scholarly journals Reconstruction of a Large Through and Through Defect of the Oral Cavity Using Double Anterolateral Thigh Free Flap

2014 ◽  
Vol 29 (1) ◽  
pp. 26-29
Author(s):  
Jefferson A. Alamani ◽  
Samantha S. Castañeda ◽  
Adrian F. Fernando
Keyword(s):  
Soft Tissue ◽  
Oral Cavity ◽  
Free Flap ◽  
Donor Site ◽  
Operating Time ◽  
Soft Tissue Defect ◽  
Full Thickness ◽  
Anterolateral Thigh ◽  
Cervical Area ◽  
Alt Flap

Objective: To present our application of a double anterolateral thigh (ALT) free flap in reconstruction of a large full thickness defect of the oral cavity, cheek and cervical area. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 77-year-old male with a 20 x 25 cm full thickness soft tissue defect on the facial and cervical area contiguous with a 6 x 6 cm buccal defect resulting from wide tumor ablation of a Stage IVA (T4aN2bM0) squamous cell carcinoma of the buccal mucosa underwent reconstruction using two ALT free flaps. An ALT flap was designed to cover the intraoral and cheek defect, while another ALT flap was used for external coverage of the cervical defect. The first ALT flap measured approximately 8 x 22 cm while the second ALT flap measured 6 x 22 cm harvested from the left and right thigh respectively. Temporary venous congestion was observed on the inferiorly placed ALT flap due to neck edema that spontaneously resolved on the 2nd post-operative day. Minimal donor site complications observed were linear scars, and a 1 x 4 cm dehiscence on the right thigh that healed spontaneously by secondary intention.   Conclusion: The utilization of a double anterolateral thigh free flap allowed single-stage reconstruction of the large soft tissue head and neck defect with little donor site morbidity, shorter operating time and shorter hospital stay.   Keywords: anterolateral thigh free flap (ALT flap), double ALT flap, full-thickness buccal defect

scholarly journals Anterolateral thigh free flap- largest size flap till date in lateral skull base defect reconstruction: an interesting case report

2021 ◽  
Vol 8 (5) ◽  
pp. 1637
Author(s):  
Madhusoodan Gupta ◽  
Abid Saleem ◽  
Raghavendra Kaladagi ◽  
Pradeep K. Singh ◽  
Rohit Chandra ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skull Base ◽  
Free Flap ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Lateral Skull Base ◽  
Anterolateral Thigh ◽  
Skull Base Defect

Vascularised free tissue transfer has revolutionized skull base defect reconstruction. It allows to restores form and functions without compromising the principles of oncoplastic surgery. Anterolateral thigh (ALT) free flap is a workhorse flap in head and neck reconstruction. The versatility of the ALT-free flap makes it unique to reconstruct almost every soft-tissue defect in head and neck reconstruction. Due to the large surface of the anterolateral thigh, a very large flap can be harvested with very little donor site morbidity. Here we have reported a case of 40 years, male patient, with a known case of primary squamous cell carcinoma (SCC) of the left parotid gland. After the surgical extirpation of the tumor, an extensive soft-tissue defect was created in the region of the left lateral skull base defect. For coverage of large defect, we did the ALT free flap size 25×18 cm (450 cm2). The donor site was partially closed primarily and partially skin grafted. The patient was discharged uneventfully on the 7th postoperative day.

LONG-TERM DONOR-SITE MORBIDITY IN COMPOSITE ANTEROLATERAL THIGH FREE FLAP FOR COMPLEX DEFECT OF LOWER LEG AND FOOT RECONSTRUCTION

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

scholarly journals Versatility of Latissimus Dorsi Free Flap-a Prospective Study

2021 ◽  
Vol 28 (2) ◽  
pp. 142-152
Author(s):  
Abu Faisal Md Ariful Islam ◽  
Mohammad Rabiul Karim Khan ◽  
Sharmin Akter Sumi ◽  
Mohammad Hedayet Ali Khan ◽  
Md Abul Kalam
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Latissimus Dorsi Flap ◽  
Tissue Defect ◽  
Medical College ◽  
The Mean

Introduction: Free flaps offer a great variable of available tissues to cover larger, multifocal or multistructural defects. The choice among different free flap is dependent upon their recipient site requirement. Reconstruction with latissimus dorsi flap is now versatile tool in coverage. It can resurface large wound with reliable vascularity, consistent anatomy ,long pedicle length, opportunity for tailoring of flap. It has less donor site morbidity and has very little post-operative complications. Objective: To evaluate the versatility of free Latissimus dorsi flap for soft tissue reconstruction. Materials and methods: A prospective, observational study design was used in Department of Plastic Surgery of Dhaka Medical College and Hospital. Here 20 patients with soft tissue defect of variable sizes over lower limb, head neck and trunk underwent coverage with microvascular surgery. The study was carried out from July 2017 to June 2018. Result: Regarding the age distribution, the mean age was 35.65with an SD of + 10.81. The lowest age was 20years and the highest age was 56 years, Male female ratio was 3:2.The major cause (65.0%) of soft tissue defect of the samples was RTA. The flap was used to reconstruct the soft tissue defect over lower leg in 13 (65%)cases, on scalp 05 (25%) cases and over anterior trunk in two cases. The mean flap dimension was 229.25cm2 and its range was between 120 – 384 cm2. The standard myocutaneous flap was harvested in 80% cases, chimeric (10%) and partial Latissimus muscle flap in two cases. The donor site in all the 20 (100%) cases was closed primarily. The outcome of reconstruction was excellent in 16(80%), good in 02 (10%) cases and poor in 02 (10%) cases. There was no significant complication during the three months postoperative period. Conclusion: The Latissimus dorsi flap is a versatile option for resurfacing the soft tissue defect in different areas of the body with variable flap components and with minimal donor site morbidity. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 142-152

scholarly journals Full-Thickness Skin Grafts for Coverage of the Pedicle in Partial Second Toe Pulp Free Flap

2021 ◽  
Vol 17 (3) ◽  
pp. 237-241
Author(s):  
Won Jin Cha ◽  
Jeong Hwa Seo ◽  
Jeeyoon Kim ◽  
Sung-No Jung ◽  
Bommie Florence Seo
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Donor Site ◽  
Skin Grafts ◽  
Full Thickness ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Graft Area

Pedicle coverage during free flap reconstruction of the digit commonly presents complicated issues. As the finger is a cylindrical unit with small volume, it is difficult to secure ample soft tissue for relaxed coverage of the pedicle. We have applied full-thickness skin grafts (FTSGs) to loosely cover the pedicle of the free flap of the fingertip and report preliminary results. Seven patients who received free toe pulp flap and FTSG for soft tissue coverage of the pedicle were analyzed. Intraoperative parameters collected were defect, flap and graft area size and donor site. Patients were observed postoperatively for up to 2 months for graft take, necrosis, digit contour, and donor site complications. The average area of the free flap was 2.39±1.03 cm<sup>2</sup> and the average graft area was 1.37±1.06 cm<sup>2</sup>. The FTSG survived without sloughing or necrosis in six patients. Early epithelial sloughing with dermis take was noted in one patient who healed with dressings. The pedicle and graft portion showed bulging immediately after the operation but decreased to normal contour by 4 weeks. FTSG is an option that can be safely used as a method of pedicle coverage during free flap reconstruction of digits.

scholarly journals Immediate Lower Extremity Reconstruction Using an Anterolateral Thigh Free Flap With Simultaneous Interposition Graft of Descending Branches of Lateral Circumflex Femoral Vessels

2018 ◽  
Vol 18 (1) ◽  
pp. 89-93
Author(s):  
Joonho Lim ◽  
Heeyeon Kwon ◽  
Kyoung Min Lee ◽  
Changsik Pak
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Limb Ischemia ◽  
Soft Tissue Defect ◽  
Acute Limb Ischemia ◽  
Interposition Graft ◽  
Tissue Defect ◽  
Anterolateral Thigh ◽  
Femoral Vessels ◽  
Lateral Circumflex Femoral

In a severely injured leg with acute limb ischemia, both immediate revascularization of an endangered part and coverage of soft tissue defect are crucial to limb salvage. In this article, we report a case of an anterolateral thigh free flap with interposition graft of descending branches of the lateral circumflex femoral vessels. A 18-cm-long graft was harvested and used to replace the injured anterior tibial vessels. One month later, a duplex sonogram revealed intact circulation to both the interposition graft and the flap. Despite anatomic inconstancy, the anterolateral thigh free flap is commonly utilized in reconstructive surgeries. When descending branches of the lateral femoral circumflex vessels were included sufficiently, its pedicle can be used to bridge a vascular defect in the extremity while covering soft tissue defect.

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 Reconstruction of Soft-Tissue Defect Around the Knee Using a Pedicled Reverse-Flow Anterolateral Thigh Flap: A Case Report

2020 ◽  
Vol 25 (1) ◽  
pp. 55-59
Author(s):  
Nam Jang ◽  
Hyun Woo Shin ◽  
Kun Chul Yoon
Keyword(s):  
Soft Tissue ◽  
Reverse Flow ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Tissue Defect ◽  
Circumflex Femoral Artery ◽  
Anterolateral Thigh ◽  
Pedicle Length ◽  
Lateral Circumflex Femoral ◽  
Alt Flap

Coverage of traumatic soft-tissue defects around the knee is a challenging problem for reconstructive surgeons though many reconstructive options are available. We planned to use a pedicled reverse-flow anterolateral thigh (ALT) flap using the distal branch of the descending branch of the lateral circumflex femoral artery (LCFA) for pedicle length extension in a patient with the ALT perforator branch originating from the proximal portion of the descending branch of LCFA. We present the successful use of a pedicled reverse-flow ALT flap to cover a soft tissue defect around the knee.

scholarly journals Salvaging a Severely Burned Ankle Using Arthrodesis and Anterolateral Thigh Free Flap

2020 ◽  
Vol 16 (1) ◽  
pp. 64-67
Author(s):  
Joong Min Suh ◽  
Yong Joon Chang ◽  
Chul Hoon Chung ◽  
Gab Lae Kim
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Free Flap ◽  
Burn Injury ◽  
Lower Leg ◽  
Soft Tissue Defect ◽  
Necrotic Tissue ◽  
Anterolateral Thigh ◽  
Underlying Diseases ◽  
Flame Burn

A 72-year-old male patient without underlying diseases presented with a flame burn injury on the fibula and talus of the ankle joint and soft tissue around the posterior lower leg. Necrotic tissue was removed with surgical debridement. Amputation was considered because loss of the bony structure on the ankle joint, including the fibula, hindered stability of the joint. We covered the soft tissue defect using an anterolateral thigh free flap and salvaged the limb using ankle and subtalar arthrodesis with tibiotalocalcaneal intramedullary nailing. The patient began self-ambulation 1 month after the surgery and did not develop any complications.

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