scholarly journals Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps

2021 ◽  
Vol 10 (17) ◽  
pp. 3863
Author(s):  
José Luis del Castillo Pardo de Vera ◽  
Carlos Navarro Cuéllar ◽  
Ignacio Navarro Cuéllar ◽  
José Luis Cebrián Carretero ◽  
Sandra Bacián Martínez ◽  
...  
Keyword(s):  
Latissimus Dorsi ◽  
Free Flaps ◽  
Team Approach ◽  
Vascular Pedicle ◽  
Scalp Reconstruction ◽  
Scalp Defects ◽  
Anterolateral Thigh ◽  
Oncologic Patients ◽  
The Aesthetic ◽  
Alt Flap

Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be considered for reconstruction of extensive scalp defects.

scholarly journals Pedicled anterolateral thigh flap for contralateral groin composite defect

2010 ◽  
Vol 43 (01) ◽  
pp. 103-105
Author(s):  
S. P. Bharath ◽  
G. Madhusudan ◽  
Suraj Manjunath
Keyword(s):  
Free Flaps ◽  
Anterior Superior Iliac Spine ◽  
Anterolateral Thigh Flap ◽  
Wide Resection ◽  
Vascular Pedicle ◽  
Anterolateral Thigh ◽  
Vascular Compromise ◽  
Femoral Vessels ◽  
Alt Flap ◽  
Composite Defect

ABSTRACTPedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.

scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

scholarly journals Free Tissue Reconstruction of the Scalp

2019 ◽  
Vol 33 (01) ◽  
pp. 067-071 ◽  
Author(s):  
Mofiyinfolu Sokoya ◽  
Emily Misch ◽  
Aurora Vincent ◽  
Weitao Wang ◽  
Sameep Kadakia ◽  
...  
Keyword(s):  
Free Tissue Transfer ◽  
Free Flaps ◽  
Advantages And Disadvantages ◽  
Scalp Reconstruction ◽  
Tissue Transfer ◽  
Scalp Defects ◽  
Calvarial Defects ◽  
Reconstructive Option ◽  
Tissue Reconstruction

AbstractReconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.

scholarly journals A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

2019 ◽  
Vol 9 ◽  
Author(s):  
Jochen Weitz ◽  
Christophe Spaas ◽  
Klaus-Dietrich Wolff ◽  
Bernhard Meyer ◽  
Ehab Shiban ◽  
...  
Keyword(s):  
Free Flaps ◽  
Team Approach ◽  
Standard Algorithm ◽  
Scalp Defects

scholarly journals Free Flap Reconstruction for Complex Scalp and Forehead Defects with Associated Full-Thickness Calvarial Bone Resections

2012 ◽  
Vol 5 (4) ◽  
pp. 205-211 ◽  
Author(s):  
Juan Larrañaga ◽  
Alfredo Rios ◽  
Edgardo Franciosi ◽  
Eduardo Mazzaro ◽  
Marcelo Figari
Keyword(s):  
Latissimus Dorsi ◽  
Vastus Lateralis ◽  
Donor Site ◽  
Free Flaps ◽  
Latissimus Dorsi Flap ◽  
Calvarial Bone ◽  
No Donor ◽  
Anterolateral Thigh ◽  
Radial Forearm ◽  
Anterolateral Thigh Flaps

Extensive defects of the scalp and forehead associated with calvarial bone resections demand complex reconstructions. Free flaps offer vascularized tissue of excellent quality and quantity. We report six patients with extensive scalp and forehead defects associated with calvarial bone resections reconstructed with free flaps. Five patients also required a cranioplasty. The flaps used were two anterolateral thigh flaps, one vastus lateralis flap, one myocutaneous latissimus dorsi flap, one latissimus dorsi flap, and one radial forearm flap. All flaps survived with no partial necrosis. There were no donor site complications. One patient presented an exposure of the alloplastic material used for cranioplasty. We strongly recommend the use of free flaps for this kind of reconstruction.

Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps

2017 ◽  
Vol 34 (02) ◽  
pp. 121-129 ◽  
Author(s):  
Pierre Moullot ◽  
André M. Gay ◽  
Baptiste Bertrand ◽  
Régis Legré ◽  
Nathalie Kerfant ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Free Flaps ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Aesthetic Outcome ◽  
Anterolateral Thigh ◽  
Alt Flap

Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. Methods We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap. Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05). Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.

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

Reconstruction of Postinfected Scalp Defects Using Latissimus Dorsi Perforator and Myocutaneous Free Flaps

2012 ◽  
Vol 23 (6) ◽  
pp. 1615-1619 ◽  
Author(s):  
Sang Wha Kim ◽  
Kyu Tae Hwang ◽  
Jong Do Kim ◽  
Youn Hwan Kim
Keyword(s):  
Latissimus Dorsi ◽  
Free Flaps ◽  
Scalp Defects

Is the Oblique Branch a Preferable Vascular Pedicle for Anterolateral Thigh Free Flaps?

2018 ◽  
Vol 34 (07) ◽  
pp. 478-484 ◽  
Author(s):  
Chengliang Deng ◽  
Kaiyu Nie ◽  
Wenhu Jin ◽  
Hai Li ◽  
Shujun Li ◽  
...  
Keyword(s):  
Free Flaps ◽  
Clinical Results ◽  
Type I ◽  
Type Ii ◽  
Vascular Pedicle ◽  
Harvest Time ◽  
Type Iii ◽  
Circumflex Femoral Artery ◽  
Anterolateral Thigh ◽  
Pedicle Length

Background The oblique branch of the lateral circumflex femoral artery is considered an alternative vascular pedicle of the anterolateral thigh (ALT) flap. However, the oblique branch has several advantages over the descending branch. Methods A total of 61 consecutive ALT free flaps were harvested according to Yu's ABC system. Vascular pedicle dimensions and length, artery course, perforator origins, and flap harvest time with the oblique branch or the descending branch were recorded. We classified the ALT flaps with oblique branches into three types according to the origin of perforator B. Type I flaps were those where perforator B originated from the descending branch. Type II flaps were those without perforator B. Type III flaps were those where perforator B originated from the oblique branch. Results The mean ± standard deviation (SD) diameter of the oblique branch at its origin was 1.68 ± 0.51 mm, with an average ± SD pedicle length of 12.92 ± 3.7 cm, while that of the descending branch was 2.27 ± 0.49 mm and 18.73 ± 5.14 cm, respectively. The percentage of septocutaneous perforators from the oblique branch was 35.59%, while that from the descending branch was 15.38%. The flap harvest time with the oblique branch was 33.73 ± 11.68 minutes, while that of the descending branch was 52.27 ± 7.21 minutes. Based on the origin of perforator B, 7 cases had type I ALT flaps, 4 had type II ALT flaps, and 10 had type III ALT flaps. Various ALT flaps based on the oblique branch were harvested, and good clinical results were achieved. Conclusion The oblique branch is sufficiently large and can be reliably used as the flap pedicle. It may be the preferred vascular pedicle for ALT free flaps.

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