scholarly journals A Thin Anterolateral Thigh Free Flap for Severe Hand Burn Deformity

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Dewi Aisiyah Mukarramah
Keyword(s):  
Free Flap ◽  
Burn Injury ◽  
Hand Function ◽  
Free Flaps ◽  
Good Alternative ◽  
Anterolateral Thigh Flap ◽  
Right Hand ◽  
Anterolateral Thigh ◽  
Contracture Release ◽  
The Right

Background: Hand is one of the most commonly involved areas in burn injury, resulting in contracture.1 Reconstruction of severe postburn hand deformity is very challenging. Because there is no adjacent skin laxity to allow for local flaps in the burned hand, distant or free flaps should be considered. 2 Application of the thin anterolateral thigh flap in hand reconstruction has become one of the most preferred options for resurfacing of soft-tissue defects after contracture release. 3 Other than closing the defect after contracture release, restoration of hand function is also essential.Patient and Methods: In 2010, a man, 37 years old presented with severe contracture on the right hand due to an explosive flame burn 1,5 years ago. On the right hand, there was hyperextension at the metacarpophalangeal (MCP) joint with flexion on the wrist and thumb abduction with hyperextension at the interphalangeal joint. Our goal is to reconstruct this severe hand burn deformity using thin ALT free flap with flap thickness 4 mm to achieved good hand contour.Results: The thin ALT free flap was vital, and 1-year follow-up gives good hand contours. Patient under rehabilitation therapy from 2 weeks postoperative to attain good functional hand.Summary: A thin anterolateral thigh free flap gives good alternative for resurfacing defect in reconstruction of burn hand than other fasciocutaneous flaps. The advantage are it provides the same color and texture, thin and pliable flap to form good hand contour.

scholarly journals Experiência de um hospital de referência com o retalho livre anterolateral da coxa na reconstrução de extremidades

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Nikolas Higa Benites ◽  
Guilherme Leipner Margatho ◽  
Fernanda Ruiz de Andrade ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Reconstruction ◽  
Anterolateral Thigh ◽  
Anterolateral Thigh Flaps ◽  
The Impact

Introdução: Com a evolução da microcirurgia ao longo dos anos o Retalho Anterolateral da Coxa vem se tornando uma das principais opções para reconstruções na cabeça, pescoço, tronco e extremidades devido sua versatilidade e confiabilidade. Objetivo: Descrever dados de um hospital terciário referência em trauma na reconstrução de extremidades com o Retalho Anterolateral da Coxa. Método: Este é um estudo retrospectivo de 18 retalhos Anterolateral da Coxa microcirúrgicos realizados entre Março de 2016 e Outubro de 2019 em pacientes de todas as idades, na reconstrução de membros, onde se observou dados referentes ao paciente: idade, sexo, membro acometido, tempo entre a lesão e a confecção do retalho; ao intraoperatório: anatomia dos vasos perfurantes, tempo cirúrgico total, vasos receptores utilizados; e informações do pós-operatório: número de cirurgias relacionadas ao retalho, necessidade de reabordagem e número de perdas. Foram excluídos pacientes que perderam seguimento ou que apresentaram dados do prontuário incompletos. Realizou-se estatística descritiva e cruzamento de algumas variáveis utilizando o teste t-Student. Resultados: Nas reconstruções houve predomínio de pacientes do sexo masculino (72%), em idade produtiva, de etiologia traumática e nos membros inferiores. O tempo médio até a reconstrução foi de 21 dias e o tempo cirúrgico foi de 384 minutos. O paciente permaneceu, em média, 39 dias internado. Dos 18 retalhos, 3 evoluíram com necrose, 2 por trombose arterial e 1 por infecção. 6 retalhos necessitaram de reaborgadem de emergência, 3 por sangramento, 2 por congestão e 1 por infecção. Foram realizadas uma média de 3 cirurgias até a alta. Foram identificadas 15 perfurantes miocutâneas (83%) e 3 septocutâneas (17%). A análise do sucesso do retalho em relação ao tempo cirúrgico e dos dias até a cirurgia não mostrou significância estatística, assim como a necessidade de reabordagem em relação ao tempo cirúrgico. Conclusão: O retalho Anterolateral da Coxa mostrou-se confiável, além de apresentar diversas vantagens como: por ser retirado com uma grande ilha de pele, apresentar pedículo longo, vasos de bom calibre, não necessitar de mudança de decúbito e apresentar baixa morbidade da área doadora.Descritores: Retalho Miocutâneo; Microcirurgia; Hospitais Especializados.ReferênciasDaniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg. 1973;52(2):111-17.Ninkovic M, Voigt S, Dornseifer U, Lorenz S, Ninkovic M. Microsurgical advances in extremity salvage. Clin Plast Surg. 2012;39(4):491-505.Tamimy MS, Rashid M, Ehtesham-ul-Haq, Aman S, Aslam A, Ahmed RS. Has the anterolateral thigh flap replaced the latissimus dorsi flap as the workhorse for lower limb reconstructions? J Pak Med Assoc. 2010; 60(2):76-81.Spyropoulou A, Jeng SF. Microsurgical coverage reconstruction in upper and lower extremities. Semin Plast Surg. 2010;24(1):34-42.Xiong L, Gazyakan E, Kremer T, Hernekamp FJ, Harhaus L, Saint-Cyr M et al. Free flaps for reconstruction of soft tissue defects in lower extremity: a meta-analysis on microsurgical outcome and safety. Microsurgery. 2016; 36(6):511-24.Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concepted based on the septocutaneous artery. Br J Plast Surg. 1984; 37(2):149-59.Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219-26Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variation and technical problems of the anterolateral thigh flap: A report of 74 cases. Plast Reconstr Surg. 1998; 102(5):1517-23Spindler N, Al-Benna S, Ring A, Homann H, Steinsträsser L, Steinau HU et al. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction. GMS Interdiscip Plast Reconstr Surg DGPW. 2015;4:Doc05.Kimura N, Satoh K, Hasumi T, Ostuka T. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg. 2001;108(5):1197-210.Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg. 2012;20(1):17-23.Kuo YR, Jeng SF, Kuo MH, Huang MN, Liu YT, Chiang YC et al. Free anterolateral thigh flap for extremity reconstruction: Clinical experience and functional assessment of donor site. Plast Reconstr Surg. 2001;107(7):1766-71Novak CB, Lipa JE, Noria S, Allison K, Neligan PC, Gilbert RW. Comparison of anterolateral thigh and radial forearm free flap donor site morbidity. Microsurgery. 2007;27(8):651-54.Pagano M, Gauvreau K. Princípios de Bioestatística. São Paulo: Pioneira Thomson Learning; 2004.SAS Institute Inc., SAS/STAT® User’s Guide. Version 9.4. Cary, NC: SAS Institute Inc.Arruda LRP, Silva MAC, Malerba FG, Turíbio FM, Fernandes MC, Matsumoto MH. Fraturas expostas: estudo epidemiológico e prospectivo. Acta ortop bras. 2009;17(6):326-30.Cunha FM, Braga GF, Drumond Jr SN, Figueiredo CTO. Epidemiologia de 1.212 fraturas expostas. Rev Bras Ortop. 1998;33(6):451-56.Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29(7):529-34.Shabtai M, Rosin D, Zmora O, Munz Y, Scarlat A, Shabtai EL et al. The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident’s laparoscopic skills. Surg Endosc. 2004;18(9):1328-30.Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg.1986;78:285-292Smit JM, Acosta R, Zeebregts CJ, Liss AG, Anniko M, Hartman EH. Early reintervention of compromised free flaps improves success rate. Microsurgery. 2007;27(7):612-16.

scholarly journals Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

2008 ◽  
Vol 2008 ◽  
pp. 1-5 ◽  
Author(s):  
N. Lumen ◽  
S. Monstrey ◽  
P. Ceulemans ◽  
E. van Laecke ◽  
P. Hoebeke
Keyword(s):  
Free Flaps ◽  
Functional Results ◽  
Good Alternative ◽  
Radial Forearm Flap ◽  
Anterolateral Thigh Flap ◽  
Forearm Flap ◽  
Free Radial Forearm Flap ◽  
Anterolateral Thigh ◽  
Aesthetic Results ◽  
Radial Forearm

Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy.Methods. Eleven males (age 15 to 42 years) were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4–49 months). Aesthetic and functional results were evaluated.Results. There were no complications related to the flap. Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula). Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion.Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.

scholarly journals Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Siti Handayani ◽  
Shelly Madona Djaprie
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Anterolateral Thigh ◽  
Wide Range ◽  
Reconstructive Microsurgery ◽  
One Year ◽  
Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

scholarly journals Pedicled anterolateral thigh flap for contralateral groin composite defect

2010 ◽  
Vol 43 (01) ◽  
pp. 103-105
Author(s):  
S. P. Bharath ◽  
G. Madhusudan ◽  
Suraj Manjunath
Keyword(s):  
Free Flaps ◽  
Anterior Superior Iliac Spine ◽  
Anterolateral Thigh Flap ◽  
Wide Resection ◽  
Vascular Pedicle ◽  
Anterolateral Thigh ◽  
Vascular Compromise ◽  
Femoral Vessels ◽  
Alt Flap ◽  
Composite Defect

ABSTRACTPedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.

scholarly journals Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Parkes ◽  
Howard Krein ◽  
Ryan Heffelfinger ◽  
Joseph Curry
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Loss ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Anterolateral Thigh ◽  
The Many ◽  
Soft Tissue Loss

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.

scholarly journals Innervated Free Flap Abdominal Wall Reconstruction: A Systematic Review

2017 ◽  
Vol 02 (02) ◽  
pp. e118-e123
Author(s):  
Paul Therattil ◽  
Stephen Viviano ◽  
Edward Lee ◽  
Jonathan Keith
Keyword(s):  
Abdominal Wall ◽  
Free Flap ◽  
Vastus Lateralis ◽  
Abdominal Wall Reconstruction ◽  
Free Flaps ◽  
Fascia Lata ◽  
Sensory Innervation ◽  
Abdominal Wall Defects ◽  
Tensor Fascia Lata ◽  
Anterolateral Thigh

Background Reconstruction of large abdominal wall defects provides unique challenges to the plastic surgeon. Reconstruction with innervated free flaps has been described and allows for true functional replacement of “like with like.” The authors sought to determine the frequency and outcomes of such reconstructions. Methods A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for research articles related to innervated free flaps in abdominal wall reconstruction. Results Nine case series (16 patients) were included who underwent free flap reconstruction of the abdominal wall with motor and/or sensory innervation. Reconstruction was performed with latissimus dorsi (n = 5), tensor fascia lata (n = 4), rectus femoris (n = 2), combined tensor fascia lata-anterolateral thigh (n = 2), combined vastus lateralis-tensor fascia lata-anterolateral thigh flaps (n = 2), and vastus lateralis-anterolateral thigh (n = 1). All but one reconstruction had motor neurotization performed (n = 15), while only 12.5% (n = 2) had sensory neurotization performed. At least 66.6% of patients (n = 10) who had motor neurotization regained motor function as evidenced by documented clinical examination findings while 93.3% (n = 14) had “satisfactory” motor function on author's subjective description of the function. Both flaps that had sensory innervation were successful with Semmes–Weinstein testing of 3.61. Conclusion A majority of neurotized free flap reconstructions for abdominal wall defects have been performed for motor innervation, which is almost invariably successful. Sensory neurotization has been carried out for a small number of these reconstructions, and also has been successful. Improvements in techniques and outcomes in innervated free flap abdominal wall reconstruction are important to advancing efforts in abdominal wall transplantation.

scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

scholarly journals Identification of spacewise dependent right-hand side in two dimensional parabolic equation

2021 ◽  
Vol 2092 (1) ◽  
pp. 012019
Author(s):  
LingDe Su ◽  
V. I. Vasil’ev
Keyword(s):  
Inverse Problem ◽  
Parabolic Equation ◽  
Numerical Solution ◽  
Hand Function ◽  
Adjoint Operator ◽  
Two Dimensional ◽  
Right Hand ◽  
Final Time Point ◽  
The Right ◽  
Constructed Self

Abstract In this paper numerical solution of the inverse problem of determining a spacewise dependent right-hand side function in two dimensional parabolic equation is considered. Usually, the right-hand side function dependent on spatial variable is obtained from measured data of the solution at the final time point. Many mathematical modeling problems in the field of physics and engineering will encounter the inverse problems to identify the right-hand terms. When studying an inverse problem of identifying the spacewise dependent right-hand function, iterative methods are often used. We propose a new conjugate gradient method based on the constructed self-adjoint operator of the equation for numerical solution of the function and numerical examples illustrate the efficiency and accuracy.

scholarly journals Extended medial sural artery perforator free flap for groin and scrotal reconstruction

2020 ◽  
Vol 47 (4) ◽  
pp. 354-359 ◽  
Author(s):  
Chad M. Teven ◽  
Jason W. Yu ◽  
Lee C. Zhao ◽  
Jamie P. Levine
Keyword(s):  
Free Flap ◽  
The Body ◽  
Anterolateral Thigh Flap ◽  
Small Surface ◽  
Pelvic Injuries ◽  
Anterolateral Thigh ◽  
Radial Forearm ◽  
Scrotal Reconstruction ◽  
Sural Artery ◽  
Artery Perforator

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearmbased flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

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

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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