Outcomes of using a modified anteromedial thigh perforator flap for repairing the anterolateral thigh free flap donor site

Objective: The anterolateral thigh (ALT) flap is a workhorse in microsurgical reconstruction. However, a flap width greater than 8 centimeters limits primary closure and discourages some surgeons from using this flap for larger defects to avoid a large and unsightly skin grafted donor site. ALT donor site closure can be made even more challenging when a more circular shaped flap is required. Methods: This study examines the use of the keystone perforator flap to close large ALT free flap donor sites in 6 patients who underwent reconstruction for various purposes who otherwise would have required donor site skin grafting. Results: Average flap dimensions were 10.5 cm × 17 cm and mean keystone flap dimensions were 12.2 cm × 22.5 cm. Average operative time of cases was 528.3 minutes and average BMI of patients was 24.8 kg/m2. There was 1 case of partial keystone flap dehiscence that required local wound care, and 1 case of drain replacement for thigh seroma. Conclusions: This series demonstrates that keystone perforator flap closure allows the thigh to maintain a relatively normal appearance, reduces postoperative pain associated with skin grafting, and can be performed in higher BMI patients with minimal complications and without increasing operative time or sensory or motor deficits. This series to date also has the largest defects closed with keystone flaps demonstrating the feasibility of this type of closure in very large ALT donor sites.

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Muscle herniation: A complication at the anterolateral thigh perforator flap donor site

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2007.12.071 ◽

2009 ◽

Vol 62 (11) ◽

pp. 1530-1533 ◽

Cited By ~ 9

Author(s):

J. Odili ◽

E. Wilson ◽

J.S. Chana

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Anterolateral Thigh

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LONG-TERM DONOR-SITE MORBIDITY IN COMPOSITE ANTEROLATERAL THIGH FREE FLAP FOR COMPLEX DEFECT OF LOWER LEG AND FOOT RECONSTRUCTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2020.5.12 ◽

2020 ◽

pp. 85-91

Author(s):

Phuc Le Hong ◽

Son Tran Thiet ◽

Thuy Nguyen Xuan

Keyword(s):

Soft Tissue ◽

Skin Graft ◽

Free Flap ◽

Donor Site ◽

Lower Extremities ◽

Lower Leg ◽

Donor Site Morbidity ◽

Thigh Circumference ◽

Anterolateral Thigh

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

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Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature

Folia Medica ◽

10.2478/v10153-011-0090-x ◽

2012 ◽

Vol 54 (2) ◽

pp. 60-65 ◽

Cited By ~ 2

Author(s):

Dimitar D. Pazardzhikliev ◽

Christo D. Shipkov ◽

Ilya P. Yovchev ◽

Regina H. Khater ◽

Ivailo S. Kamishev

Keyword(s):

Case Report ◽

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Functional Results ◽

Donor Site Morbidity ◽

Oral Feeding ◽

Tram Flap ◽

Radial Forearm Free Flap ◽

Radial Forearm

ABSTRACT Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free flap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48- year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free flap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as “excellent” and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable flap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator flap, RFFF, anterolateral thigh and ulnar forearm flap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM flap, latissimus dorsi myocutaneous free flap, pectoralis major musculocutaneous flap and trapezius island flap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

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Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1603351 ◽

2017 ◽

Vol 33 (08) ◽

pp. 557-562

Author(s):

Ji Yim ◽

Yeon Lee ◽

Young Kim ◽

Eun Kim ◽

Taik Lee ◽

...

Keyword(s):

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Vascular Pedicle ◽

Inferior Epigastric Artery ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Time Required ◽

Artery Perforator

Background Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.

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Objective preoperative estimation of the ability of primary closure on anterolateral thigh free flap donor site: Circumference and area ratios of deep tissue to thigh

Microsurgery ◽

10.1002/micr.22080 ◽

2013 ◽

Vol 33 (4) ◽

pp. 270-274 ◽

Cited By ~ 4

Author(s):

Kyeongho Song ◽

Subong Nam ◽

Soojong Choi ◽

Joohyoung Kim ◽

Jaewoo Lee ◽

...

Keyword(s):

Free Flap ◽

Primary Closure ◽

Donor Site ◽

Deep Tissue ◽

Anterolateral Thigh

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Reconstruction of a Large Through and Through Defect of the Oral Cavity Using Double Anterolateral Thigh Free Flap

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v29i1.459 ◽

2014 ◽

Vol 29 (1) ◽

pp. 26-29

Author(s):

Jefferson A. Alamani ◽

Samantha S. Castañeda ◽

Adrian F. Fernando

Keyword(s):

Soft Tissue ◽

Oral Cavity ◽

Free Flap ◽

Donor Site ◽

Operating Time ◽

Soft Tissue Defect ◽

Full Thickness ◽

Anterolateral Thigh ◽

Cervical Area ◽

Alt Flap

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

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Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v2i3.165 ◽

1970 ◽

Vol 2 (3) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Afriyanti Sandhi

Keyword(s):

Free Flap ◽

Weight Bearing ◽

Donor Site ◽

Three Dimensional ◽

Free Flaps ◽

Donor Site Morbidity ◽

Common Procedure ◽

Anterolateral Thigh ◽

Protective Sensation ◽

And Function

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

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A simple and cost-effective protocol for the management of anterolateral thigh free-flap donor site

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699275 ◽

2008 ◽

Vol 41 (02) ◽

pp. 235-236

Author(s):

Tuli Puneet ◽

Biswas Gautam ◽

Parashar Atul ◽

K. Sharma Ramesh

Keyword(s):

Free Flap ◽

Donor Site ◽

Cost Effective ◽

Anterolateral Thigh

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Application of an Iliac Osteocutaneous and Fabricated Chimeric Iliac Osteocutaneous Flap for Foot and Ankle Reconstruction

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0037-1604341 ◽

2017 ◽

Vol 02 (02) ◽

pp. e111-e117

Author(s):

Zhao Pan ◽

Ping Jiang ◽

Shan Xue ◽

Jian Wang

Keyword(s):

Blood Supply ◽

Donor Site ◽

Small Diameter ◽

Perforator Flap ◽

Foot And Ankle ◽

Skin Paddle ◽

Anterolateral Thigh ◽

Osteocutaneous Flap ◽

Alt Flap ◽

Tissue Defects

Background As understanding of the blood supply by superficial circumflex iliac artery (SCIA) to the skin and iliac bone has improved and the use of a perforator flap has become accepted, most previous drawbacks of SICA iliac osteocutaneous flaps, such as bulky flap, small diameter, and inadequate blood supply to bone, can now be overcome. Here, the authors present their experience of using such flaps for the reconstruction of complex defects in the foot and ankle with a focus on feasibility and safety. Methods A retrospective review of patients who underwent foot and ankle reconstruction using an SCIA iliac osteocutaneous flap between 2010 and 2015 was performed to assess outcomes. Results Four patients who underwent treatment with SCIA iliac osteocutaneous flaps and eight patients treated with fabricated chimeric iliac osteocutaneous flaps were identified. The iliac segment size ranged from 1 × 3 × 0.7 to 3 × 6 × 1 cm and the skin paddle size ranged from 1 × 4 to 8 × 16 cm. All flaps survived uneventfully except for marginal necrosis in one anterolateral thigh (ALT) flap and one iliac osteocutaneous flap. The median time to bone union was 4 months. All patients were able to walk in normal footwear and none developed significant complications at the donor site. Conclusion The use of free SCIA iliac osteocutaneous and fabricated chimeric iliac osteocutaneous flaps provides an alternative for treating small- and medium-sized bone defects (smaller than 8 cm) along with soft tissue defects in the foot and ankle region.

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