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 Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

2021 ◽  
Author(s):  
Feiyu Cai ◽  
Yanshi Liu ◽  
Kai Liu ◽  
Jiasharete Jielile ◽  
Aihemaitijiang Yusufu
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Island Flap ◽  
Anterolateral Thigh Flap ◽  
High Survival ◽  
Anterolateral Thigh ◽  
Mean Size ◽  
The Mean ◽  
Alt Flap

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.

DORSAL PENTAGONAL ISLAND FLAP: A TECHNIQUE OF WEB RECONSTRUCTION FOR SYNDACTYLY THAT FACILITATES DIRECT CLOSURE

Hand Surgery ◽  
2004 ◽  
Vol 09 (02) ◽  
pp. 245-252 ◽  
Author(s):  
L. C. Teoh ◽  
J. Y. L. Lee
Keyword(s):  
Operative Time ◽  
Wound Care ◽  
Donor Site ◽  
Skin Grafting ◽  
Donor Site Morbidity ◽  
Island Flap ◽  
Direct Closure ◽  
Web Reconstruction ◽  
The Web

Though many techniques have been described for the correction of syndactyly, current methods result in skin deficiency that requires skin grafting, especially at the finger bases. We discuss the technical aspects and document our experience with the dorsal pentagonal metacarpal island flap for reconstruction of the web commissure in a series of 12 patients (22 webs) with syndactyly of varying complexity. In appropriately selected cases, this technique can improve reconstruction of the web commissure, facilitating direct closure, minimising the need for skin grafts and offers the potential for continued growth. This reduces operative time significantly and simplifies post-operative wound care. In this series, all our cases healed primarily in two to three weeks with minimal donor site morbidity. There were no post-operative complications, although the prominent dorsal scar remains a concern. At an average follow-up of 33.7 months, no cases of contracture or web creep after correction were noted.

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

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 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 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.

scholarly journals Pedicled Anterolateral Thigh Flap As A Workhourse Flap for Reconstruction of Inguino-Scrotal Defects

2021 ◽  
Vol 2 (S1) ◽  
pp. 1-5
Author(s):  
Mukesh Sharma ◽  
Naveen Kumar ◽  
V Suman Babu
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Average Period ◽  
Partial Loss ◽  
Post Operative Period ◽  
Complex Anatomy ◽  
Anterolateral Thigh ◽  
Pedicle Length ◽  
Alt Flap

Background: Reconstructions around inguinoscrotal region has been a challenging task owing to complex anatomy. There are variety of flap options available for reconstruction of Inguinoscrotal region. Our study was done to evaluate the use of pedicled anterolateral thigh flap for reconstruction of defects around inguinoscrotal regions. Methodology: In this study a total of 18 patients with various types of defects around inguinoscrotal region were evaluated. The etiology of defects included trauma (𝑛=6), infection (𝑛=8), malignancy (𝑛=2) and burn (𝑛=2). Patients were evaluated in terms of viability of the flap, number of perforators included, pedicled length and flap dimensions and donor site morbidity. Results: All flaps were survived well except 1 flap develop venous congestion in immediate post operative period due to tension over vascular pedicle which was managed by increasing pedicle length. 2 patients had developed partial loss of the skin graft at the donor site which got healed secondarily in due course. All patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion: Pedicled ALT flap is a versatile, reliable flap, with wide arc of rotation which makes it as an ideal flap for the coverage of defects around inguinoscrotal region.

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.

scholarly journals Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps

2021 ◽  
Author(s):  
Stephan Alois Steiner ◽  
Riccardo Schweizer ◽  
Holger Klein ◽  
Matthias Waldner ◽  
Pietro Giovanoli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Abstract Background Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction. Methods We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications. Results Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months). Conclusions Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites. Level of evidence: Level IV, therapeutic study.

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