scholarly journals Modified Recipient Blood Flow-Preserved Cross-Leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

2021 ◽  
Author(s):  
Hong-Xiang Zhou ◽  
Liang He ◽  
Dong Yin ◽  
Yang Niu ◽  
Zhe Jin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Posterior Tibial Artery ◽  
Anterolateral Thigh Flap ◽  
Posterior Tibial ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Flap Procedure ◽  
Tissue Defects

Abstract Background Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy. Methods Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up. Results All 22 flaps survived. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed in a single fashion, and four flaps were bilobed. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries was confirmed during follow-up. All flaps recovered sensation at the final follow-up. The postoperative follow-up ranged from 18 to 84 months, and no long-term complications were observed. Conclusions The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing the major artery of the uninjured lower limb.

scholarly journals Modified Recipient Blood Flow-preserved Cross-leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

2021 ◽  
Author(s):  
Hong-Xiang Zhou ◽  
Liang He ◽  
Dong Yin ◽  
Yang Niu ◽  
Zhe Jin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Posterior Tibial Artery ◽  
Anterolateral Thigh Flap ◽  
Posterior Tibial ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Flap Procedure ◽  
Tissue Defects

Abstract Background: Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. We here introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy.Methods: Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent the modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were stubborn ulcers, and 1 case was degloving injury. The arterial pedicle of flap was prepared as Y-shaped fashion and microanastomosed to contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed as single or bilobed fashions according to the shape of defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up.Results: All of 22 flaps survived. The flap sizes ranged from to 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed as single fashion, and four flaps were bilobed fashion. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision were performed in 16 cases, while additional full-thickness skin grafting were performed in remaining 6 cases. Further bone transport procedure was performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries were all confirmed during follow-up. The postoperative follow-up ranged 18 to 84 months, and no long-term complications were observed.Conclusions: The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing major artery of uninjured lower limb.

ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

2019 ◽  
pp. 44-48
Author(s):  
Hong Phuc Le ◽  
Thiet Son Tran ◽  
Nghi Thanh Nhan Le
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Fasciocutaneous Flaps ◽  
Limb Reconstruction ◽  
Anterolateral Thigh ◽  
Lower Limb Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

2019 ◽  
pp. 44-48
Author(s):  
Hong Phuc Le ◽  
Thiet Son Tran ◽  
Nghi Thanh Nhan Le
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Fasciocutaneous Flaps ◽  
Limb Reconstruction ◽  
Anterolateral Thigh ◽  
Lower Limb Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

A New Recipient Artery for Reconstruction of Soft-Tissue Defects in the Lower Limb with a Free Anterolateral Thigh Flap

2012 ◽  
Vol 130 (5) ◽  
pp. 1059-1065 ◽  
Author(s):  
Shun-Hong Gao ◽  
Shi-Ming Feng ◽  
Chao Chen ◽  
Cheng Jiao ◽  
Lai-Qin Sun ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Recipient Artery ◽  
Anterolateral Thigh ◽  
Tissue Defects

Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap Procedure for Lower Extremity Reconstruction

2020 ◽  
Vol 19 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Zulfukar Ulas Bali ◽  
Berrak Karatan ◽  
Yavuz Tuluy ◽  
Yavuz Kececi ◽  
Levent Yoleri
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Free Flaps ◽  
Posterior Tibial Artery ◽  
Anterolateral Thigh Flap ◽  
Recipient Artery ◽  
Anterolateral Thigh ◽  
Thoracodorsal Artery ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.

Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap

2021 ◽  
pp. 153473462098223
Author(s):  
Jong-Ho Kim ◽  
Hyokyung Yoo ◽  
Seokchan Eun
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Distal Portion ◽  
Outcome Data ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Flap Viability ◽  
Anterolateral Thigh ◽  
Large Skin ◽  
Tissue Defects

The anterolateral thigh flap is a classic flap used for various reconstruction defects. However, the flap viability of extended large skin paddles (ie, 240 cm2) was doubted by many surgeons. This study reports successful experience of reconstructing extensive soft tissue defects of lower extremity using extended large skin paddles. Twelve consecutive patients who had undergone reconstruction of defects using an extended anterolateral thigh flap were identified. Patient characteristics (age, sex, defect location, injured structures, and type of flap) and outcome data were analyzed retrospectively. One artery and 2 accompanying veins were anastomosed to vascularize each flap. Follow-up periods ranged from 10 to 91 months postoperatively. The average size of the flaps was 268.75 cm2 (range = 220-391 cm2). All flaps were perforator flaps with one perforator except that 2 perforators were used in 3 patients. Two patients suffered partial flap necrosis of the distal portion with delayed healing. In conclusion, the extended anterolateral thigh flap is a considerable option for massive defects requiring composite tissue coverage. This flap is advantageous for reconstructing various complex defects in the lower extremities, providing a pliable and vascularized tissue to cover exposed extensive defects including tendons, nerves, and bones.

Cardiovascular responses to head-stand posture

1963 ◽  
Vol 18 (5) ◽  
pp. 987-990 ◽  
Author(s):  
Shanker Rao
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
High Pressure ◽  
Blood Flow ◽  
Arterial Pressure ◽  
Skin Temperature ◽  
Cardiovascular Responses ◽  
Posterior Tibial Artery ◽  
Nervous Control ◽  
Posterior Tibial

Reports of cardiovascular responses to head-stand posture are lacking in literature. The results of the various responses, respectively, to the supine, erect, and head-stand posture, are as follows: heart rate/min 67, 84, and 69; brachial arterial pressure mm Hg 92, 90, and 108; posterior tibial arterial pressure mm Hg 98, 196, and 10; finger blood flow ml/100 ml min 4.5, 4.4, and 5.2; toe blood flow ml/100 ml min 7.1, 8.1, and 3.4; forehead skin temperature C 34.4, 34.0 and 34.3; dorsum foot skin temperature C 28.6, 28.2, and 28.2. It is inferred that the high-pressure-capacity vessels between the heart level and posterior tibial artery have little nervous control. The high-pressure baroreceptors take active part in postural adjustments of circulation. The blood pressure equating mechanism is not as efficient when vital tissues are pooled with blood as when blood supply to them is reduced. man; heart rate; blood flow; skin temperature Submitted on January 3, 1963

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