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.

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.

Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

2014 ◽  
Vol 40 (6) ◽  
pp. 583-590 ◽  
Author(s):  
X. Zhang ◽  
C. Chen ◽  
Y. Li ◽  
X. Shao ◽  
W. Guo ◽  
...  
Keyword(s):  
Nerve Repair ◽  
Donor Site ◽  
Digital Nerve ◽  
Great Toe ◽  
Dorsal Branch ◽  
Mean Size ◽  
The Mean ◽  
Repair Group ◽  
Composite Flap

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

scholarly journals Versatility of Adipofascial Anterolateral Thigh Flap for Reconstruction of Maxillary Defects with Infratemporal Fossa Extension

2014 ◽  
Vol 7 (3) ◽  
pp. 213-217 ◽  
Author(s):  
Vikram D. Kekatpure ◽  
Naveen Hedne ◽  
Sachin Chavre ◽  
Vijay Pillai ◽  
Nirav Trivedi ◽  
...  
Keyword(s):  
Hard Palate ◽  
Donor Site ◽  
Infratemporal Fossa ◽  
Mouth Opening ◽  
Case Series ◽  
Anterolateral Thigh Flap ◽  
No Donor ◽  
Anterolateral Thigh ◽  
Tissue Flap ◽  
Anterolateral Thigh Flaps

Tumors arising from the posterior hard palate or posterolateral maxilla may extend to involve the infratemporal fossa (ITF). Resection of these tumors results in infrastructural maxillectomy with ITF defects. In this study, we describe the use of an adipofascial anterolateral thigh flap (ALT) specifically for such defects. This case series includes four patients who underwent an infrastructure maxillectomy with ITF clearance and the resultant defects were reconstructed using adipofascial anterolateral thigh flaps. The complications as well as the functional outcomes were assessed. This study included patients with lesions involving the hard palate, posterolateral part of maxilla with extension into the ITF. The mean flap dimension was 150 cm2 (range, 120–180 cm2). All flaps were harvested based on a single perforator. The flap was used to obliterate the ITF defect and also to achieve oroantral separation. All flaps mucosalized well within 6 weeks. All patients were on oral diet and had adequate mouth opening. There were no donor-site complications. Adipofascial ALT is an excellent choice for infrastructural maxillectomy defects with ITF extension. The intraoral part got mucosalized well and provided a smooth and taut surface. A large adipofascial tissue flap helps obliterate the ITF, thus minimizing complications.

scholarly journals Safety and Efficacy of Pterygium Extended Removal Followed by Extended Conjunctival Transplant for Recurrent Pterygia

2021 ◽  
Author(s):  
Walid Allam ◽  
Ahmed Roshdy Alagorie ◽  
Mohammed Nasef ◽  
Molham El-Bakary
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Surgical Excision ◽  
Safety And Efficacy ◽  
Case Series Study ◽  
Corrected Distance Visual Acuity ◽  
The Mean ◽  
Prospective Case Series ◽  
Series Study

Abstract Purpose To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Methods Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was done for all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications. Results The mean age of the participants was 41.2 ± 10.3 years (range 22–60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12–43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2–1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3–1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure. Conclusions In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.

scholarly journals Successful Management of Peri-Implantitis around Short and Ultrashort Single-Crown Implants: A Case Series with a 3-Year Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Giorgio Lombardo ◽  
Mauro Marincola ◽  
Andrea Cicconetti ◽  
Miguel Angel Simancas-Pallares ◽  
Jacopo Pighi ◽  
...  
Keyword(s):  
Bone Defect ◽  
Treatment Options ◽  
Case Series ◽  
Bone Substitutes ◽  
High Survival ◽  
Retrospective Case ◽  
Implant Surface ◽  
Single Crown ◽  
The Mean

Introduction and Aim. In case of peri-implantitis, resective surgery is contraindicated for short and ultrashort implants, limiting the treatment options to regenerative surgery or to implant removal. This retrospective case series presents the clinical and radiographic outcomes of a surgical regenerative procedure to treat peri-implantitis around short and ultrashort implants. Materials and Methods. The study is a retrospective evaluation of patients suffering from peri-implantitis and those who underwent access flap surgery, concomitant chemical and mechanical decontamination of implant surface, and bone grafting using a self-hardening mixture of bone substitutes and biphasic calcium sulfate. No membranes were applied to cover the grafting material, and primary tension-free closure was achieved. The retrospective protocol was reviewed and approved by the Ethics Committee for Clinical Sperimentation (CESC) of Verona and Rovigo, Italy (based in the University of Verona) (Prog. 1863CESC. Date of approval: 2018-07-04). Results. 15 patients (17 implants) have been diagnosed with peri-implantitis after a mean follow-up of 24 months after loading. Implant length was between 5 and 8 mm. 8 patients (10 implants) had a history of periodontitis. At baseline, the mean PD (probing pocket dept) at the deepest site was 8.12 mm, with an average mBI (modified bleeding index) of 2.35 and a mean BD (bone defect depth) of 3.04 mm. At the 3-year follow-up, the CSR was 100%, the mean mBI was 0.88 (average reduction: −1.47), the mean PD was 3.35 mm (mean PD reduction: 4.77 mm), and the mean bone defect was reduced by 1.74 mm, with a mean bone fill of 55%. Conclusions. The results of the present case series suggest that if accurate surface decontamination is achieved, high survival rate and good clinical and radiographic results can be obtained after 3 years. However, only the histological examination could confirm the growth of new bone in direct contact with the implant surface or if the grafted material only fills the space left by the peri-implant defect.

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.

Anterolateral Thigh Flap in a Chicken Model: A Novel Perforator Training Model

2019 ◽  
Vol 35 (07) ◽  
pp. 485-488 ◽  
Author(s):  
Alfio Luca Costa ◽  
Filippo Cucinotta ◽  
Antonina Fazio ◽  
Gabriele Delia ◽  
Mariarosaria Galeano ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Perforator Flap ◽  
Training Model ◽  
Anterolateral Thigh Flap ◽  
Swine Model ◽  
Anterolateral Thigh ◽  
The Mean ◽  
Chicken Legs ◽  
Alt Flap ◽  
Chicken Model

Background Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. Methods A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. Results The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. Conclusion This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.

scholarly journals Anterolateral Thigh Skin and Fascia in Facial Skin Defects with Trismus: Two Problems, One Solution

2021 ◽  
Author(s):  
Prakash Panagatla ◽  
Parvathi Ravula ◽  
S. Praveen ◽  
Narsimha Rao Varagani ◽  
R. Srikanth ◽  
...  
Keyword(s):  
Mouth Opening ◽  
Case Series ◽  
Anterolateral Thigh Flap ◽  
Delayed Presentation ◽  
Facial Skin ◽  
Radiation Fibrosis ◽  
Interposition Graft ◽  
Anterolateral Thigh ◽  
Skin Loss

AbstractA case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.

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.

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