Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

Purpose: The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps.Methods: A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system.Results: A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p<0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type).Conclusion: Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

APPLICATION MAXILLOFACIAL MICROSURGERY AT HANOI NATIONAL HOSPITAL OF ODONTO-STOMATOLOGY

Background: Microsurgery is a highly complex technique that requires specialized equipment and steady surgical techniques. This is a retrospective review of the development progress of microsurgical techniques at Hanoi National Hospital of Odonto-Stomatology (NHOS) during the past 12 years. Methods: Retrospective study assessing the training and developing process of microsurgical techniques at NHOS in 12 years. Results: NHOS has performed 665 microsurgical flaps reconstructions after surgical removal of large tumors in maxillomandibular area. 441 fibular free flaps were harvested for mandibular reconstructions after resections of ameloblastoma and osteofibroma. 4 fibular flaps were used for maxillary reconstructions. 119 osteocutaneous fibular free flaps were harvested for mandibular reconstructions in oral cancer surgeries. 83 lateral arm flaps and 13 anterolateral thigh flaps reconstructions were performed following cancer ablations. 5 patients underwent reconstruction after cancer resection with 2 fibular free flaps and anterolateral thigh flaps. Success rate is 654/665 (98.35%). Conclusion: The implementation of microsurgery technique at NHOS has been carried out for only 12 years but rapid and significant progress has been made. Free flap reconstruction is a flexible reconstructive option to restore essential functions and aesthetics of the facial area and to improve the patient's quality of life.

Surgical management of a giant abdominal wall desmoid tumour

Desmoid tumours are clonal fibroblastic proliferations in soft tissues, characterised by infiltrative growth and local recurrence, but not metastasis. Various treatment strategies for desmoid tumours exist, varying from observation, medical and systemic therapy to radiotherapy and surgery. A 25-year-old woman with a background of familial adenomatous polyposis was referred with an enlarging abdominal desmoid tumour measuring 40×40×40 cm despite repeated radiofrequency ablation, surgical debulking and hormone therapy. The patient had a two-stage operation. The first stage involved excision of the desmoid tumour with full-thickness abdominal wall. The abdominal wall was not closed, and a topical negative pressure seal was applied. After 2 days, she underwent the second stage: reconstruction of the abdominal wall defect with a large porcine mesh which was covered with anterolateral thigh flaps. Postoperative complications included ileus and a fall which required further surgery. The patient was discharged 1 month after the first operation. Abdominal MRI scans were performed at 3 and 7 months postdischarge and showed no recurrence of diseaseBackground

Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors

Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result.Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area).Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant.Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion.Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients.

Pedicled sural flaps versus free anterolateral thigh flaps in reconstruction of dorsal foot and ankle defects in children: a systematic review

Background This systematic review compared free anterolateral thigh (ALT) flaps versus pedicled distally based sural artery (DBSA) flaps for reconstruction of soft tissue defects of dorsal foot and ankle in children.Methods A systematic literature search was performed to identify cases where an ALT or DBSA was used to reconstruct the dorsal foot in children. A total of 19 articles were included in the systematic review.Results Eighty-three patients underwent an ALT reconstruction and 138 patients underwent a DBSA reconstruction. Patients who had a DBSA were more likely to require grafting of the donor site (P<0.001). The size of ALT flaps was significantly larger than DBSA flaps (P=0.002). Subsequent flap thinning was required in 30% of patients after ALT and 12% of patients after DBSA reconstruction (P<0.001). Complications occurred in 11.6% of DBSA and 8.4% of ALT flaps (8.4%).Conclusions Both flaps are valid options in reconstructing pediatric foot and ankle defects. Each flap has advantages and disadvantages as discussed in this review article. In general for larger defects, an ALT flap was used. Flap choice should be based on the size of the defect.

Aesthetic and functional outcomes of thinned anterolateral thigh flap in reconstruction of complex wounds of the upper limb

We studied outcomes of reconstruction of complex upper limb wounds using thinned anterolateral thigh flaps. There were 18 patients with a mean age of 27.5 years. The mean thickness of the flap before and after thinning was 23 mm and 5 mm, respectively. Two patients had partial tip necrosis that was treated conservatively. Aesthetic and functional evaluations were performed using a 5-point Likert scale, QuickDASH score, passive range of motion and power grip at 12 months after surgery. The study showed good results in the aesthetic evaluation by a panel of plastic surgeons (mean score: 19.7) and patient self-assessment (mean score: 18.1). There was a significant correlation between the total scores of the panel and the patients. The mean QuickDASH score was 21, with a high percentage in the middle category ‘had a problem but working’. The thinned anterolateral thigh flap is versatile and safe in upper limb reconstruction with good aesthetic and functional results. Level of evidence: IV