scholarly journals The Free Anterolateral Thigh (ALT) Flap for Microsurgical Reconstruction of Traumatic Defects in Pediatric Foot

2018 ◽  
Vol 02 (01) ◽  
Author(s):  
Georgios Christopoulos
Keyword(s):  
Microsurgical Reconstruction ◽  
Anterolateral Thigh ◽  
Pediatric Foot ◽  
Alt Flap

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes

2021 ◽  
Author(s):  
Rajiv P. Parikh ◽  
Austin Ha ◽  
Thomas Tung
Keyword(s):  
Limb Salvage ◽  
Functional Outcomes ◽  
Free Flaps ◽  
Ankle Injuries ◽  
Foot And Ankle ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Microsurgical Reconstruction ◽  
Pediatric Foot

Abstract Background Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. Methods This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated. Results Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years. Conclusion Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.

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.

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.

Microsurgical Reconstruction of the Oral Cavity with Free Flaps from the Anterolateral Thigh and the Radial Forearm: A Comparison of Perioperative Data from 161 Cases

2011 ◽  
Vol 18 (7) ◽  
pp. 1988-1994 ◽  
Author(s):  
Marco Rainer Kesting ◽  
Frank Hölzle ◽  
Craig Wales ◽  
Lars Steinstraesser ◽  
Stefan Wagenpfeil ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Free Flaps ◽  
Microsurgical Reconstruction ◽  
Anterolateral Thigh ◽  
Radial Forearm

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.

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

2017 ◽  
Vol 33 (07) ◽  
pp. 466-473 ◽  
Author(s):  
Akhil Seth ◽  
Matthew Iorio
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Venous Anastomosis ◽  
Distal Extremity ◽  
Anterolateral Thigh ◽  
Effective Option ◽  
Tissue Reconstruction ◽  
Extremity Reconstruction ◽  
Alt Flap

Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial (n = 14) or super-thin (n = 11) ALT flap reconstruction for primarily lower extremity wounds (n = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m2, respectively. Follow-up was 6.3 months. Comorbidities included smoking (n = 7), diabetes (n = 8), peripheral vascular disease (n = 6), and hypertension (n = 8). The presence of hardware (n = 9), trauma (n = 10), and chronic infection (n = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n = 16) taken on one perforator. Forty-eight percent (n = 12) were end-to-side anastomoses and 62% (n = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n = 6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.

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

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