pedicle. The ALT flap was usually used as the first choice when available and suitable. Results: Free AMT skin flaps were harvested in 24 patients. All flaps were used for the head and neck reconstruction. Two flaps had marginal flap necrosis. One flap was lost due to venous thrombosis. Discussion: The thigh is an excellent donor site as it has large available skin territory, expendable lateral circumflex femoral artery system and low donorsite morbidity. The ALT flap is the most commonly used flap for reconstruction of soft-tissue defects. However, it is characterised by variable vascular pedicle and perforator anatomy. The AMT flap is an excellent alternative when the ALT flap is not available due to variable perforator anatomy, injury to perforator, when an intermediate thickness is needed between distal and proximal thigh or a chimeric flap is needed. Conclusion: The AMT flap offers all the advantages of the ALT flap without increasing donor-site morbidity. The anterior non-committal approach keeps both the ALT and the AMT flap options viable.

Perforator flap from adjacent thigh skin to improve the repair of the donor site of the anterolateral thigh flap

Microsurgery ◽  
2013 ◽  
Vol 33 (3) ◽  
pp. 249-250 ◽  
Author(s):  
Anı Cinpolat ◽  
Özlenen Özkan ◽  
Gamze Bektas ◽  
Polat Biçici ◽  
Ömer Özkan
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

scholarly journals Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

2021 ◽  
Author(s):  
Kyung Jin Lee ◽  
Ilou Park ◽  
Si Young Roh ◽  
Sung Hoon Koh ◽  
Jin Soo Kim ◽  
...  
Keyword(s):  
Doppler Ultrasonography ◽  
Color Doppler ◽  
Preoperative Evaluation ◽  
Vascular Anatomy ◽  
Color Doppler Ultrasonography ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Group A ◽  
Perforator Vessels ◽  
Anterolateral Thigh Flaps

Purpose: The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps.Methods: A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system.Results: A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p<0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type).Conclusion: Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

Alternative flaps for microsurgical breast reconstruction

2021 ◽  
pp. 1107-1114
Author(s):  
Hinne A. Rakhorst
Keyword(s):  
Breast Reconstruction ◽  
Standard Care ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
The Body ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Muscle Sparing ◽  
Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

scholarly journals Assessment of Quality of Life of Free Anterolateral Thigh Flap for Reconstruction of Tissue Defects of Total or Near-Total Glossectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Sanke Zhang ◽  
Shuang Wu ◽  
Lei Liu ◽  
Dandan Zhu ◽  
Qiuyu Zhu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Impact ◽  
Anterolateral Thigh Flap ◽  
Perforator Flaps ◽  
Anterolateral Thigh ◽  
After Cancer ◽  
The University ◽  
Psychological Disability ◽  
Tissue Defects

Background. The aim of this study was to evaluate quality of life of free anterolateral thigh flap (ALTFF) for reconstruction of tissue defects of total or near-total glossectomy. Methods. Quality of life was assessed by means of the University of Washington Quality of Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14), after 12 months postoperatively. Results. 65 of 79 questionnaires were returned (82.27%). In the UW-QOL, the best-scoring domain was “shoulder,” whereas the lowest scores were for “chewing” and “pain.” In the OHIP-14, the lowest-scoring domain was “handicap,” followed by “Social disability” and “Psychological disability.” Conclusion. Free anterolateral thigh perforator flaps for reconstruction of total or near-total glossectomy defects after cancer resection would have significantly influenced the patients’ oral functions and quality of life.

scholarly journals Achieving Direct Closure of the Anterolateral Thigh Flap Donor Site—An Algorithmic Approach

2014 ◽  
Vol 2 (10) ◽  
pp. e232 ◽  
Author(s):  
Jaime Eduardo Pachón Suárez ◽  
Parviz Lionel Sadigh ◽  
Hsiang-Shun Shih ◽  
Ching-Hua Hsieh ◽  
Seng Feng Jeng
Keyword(s):  
Donor Site ◽  
Anterolateral Thigh Flap ◽  
Direct Closure ◽  
Algorithmic Approach ◽  
Anterolateral Thigh

scholarly journals An assessment of the anatomical basis of the thoracoacromial artery perforator flap

2003 ◽  
Vol 11 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Christopher Robert Geddes ◽  
Maolin Tang ◽  
Daping Yang ◽  
Steven F Morris
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Perforator Flap ◽  
Neck Region ◽  
Donor Site Morbidity ◽  
Pedicled Flap ◽  
Perforator Flaps ◽  
Thoracoacromial Artery ◽  
Lateral Thoracic Artery ◽  
Anatomical Basis

Background Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. Perforator flaps are becoming increasingly popular for many applications. In the present study, we set out to examine the various perforators of the thoracoacromial axis through the pectoralis major (PM) muscle with respect to their suitability for transfer to the head and neck region as a pedicled flap. Methods A series of 10 fresh cadavers were injected with lead oxide, gelatin and water (250 mL/kg) through the femoral vessels. The cadavers were cooled and the integument was removed. Perforating vessels from the underlying muscles were marked and the resulting angiograms of the integument and deep tissues were compared with the dissection notes describing the course, size and distribution of the perforating vessels. Results The perforators through the PM muscle to the overlying skin included three regional groups: perforators of the thoracoacromial axis; perforators of the medial intercostal vessels; and perforators of the lateral thoracic artery. The major group of perforators supplying the overlying skin was from the intercostal vessels. However, the thoracoacromial axis did consistently give rise to perforators in the upper portion of the PM muscle. In particular, there were reliable perforators from the clavicular and deltoid branches of the thoracoacromial artery. Discussion The present study illustrates the potential clinical applications of a series of perforator flaps based on the thoracoacromial axis, which may be useful in head and neck reconstructive surgery.

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