Post-operative Complication at the Donor Site of Fibular Free Flap in a Pediatric Patient

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

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Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

Anais Brasileiros de Dermatologia ◽

10.1590/s0365-05962011000600013 ◽

2011 ◽

Vol 86 (6) ◽

pp. 1145-1150

Author(s):

Francisco Miguel Camacho-Martínez ◽

Angel Rollón ◽

Clara Salazar ◽

Elena M Rodríguez-Rey ◽

David Moreno

Keyword(s):

Free Flap ◽

Malignant Tumors ◽

Donor Site ◽

Free Flaps ◽

Single Step ◽

Rectus Abdominis ◽

Original Position ◽

Random Pattern ◽

Recipient Site ◽

Palmar Surface

BACKGROUND: Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE: To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS: We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS: Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting - a situation that some patients do not accept. CONCLUSIONS: In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese patients with deep and voluminous defects, although it is necessary to dislocate the navel from its original position

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Use of Osteofasciocutaneous Fibular Free Flap and Radial Head Arthroplasty in Trauma for Limb Salvage and Continued Elbow Function

Case Reports in Orthopedics ◽

10.1155/2018/8295736 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Catherine Kilmartin ◽

Katharine D. Harper ◽

Chirag Mehta ◽

Joseph Thoder ◽

Andrew Newman

Keyword(s):

Limb Salvage ◽

Free Flap ◽

Radial Head ◽

Radial Head Prosthesis ◽

Review Of The Literature ◽

Joint Function ◽

Radial Head Arthroplasty ◽

Elbow Function ◽

Fibular Free Flap ◽

Proximal Forearm

Reconstructive flaps have revolutionized the ability of surgeons to restore function and cosmesis for patients. While reconstructive flaps have been used to bridge large defects due to oncologic or congenital maladies necessitating large debridements, few cases have observed salvage flaps in traumas which provide additional challenges secondary to an injury trajectory. This case report details use of an osteofasciocutaneous fibular free flap and radial head prosthesis to restore forearm function in a 64-year-old female with a comminuted fracture of the proximal radius. The patient has sustained a 5.5 cm epiphyseal radial defect with an associated 20 × 15 cm overlying tissue defect after serial debridement. In review of the literature, only one nontraumatic case using a combined free flap and radial head prosthesis for proximal forearm defect to restore joint function has been reported. We suggest that, for proximal forearm fractures, this technique can be used to restore elbow joint function in limb salvage.

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Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1668142 ◽

2018 ◽

Vol 35 (02) ◽

pp. 156-162 ◽

Cited By ~ 2

Author(s):

Magdy Sherbiny ◽

Nehal Kamal ◽

Ahmed Ghoneimy

Keyword(s):

Functional Outcome ◽

Free Flap ◽

Average Length ◽

Femoral Shaft ◽

Wide Resection ◽

Level Of Evidence ◽

Bone Sarcomas ◽

Fibular Free Flap ◽

The Mean ◽

Resected Femoral

Background Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. Methods Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome. Results The mean follow-up period was 48.7 months (12–104 months). The mean age at presentation was 10.3 years (5–17 years). The average length of the resected femoral shaft was 19.2 cm (15–24 cm) and the average length of the harvested fibula was 17.4 cm (15–21 cm). The mean time to union was 4.8 months (1–6 months) and the mean hypertrophy index was 78% (15.5–184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56–100%) and the mean limb length inequality was 4.75 cm (3–11 cm). Conclusion Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting. Level of Evidence IV.

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