scholarly journals Reconstruction of Complex Lateral Skull Base Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Flap

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhaojian Gong ◽  
Shanshan Zhang ◽  
Chang Chen ◽  
Yuan Zhi ◽  
Moxin Zi
Keyword(s):  
Oral Cancer ◽  
Skull Base ◽  
Anterolateral Thigh Flap ◽  
Cancer Resection ◽  
Defect Reconstruction ◽  
Lateral Skull Base ◽  
Anterolateral Thigh ◽  
Skull Base Defect ◽  
Skull Base Defects ◽  
Alt Flap

ObjectivesComplex lateral skull base defects resulting from advanced or recurrent oral cancer resection are continuously challenging reconstructive surgeons. This study aimed to use reconstructive methods for lateral skull base defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) flaps.Patients and MethodsWe performed a retrospective case series of 37 patients who underwent lateral skull base defect reconstruction using the ALT/anteromedial thigh (AMT) flap between March 2016 and May 2021 at the Second Xiangya Hospital. The design and harvest of the flaps, methods for defect reconstruction, and reconstructive efficacy are described.ResultsOf the 37 patients, 3 were women and 34 were men, with a mean age of 51.7 years. Among the defects, 26 were through-and-through defects and were reconstructed using ALT chimeric flaps, double ALT flaps, folded ALT flap, combined ALT chimeric flaps and AMT flaps, or combined ALT chimeric flaps and pectoralis major flaps; the large lateral skull base dead spaces were filled with muscle tissues or fatty tissues. Postoperatively, 38 of the 39 ALT/AMT flaps survived completely, and the remaining flap experienced partial necrosis. Venous compromise occurred in one patient who was salvaged after operative exploration. Oral and maxillofacial wound infections occurred in two patients, salivary fistula in three patients, and thigh wound effusion in three patients. The wounds healed gradually in all patients after repeated dressing changes. Thirty-three patients were followed up for approximately 3–60 months; their oral functions and appearance were acceptable, and thigh motor dysfunction was not observed.ConclusionsWith the convenient flap design and muscle flap harvest, large and individualized tissue supply, feasible combination with other flaps, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT flap is an appropriate choice for complex lateral skull base defect reconstruction.

scholarly journals Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

2019 ◽  
Vol 276 (12) ◽  
pp. 3487-3494 ◽  
Author(s):  
Piotr Trojanowski ◽  
Marcin Szymański ◽  
Agnieszka Trojanowska ◽  
Adrian Andrzejczak ◽  
Dariusz Szczepanek ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Free Flap ◽  
Anterolateral Thigh Flap ◽  
Petrous Apex ◽  
Recipient Site ◽  
Lateral Skull Base ◽  
Anterolateral Thigh ◽  
Skull Base Defects ◽  
Alt Flap

Abstract Purpose Evaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution. Methods An analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap. Results Tumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications. Conclusions The ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

Anterolateral Thigh Flap for Skull Base Reconstruction

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P30-P30
Author(s):  
Matthew M Hanasono ◽  
Neha Goel ◽  
Martina Ayad ◽  
Roman Skoracki ◽  
Justin Michael Sacks
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Donor Site ◽  
Csf Leak ◽  
Anterolateral Thigh Flap ◽  
Wound Complications ◽  
Skull Base Reconstruction ◽  
Anterolateral Thigh ◽  
Facial Reanimation ◽  
Skull Base Defects

Objective 1) Review our experience with the anterolateral thigh (ALT) free flap in skull base reconstruction. 2) Describe reconstructive techniques for skull base defects and dural coverage with simultaneous facial reanimation. Methods A retrospective review was performed for 25 consecutive patients with defects of the skull base who were reconstructed with the ALT free flap. Results Reconstructed sites consisted of 2 anterior, 7 lateral, and 16 posterior skull base defects. Neoadjuvant and adjuvant radiotherapy (RT) was administered to 32% and 36% of the patients, respectively. The overall complication rate was 36% (66% recipient site and 34% donor site). One patient developed a CSF leak and one a nasocutaneous fistula. RT was associated with a two-fold increase in wound complications relative to controls. There were no flap losses and no long-term donor site probleMS 3 nerve grafts using the lateral femoral cutaneous nerve and 12 static slings for facial reanimation using the tensor fascia lata were performed simultaneously with free flap reconstruction from the same donor site. 4 gold eyelid weights, 2 lateral canthoplasties, and 3 direct browlifts were also performed simultaneously. Conclusions The ALT free flap provides reliable and versatile reconstruction of skull base defects. Primary advantages of this flap reside in the ability to harvest variable amounts of skin and vastus lateralis muscle along with nerve and fascial grafts from the same operative site, minimizing operative time and donor site morbidity. In our practice, the ALT flap represents a first-line option for composite skull base defects.

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.

The Surgical Management of Temporal Bone and Lateral Skull Base Defects

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Hannah North ◽  
Simon Freeman ◽  
Scott Rutherford ◽  
Andrew King ◽  
Chorlatte Hammerbeck-Ward ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Surgical Management ◽  
Lateral Skull Base ◽  
Skull Base Defects

Reconstruction of Lateral Skull Base Defects after Combined Parotidectomy and Temporal Bone Resection for Advanced Malignancy

Skull Base ◽  
2011 ◽  
Vol 21 (S 01) ◽  
Author(s):  
Zoukaa Sargi ◽  
Robert Gerring ◽  
Adrien Eshraghi ◽  
David Arnold ◽  
Francisco Civantos ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Bone Resection ◽  
Advanced Malignancy ◽  
Lateral Skull Base ◽  
Temporal Bone Resection ◽  
Skull Base Defects

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Reece Moore ◽  
Donna Mullner ◽  
Georgina Nichols ◽  
Isis Scomacao ◽  
Fernando Herrera
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
False Positive ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Preoperative Imaging ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

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