Combined Free Fibula Osteocutaneous and Anterolateral Thigh-Vastus Lateralis Free Flaps for Clavicule and Extensive Chest Wall Reconstruction After Sarcoma Resection

Background Reconstruction of large abdominal wall defects provides unique challenges to the plastic surgeon. Reconstruction with innervated free flaps has been described and allows for true functional replacement of “like with like.” The authors sought to determine the frequency and outcomes of such reconstructions. Methods A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for research articles related to innervated free flaps in abdominal wall reconstruction. Results Nine case series (16 patients) were included who underwent free flap reconstruction of the abdominal wall with motor and/or sensory innervation. Reconstruction was performed with latissimus dorsi (n = 5), tensor fascia lata (n = 4), rectus femoris (n = 2), combined tensor fascia lata-anterolateral thigh (n = 2), combined vastus lateralis-tensor fascia lata-anterolateral thigh flaps (n = 2), and vastus lateralis-anterolateral thigh (n = 1). All but one reconstruction had motor neurotization performed (n = 15), while only 12.5% (n = 2) had sensory neurotization performed. At least 66.6% of patients (n = 10) who had motor neurotization regained motor function as evidenced by documented clinical examination findings while 93.3% (n = 14) had “satisfactory” motor function on author's subjective description of the function. Both flaps that had sensory innervation were successful with Semmes–Weinstein testing of 3.61. Conclusion A majority of neurotized free flap reconstructions for abdominal wall defects have been performed for motor innervation, which is almost invariably successful. Sensory neurotization has been carried out for a small number of these reconstructions, and also has been successful. Improvements in techniques and outcomes in innervated free flap abdominal wall reconstruction are important to advancing efforts in abdominal wall transplantation.

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Chest Wall Reconstruction Following Tumor

10.2310/ps.10048 ◽

2020 ◽

Author(s):

Farooq Shahzad ◽

Evan Matros

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Free Flaps ◽

Chest Wall Reconstruction ◽

Chest Wall Tumor ◽

Soft Tissue Coverage ◽

Soft Tissue Reconstruction ◽

Pedicled Flaps ◽

Ablative Surgery ◽

Tissue Reconstruction

Plastic surgeons are typically called upon to reconstruct the chest wall in four situations: oncologic resection, infections, trauma and osteoradionecrosis. In this chapter we will discuss post-oncologic reconstruction. Chest wall reconstruction following tumor resection is typically performed at the same setting as the ablative surgery; this results in quicker patient recovery and overall better outcomes. The reconstruction should be planned with the ablative surgeon so that an assessment can be made of the extent of resection and available donor sites for reconstruction. The major components of reconstruction are 1) skeletal support and 2) soft tissue coverage. Skeletal support is indicated if the defect is >5 cm, 4 or more ribs are removed or more than 2/3rd of the sternum is resected. Prosthetic mesh is most commonly used. Soft tissue reconstruction is performed with regional pedicled flaps in the vast majority of cases. Free flaps are used when regional flaps are not sufficient (large defects) or not available. This review contains 11 figures, 3 tables, and 49 references. Keywords: chest wall, tumor, skeletal reconstruction, soft tissue reconstruction, mesh, acellular dermal matrix, titanium osteosynthesis systems, resorbable plates, pedicled flaps, free flaps

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Anterior Middle Chest Wall Reconstruction Using a Free Anterolateral Thigh Flap Resulted in Flail Chest

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000002386 ◽

2019 ◽

Vol 7 (8) ◽

pp. e2386 ◽

Cited By ~ 1

Author(s):

Itaru Tsuge ◽

Susumu Saito

Keyword(s):

Chest Wall ◽

Flail Chest ◽

Chest Wall Reconstruction ◽

Anterolateral Thigh Flap ◽

Anterolateral Thigh

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

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0032-1322534 ◽

2012 ◽

Vol 5 (4) ◽

pp. 205-211 ◽

Cited By ~ 11

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.

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