scholarly journals Utilization of a Continuous External Tissue Expansion System to Assist in Primary Closure of a Large Anterolateral Thigh Donor Site Defect

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Andrew G. Silver ◽  
Richard C. Baynosa
Keyword(s):  
Primary Closure ◽  
Donor Site ◽  
Tissue Expansion ◽  
Skin Grafting ◽  
Flap Coverage ◽  
Anterolateral Thigh ◽  
Expansion System ◽  
Donor Site Defect ◽  
Alt Flap

Primary closure of a large anterolateral thigh (ALT) flap donor site defect with the assistance of an external tissue expansion system is presented. The dimensions of this donor site (12 cm × 40 cm) and its percentage of leg circumference (34%) would make this site likely to require skin grafting or further flap coverage based on the results of previously published literature.

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

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.

scholarly journals Reduced Anterolateral Thigh Flap Donor-Site Morbidity Using Incisional Negative Pressure Therapy

2018 ◽  
Vol 35 (03) ◽  
pp. 229-234 ◽  
Author(s):  
Pedro Cuevas ◽  
José Rodriguez ◽  
Nicolás Pereira ◽  
Enrica Ramirez ◽  
Ricardo Yañez ◽  
...  
Keyword(s):  
Primary Closure ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Control Group ◽  
Study Group ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Anterolateral Thigh ◽  
Alt Flap

Background Primary closure of the donor-site after harvest of a large anterolateral thigh flap (ALT) is associated with significant morbidity. Incisional negative pressure therapy (INPT) may decrease complications in high-risk incisions. This study assessed if the incidence of complications after primary closure of the ALT flap donor-site decreases with INPT. Methods Retrospective cohort study of a prospectively maintained database including patients who underwent upper and lower limb reconstruction, using an ALT free flap with primary closure of the donor-site. Two groups were defined: primary closure and INPT (study group) and primary closure with traditional dressings (control group). Nonparametric statistics were employed to identify prognostic factors, p < 0,05. Results Fifty-eight free ALT flaps in 58 patients (study group n = 28; control group n = 30) were included. Median flap width and length were 9 cm (range: 5–14) and 25 cm (range: 10–48), respectively. Median follow-up was 19 months (range: 3–78 months). No significant differences in age or flap size were identified in both groups (p > 0.05). The global complication rate was 7.14% (n = 2) in the INPT group, and 37% (n = 11) in the control group (p = 0.007). The study group had a lower dehiscence and skin necrosis rate (p < 0.05). Multivariate logistic regression analysis showed IPNT was associated with a significant reduction of donor-site complications (p = 0.006), especially in patients with defects > 8 cm (p = 0.003). Conclusion In this cohort study the use of INPT significantly reduced the donor-site morbidity after ALT flap harvest.

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

Retroauricular skin flap and primary Z-plasty for donor site closure in partial ear reconstruction

2003 ◽  
Vol 117 (6) ◽  
pp. 487-489 ◽  
Author(s):  
Raymund E. Horch ◽  
Joerg Schipper ◽  
Roland Laszig
Keyword(s):  
Primary Closure ◽  
Skin Flap ◽  
Donor Site ◽  
Single Stage ◽  
Ear Reconstruction ◽  
Cartilage Graft ◽  
Conchal Cartilage ◽  
Primary Donor ◽  
Conchal Cartilage Graft ◽  
Donor Site Defect

Helical rim defects are noticeable and may well need reconstruction, especially in men. A method for reconstructing this type of defect together with primary donor site closure by Z-plasty is described.To close partial helical rim defects, a retroauricular caudally based rotational skin flap is performed to cover a conchal cartilage graft from the same ear that is harvested first and sutured into place to remodel the helical rim. To primarily close the donor site defect a retroauricular Z-plasty was developed which easily allowed primary closure of the donor site.The technique described here is straightforward, safe and reproducible. The Z-plasty approach for closing the donor site is useful, since the slight disturbance of the hairline is well hidden retroauricularly. This technique can be considered as a single-stage repair modality for the reconstruction of helical rim defects within primary donor site closure.

V-Y Tensor Fascia Lata for Trochanteric Pressure Sore Treatment

1997 ◽  
Vol 5 (4) ◽  
pp. 213-216
Author(s):  
Daniel álvaro Alvarez Lazo ◽  
Olímpio Colicchio Filho ◽  
Ricardo Galvão Chaim ◽  
Paula Zuccolotto Moro
Keyword(s):  
Surgical Technique ◽  
Primary Closure ◽  
Donor Site ◽  
Skin Grafting ◽  
Pressure Sore ◽  
Fascia Lata ◽  
Tensor Fascia Lata ◽  
Precise Evaluation ◽  
Tensor Fascia Lata Flap

There are several alternatives for pressure sore reconstruction, but it is of utmost importance that an appropriate surgical technique be adopted, because although treatment is successful, recurrence of these ulcers is frequent. The purpose of this study was to conduct a precise evaluation of the V-Y tensor fascia lata flap, pointing out its advantages compared with the classical flap and with other possibilities described in the literature. The author employed 20 V-Y tensor fascia lata flaps to correct 20 trochanteric ulcers. The use of the classical tensor fascia lata flap to cover trochanteric ulcers is unquestionable. However, primary closure for flaps wider than 10 cm is difficult, necessitating an eventual skin grafting of the donor site. The V-Y tensor fascia lata allows a covering similar to the classical flap, simplifies primary closure and essentially presents the possibility of numerous reutilizations.

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 ◽  
2013 ◽  
Vol 33 (4) ◽  
pp. 270-274 ◽  
Author(s):  
Kyeongho Song ◽  
Subong Nam ◽  
Soojong Choi ◽  
Joohyoung Kim ◽  
Jaewoo Lee ◽  
...  
Keyword(s):  
Free Flap ◽  
Primary Closure ◽  
Donor Site ◽  
Deep Tissue ◽  
Anterolateral Thigh

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

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

Preoperative Computed Tomography Angiography for ALT Flaps Optimizes Design and Reduces Operative Time

2021 ◽  
Author(s):  
Christopher M. Schneider ◽  
Patrick A. Palines ◽  
Daniel J. Womac ◽  
Charles T. Tuggle ◽  
Hugo St Hilaire ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Operative Time ◽  
Donor Site ◽  
Vascular Anatomy ◽  
Complication Rates ◽  
Anterolateral Thigh ◽  
Extremity Reconstruction ◽  
Alt Flap ◽  
Selection Of

Abstract Background Computed tomography angiography (CTA) has been widely used for perforator mapping in abdominal-based reconstruction, but it is less widespread in the anterolateral thigh (ALT) flap. However, CTA may be quite useful for ALT planning, as this flap has demonstrated substantial variability in intrapatient bilateral vascular anatomy. This study investigated whether standard use of preoperative CTA resulted in selection of the donor extremity with preferential perforator anatomy, and whether this affected operative time and postoperative outcomes. Methods A retrospective review of 105 patients who underwent proposed ALT flap reconstruction was performed. Seventy-nine patients received bilateral lower extremity CTAs, which were evaluated for dominant perforator anatomy (septocutaneous, musculoseptocutaneous, or musculocutaneous). Donor extremity selection was noted, and predicted perforator anatomy was compared with that encountered intraoperatively. Results Among the 73 patients who received bilateral imaging and ultimately received an ALT, congruent findings between imaging and surgical exploration were observed in 51 (69.8%) patients. Thirty (37.9%) patients had asymmetric perforator anatomy between their bilateral extremities on imaging. Among these, the leg with optimal perforator anatomy was selected in 70% of cases. There were no significant reductions among postoperative complication rates, but selection of the donor site with preferential anatomy was associated with a decrease in operative time (p = 0.049) among patients undergoing extremity reconstruction. Conclusion CTA is a useful tool for optimizing donor site selection for ALT flaps and reducing operative time. We believe that standard use of preoperative CTA in ALTs warrants further consideration.

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

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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