Extracorporeal Perfusion for Free Fillet Lower Leg Flap After External Hemipelvectomy for Recurrent Osteosarcoma: A New Surgical Technique

Abstract BackgroundExternal hemipelvectomy often results in exposure of noble structures such as pelvic organs, joint surfaces, iliac neurovascular bundle and bone. Consequently, reconstructive surgery is always challenging. The free fillet lower leg flap is an optimal solution since it allows the transfer of a large amount of tissue and the it determines the absence of donor site morbidities. The prolonged ischemic time represents the weak point of this flap.Methods We presented the case of a 38-year-old man with recurrent radio-induced osteosarcoma arisen on pelvic cavity and involving common iliac vessels, bladder, left ureter and left kidney. We decided to use extracorporeal circulation (ECMO) in order to reduce ischemic time of the flap, since iliac vessels were necessary ligated in the middle of oncologic resection. We perfused the popliteal-based filleted lower leg musculocutaneous free flap with homologue blood and saline solution, while the oncologic dissection was completed.ResultsThe free fillet flap remained vital in the immediate postoperative period and in the following months. The patient did not come back to a life-threatening condition at 1y follow-up. ConclusionWe believed that ECMO expand the reconstructive indications in those cases in which a complex and long-lasting oncologic resection would make impossible a free flap due to prolonged ischemic time.

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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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Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02117-y ◽

2021 ◽

Cited By ~ 1

Author(s):

Dimitra Kotsougiani-Fischer ◽

Laura Sieber ◽

Sebastian Fischer ◽

Christoph Hirche ◽

Spyridoula Maraka ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site

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Abdominal or forearm V-Y? Comparison of radial forearm free flap donor site following skin graft reconstruction - what do patients think?

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2014.07.192 ◽

2014 ◽

Vol 52 (8) ◽

pp. e106

Author(s):

Alan Parbhoo ◽

T. Mirza ◽

P. Shah ◽

P.J. Ameerally ◽

A.C. Camilleri ◽

...

Keyword(s):

Skin Graft ◽

Free Flap ◽

Donor Site ◽

Radial Forearm Free Flap ◽

Radial Forearm ◽

Graft Reconstruction

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Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

Anais Brasileiros de Dermatologia ◽

10.1590/s0365-05962011000600013 ◽

2011 ◽

Vol 86 (6) ◽

pp. 1145-1150

Author(s):

Francisco Miguel Camacho-Martínez ◽

Angel Rollón ◽

Clara Salazar ◽

Elena M Rodríguez-Rey ◽

David Moreno

Keyword(s):

Free Flap ◽

Malignant Tumors ◽

Donor Site ◽

Free Flaps ◽

Single Step ◽

Rectus Abdominis ◽

Original Position ◽

Random Pattern ◽

Recipient Site ◽

Palmar Surface

BACKGROUND: Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE: To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS: We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS: Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting - a situation that some patients do not accept. CONCLUSIONS: In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese patients with deep and voluminous defects, although it is necessary to dislocate the navel from its original position

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Clinical application of the anterolateral thigh free flap in high energy injuries of the lower extremity

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211374 ◽

2021 ◽

Vol 9 (4) ◽

pp. 1192

Author(s):

Del Carmen-Ortega Ignacio ◽

Cahuana-Quispe Alberto Ignacio ◽

Jaimes-Duran Edwing Michel ◽

Soulé-Martínez Christian Enrique

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Donor Site ◽

High Energy ◽

Road Accident ◽

Anterior Tibial Artery ◽

Osteosynthesis Material ◽

Anterior Tibial ◽

End To End ◽

The Right

One of the recurring problems in plastic and reconstructive surgery is the loss of tissues of the lower extremities as a result of high-energy injuries. The difficulty of this reconstruction lies in the need for a sufficiently suitable and resistant tissue to allow this restoration. The thigh-free anterolateral flap, since its description in 1984, has great versatility for complex or extensive lower extremity reconstructions. We presented the case of a 37-year-old male patient who had a high-energy road accident on a bicycle, impacting a moving vehicle causing a multi fragmented fracture of the right proximal tibia AO 41 C2.2/Schatzker V. He was treated surgically with material from osteosynthesis and iliac crest graft. It is complicated by infection of the surgical wound, exposure of osteosynthesis material and absence of skin covering. Reconstruction of the upper third of the right leg was performed with a thigh-free anterolateral free flap with 2 end-to-end venous anastomoses from the flap to anterior tibial veins, and 1 end-to-end anastomosis from perforating artery to anterior tibial artery, with no associated complications. The thigh-free anterolateral free flap is a versatile and reliable mechanism for the reconstructive surgeon, as it provides excellent coverage for complex lower extremity wounds as well as low donor site morbidity. Outpatient follow-up with adequate clinical evolution was done.

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DIEP and Muscle Sparing Breast Free Flap

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0075 ◽

2019 ◽

pp. 781-794

Author(s):

Maurice Y. Nahabedian

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site ◽

The Other ◽

No Donor ◽

Technical Aspects ◽

Body Habitus ◽

Deep Inferior Epigastric Perforator ◽

Muscle Sparing

The deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flaps are arguably the most common flaps used for autologous breast reconstruction. The benefit of these flaps is that very little to no donor site muscle is harvested. The decision to use one or the other is occasionally made preoperatively based on body habitus but often intraoperatively based on the quality of the perforating vessels. The technical aspects of the operation are similar except for the actual dissection around the perforating vessels. Studies have demonstrated no significant differences in outcome when comparing the DIEP and MS free TRAM flaps.

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Subjective morbidity following radial free flap reconstruction in head and neck tumour patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000197 ◽

2019 ◽

Vol 133 (03) ◽

pp. 230-235 ◽

Cited By ~ 1

Author(s):

A Minkara ◽

M R Simmons ◽

A Goodale ◽

Y J Patil

Keyword(s):

Free Flap ◽

Short Form ◽

Donor Site ◽

Radial Forearm Free Flap ◽

Short Musculoskeletal Function Assessment ◽

Neck Tumour ◽

Radial Forearm ◽

Musculoskeletal Function ◽

Assessment Questionnaire ◽

Function Assessment

AbstractObjectiveEvaluation of post-operative donor site disability remains unaddressed in radial forearm free flap cases. This study aimed to assess donor site dysfunction following radial forearm free flap harvest using validated general, disease-specific and site-specific disability questionnaires.MethodsIn this retrospective case series of 24 patients at a tertiary academic medical centre, patients were assessed using the Short Form 36 Health Survey, Short Musculoskeletal Function Assessment questionnaire, and Disabilities of the Arm, Shoulder and Hand questionnaire. One-sample z-tests were performed, comparing means of the cohort to controls.ResultsCompared to population controls, the cohort had higher mean scores for the Disabilities of the Arm, Shoulder and Hand questionnaire (18.22 vs 10.1, p < 0.01), and Short Musculoskeletal Function Assessment questionnaire bothersome index (21.44 vs 13.77, p = 0.04), and a lower mean score for the Short Form 36 Health Survey physical component (38.88 vs 50, p < 0.01), indicating a greater disability for the cohort compared to controls.ConclusionRadial forearm free flap harvest causes significant long-term donor site disability in head and neck tumour patients. The Disabilities of the Arm, Shoulder and Hand questionnaire is a concise tool for measuring this dysfunction.

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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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