Anterolateral Thigh Flap Reconstruction of Large External Facial Skin Defects: A Follow-Up Study on Functional and Aesthetic Recipient- and Donor-Site Outcome

Abstract Purpose: With the development of microsurgical techniques, the anterolateral thigh (ALT) flap has been widely used in reconstruction of various soft-tissue defects. However, there were few studies focusing on the closure of the ALT flap donor site, especially when the width of the harvested ALT flap was more than 6 cm. The purpose of this study was to share our experience of using Keystone Design Perforator Island Flap (KDPIF) to repair the ALT flap donor site where can’t be closed without a skin graft.Method: A retrospective study was used to analyze 12 patients who underwent the reconstruction of the ALT flap donor site using KDPIF from February 2018 to December 2020. Demographics, flap characteristics, surgical technique, postoperative complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score were statistically analyzed.Results: 12 patients (10 males, 2 females) with the mean age 47.5 years (range, 27-66 years) were included in this study. All ALT flap donor sites were closed by the KDPIF. The mean size of the harvested ALT flap (the donor site size) was 8.1 cm × 14.4 cm (range from 8.0 cm × 11.0 cm to 9.0 cm × 21.0 cm), and the mean size of keystone flap was 9.1 cm × 16.4 cm (range from 8.0 cm × 13.0 cm to 12.0 cm × 19.0 cm). At the mean follow-up of 8.3 months (range, 6-12 months), two patients suffered from the skin infection around the flap, which was controlled under the treatment of wound dressing change and oral antibiotics. Wound dehiscence, osteofascial compartment syndrome (OCS), venous return disorder, and skin necrosis were not presented in any patients. All patients were evaluated at the final follow-up with ASS core (mean, 6.7; range, 5-8) and SCAR core (mean, 7.3; range, 6-9).Conclusion: This study demonstrated that the KDPIF that can be used to close the ALT flap donor site primarily is an effective and alternative treatment for patients with a the width of the donor site more than 6 cm including the advantages of high survival rate, low morbidity, good aesthetics, and simple operation.

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Comparison of the modified direct closure method and skin grafting for wounds at the anterolateral thigh flap donor site

Journal of International Medical Research ◽

10.1177/0300060520925372 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092537

Author(s):

Song Gu ◽

Yuxuan Zhang ◽

Yinjun Huang ◽

Huichao Fu ◽

Guheng Wang ◽

...

Keyword(s):

Operative Time ◽

Donor Site ◽

Skin Grafting ◽

Anterolateral Thigh Flap ◽

Direct Closure ◽

Anterolateral Thigh ◽

Closure Method ◽

Alt Flap ◽

Scar Score

Objective This study was performed to compare the modified direct closure method and traditional skin grafting for wounds at the anterolateral thigh (ALT) flap donor site. Methods Among 29 consecutive patients with wounds at the ALT flap donor site, 14 underwent the modified direct closure method (MDC group) and 15 underwent traditional skin grafting (SG group). The operative time, follow-up time, complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score of the two groups were statistically analyzed. Results The mean follow-up times in the MDC and SG group were 16.1 and 16.7 months, respectively. Two patients showed partial skin necrosis after skin grafting, but the remaining patients’ wounds healed uneventfully. The operative time in the MDC group was an average of about 64 minutes shorter than that in the SG group. The average VSS and SCAR scores in the MDC group were 2.1 and 3.0 points lower, respectively, than those in the SG group. Conclusions Compared with traditional skin grafting, the modified direct closure method is more efficient for repair of wounds at the ALT flap donor site because of its shorter operative time, better postoperative appearance of the donor site, and higher patient satisfaction.

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Anterolateral Thigh Skin and Fascia in Facial Skin Defects with Trismus: Two Problems, One Solution

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1729504 ◽

2021 ◽

Author(s):

Prakash Panagatla ◽

Parvathi Ravula ◽

S. Praveen ◽

Narsimha Rao Varagani ◽

R. Srikanth ◽

...

Keyword(s):

Mouth Opening ◽

Case Series ◽

Anterolateral Thigh Flap ◽

Delayed Presentation ◽

Facial Skin ◽

Radiation Fibrosis ◽

Interposition Graft ◽

Anterolateral Thigh ◽

Skin Loss

AbstractA case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.

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Modified Recipient Blood Flow-Preserved Cross-Leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

10.21203/rs.3.rs-411666/v2 ◽

2021 ◽

Author(s):

Hong-Xiang Zhou ◽

Liang He ◽

Dong Yin ◽

Yang Niu ◽

Zhe Jin ◽

...

Keyword(s):

Blood Flow ◽

Lower Limb ◽

Posterior Tibial Artery ◽

Anterolateral Thigh Flap ◽

Posterior Tibial ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Flap Procedure ◽

Tissue Defects

Abstract Background Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy. Methods Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up. Results All 22 flaps survived. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed in a single fashion, and four flaps were bilobed. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries was confirmed during follow-up. All flaps recovered sensation at the final follow-up. The postoperative follow-up ranged from 18 to 84 months, and no long-term complications were observed. Conclusions The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing the major artery of the uninjured lower limb.

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Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

Foot & Ankle Orthopaedics ◽

10.1177/2473011419884269 ◽

2019 ◽

Vol 4 (4) ◽

pp. 247301141988426 ◽

Cited By ~ 1

Author(s):

John T. Stranix ◽

Merisa L. Piper ◽

Said C. Azoury ◽

Geoffrey Kozak ◽

Oded Ben-Amotz ◽

...

Keyword(s):

Free Flap ◽

Femoral Condyle ◽

Donor Site ◽

Case Series ◽

Medial Femoral Condyle ◽

Flap Reconstruction ◽

Foot And Ankle ◽

Osseous Union ◽

Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

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