Reconstruction of a large chest wall defect with a musculocutaneous free flap using anterolateral thigh musculature

Reconstruction of a large postmastectomy irradiated chest wall defect was accomplished with a large musculocutaneous free flap of anterolateral thigh musculature and skin. The vascular anatomy of the donor area allows a very substantial flap and skin island to be transferred, leaving a well-tolerated donor defect.     

Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap

Background:

The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage.

Materials and Methods:

From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft.

Result:

All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance.

Conclusion:

Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.     

Reconstruction of two separate defects in the upper extremity using anterolateral thigh chimeric flap

We presented our experience on the use of anterolateral thigh (ALT) chimeric flap to reconstruct two separate defects in upper extremity. From December 2009 to August 2012, we used this ALT chimeric flap to reconstruct two separate defects in upper extremity on five patients (mean age: 36.6 years; range: 15～47 years). The locations of defect were palm and fingers in four patients and forearm in the other patient. The sizes of defect ranged from 4.5 × 1.5 cm to 20 × 10 cm. A minimum of two separate perforator vessels in the flap were identified. The skin paddle was then split between the two perforators to shape two separate paddles with a common vascular supply. There were no cases of flap failure or re‐exploration. Four donor sites were directly closed and one was covered by a skin graft. Donor‐site morbidity was negligible. The ALT chimeric flap provides customized cover for two separate defects in upper extremity. © 2013 Wiley Periodicals, Inc. Microsurgery 33:631–637, 2013.     

One-stage reconstruction of large scalp defects: anterolateral thigh flap

Seven patients with large scalp and calvarial defects underwent reconstruction with free tissue transfer. Patients fell into two groups according to etiology: tumoral (five) or traumatic (two). A single type of free flap was used in each patient, i.e., the anterolateral thigh flap. Duraplasties with the flaps' vascularized fasciae were performed in two patients with minor calvarial defects, and nonvascularized fasciae were used in another two, with a cranioplasty using methylmethacrylate. One postoperative death and one venous congestion necessitating exploration were observed. The explored anastomosis revealed occlusion of the venous anastomosis; drainage with a venous graft into the neck veins was performed. Minor tissue loss with secondary healing was observed in the flap. Extensive scalp defects often necessitate challenging reconstructive procedures. Single-stage reconstruction with good qualified tissue is possible with a free tissue transfer. The anterolateral thigh flap provides a large amount of tissue with decreased donor-site morbidity and good cosmetic results.     

携血管化阔筋膜的股前外侧皮瓣动力性修复下唇大型缺损

目的探讨应用携血管化阔筋膜的股前外侧皮瓣修复下唇大型复杂缺损的临床效果。方法回顾性分析2013年1月至2020年6月,上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科同一课题组应用携血管化阔筋膜的股前外侧皮瓣修复的下唇大型复杂缺损患者的临床资料。股前外侧皮瓣用于恢复缺损的组织,重建下唇外形,阔筋膜与余留的口轮匝肌形成"闭环"结构进行动力性重建。术后每2~3个月随访1次,观察皮瓣存活情况、唇部外形、张闭口及饮水等情况。结果共纳入4例患者,均为男性,年龄26~63岁,2例为下颌骨鳞状细胞癌侵犯下唇,1例为下唇动静脉畸形栓塞术后,1例为下唇鳞状细胞癌。4例患者均顺利完成下唇的修复重建,移植皮瓣面积18 cm×7 cm~26 cm×8 cm,两端携带(5~8)cm×1 cm的阔筋膜,皮瓣均全部存活。术后随访时间6~80个月,患者下唇外形良好,张口度2~3横指,闭口时能完全密封,饮水达到基本不漏水。结论携血管化阔筋膜的股前外侧皮瓣可对下唇大型复杂缺损进行外形修复及动力性重建,能达到较好的临床效果。     

The preexpanded anterolateral thigh free flap

The anterolateral thigh flap has many of the attributes of the ideal soft-tissue flap. However, a major detriment is the potential conspicuous donor site deformity, especially if skin grafted. In elective situations, preexpansion of the lateral thigh with subsequent transfer of even a wide anterolateral thigh flap can permit primary donor site closure and avoidance of a skin graft. This has been achieved successfully in 2 compliant patients, and is a reasonable solution to minimize the morbidity of this otherwise important donor site.     

One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata

OBJECTIVE: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata. METHODS: Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer. RESULTS: All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients. CONCLUSION: The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects.     

游离削薄股前外侧皮瓣修复手腕部软组织缺损

目的探讨游离削薄型股前外侧皮瓣修复手腕部较大面积软组织缺损的临床效果方法首先对手腕部创面控制感染，减少分泌物，术中彻底清创，对受区血管状况做出判断，保证吻合血管质量，其次切取股前外侧皮瓣后，断蒂前修薄皮瓣至浅筋膜层，一般保留穿支血管周围1．5～2．0cm血管袖组织，可仅保留1支穿支血管。皮瓣移植修复创面后密切观察血供，及时处理血管危象：结果临床应用19例，移植皮瓣均成活，其中2例手术后24h出现血液循环危象，经及时处理后恢复皮瓣血液循环。结论削薄型股前外侧皮瓣厚度适宜，供区隐蔽、简便实用，可用于手腕部创面缺损修复，尤其适用于较大面积及肌腱、血管、神经外露创面的修复     

Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: structural and aesthetic outcomes

The advent of free tissue transfer has provided multiple options that allow preservation and maintain both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Eleven free anterolateral thigh flaps were used to reconstruct soft-tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, six for temporal regions, two for the frontoparietal midline region, and the remaining flap for a defect of the forehead. The study consisted of 10 males and one female whose ages ranged from 18 to 82 years (mean age: 52.5 years). Six patients had primary or recurrent cancer, four had acute or subacute wounds resulting from trauma or craniotomy, and one had high-tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width. The overall flap success rate was 100%. In two cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in one patient and a forehead defect in the other. In two patients, the fascial layer of the flap was used as a source for a vascularized fascial flap to cover defects of the dura mater. No secondary corrections, including debulking procedures or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor-site morbidity was observed. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent flap option for most scalp defects.     

Reconstruction of maxillary and palatal defects with the free radial forearm flap

We present six patients with maxillary and palate defects that were reconstructed with the radial forearm flap. Four patients had malignant neoplasms involving the maxilla, three with squamous cell carcinoma and the fourth with recurrent basal cell carcinoma. They were treated with excision and immediate reconstruction using a radial forearm free flap. The other two patients presented with large fistulae between the maxilla and nasal sinuses, these being sequelae of previous surgical treatment for malignancies. The fistulae were closed with radial forearm free flaps. This method provides primary wound healing, restoration of palatal function, preservation of facial contour, and a minimal morbidity while obviating the need for palatal prosthesis. In the six cases, the oral cavity has been completely separated from the paranasal sinus and nasal cavity, and all patients demonstrated satisfactory deglutition and intelligible speech.     

游离股前外侧皮瓣修复口腔软组织缺损

目的 探讨分析3种游离股前外侧皮瓣在口腔软组织缺损修复中的临床特点与治疗效果。方法 2008年12月至2010年12月收治67例口腔肿瘤患者,切除肿瘤的同时,应用游离股前外侧皮瓣修复缺损处,包括舌、颊、牙龈、口底,通常将皮瓣的旋股外侧动脉降支与受区的颌外动脉或甲状腺上动脉吻合,伴行静脉与受区的面总静脉或颈外静脉吻合。根据游离股前外侧皮瓣的厚度将其分成3种类型：股前外侧肌皮瓣、股前外侧脂肪筋膜皮瓣和薄型股前外侧皮瓣。结果 67例中股前外侧肌皮瓣为35例,股前外侧脂肪筋膜皮瓣17例,薄型股前外侧皮瓣15例。66例皮瓣存活,成功率为98.5％,其中1例糖尿病患者皮瓣发生小部分坏死,经清创换药后痊愈;1例皮瓣完全坏死。67例皮瓣中41例吻合2条静脉,26例吻合1条静脉。8例出现血管危象：6例为静脉血栓（5例抢救成功、1例皮瓣完全坏死）,1例为术区血肿,1例为穿支血管扭转,经过相应处理,血管危象均得到缓解。术后随访2～ 24个月,平均8.7个月,受区组织缺损修复效果满意,供区创面愈合良好。结论 游离股前外侧皮瓣的受区功能良好,供区并发症少,是一种修复口腔软组织缺损的较为理想的方法。     

Customized reconstruction with the free anterolateral thigh perforator flap

From April of 2003 through September of 2006, 70 free anterolateral thigh (ALT) flaps were transferred for reconstructing soft-tissue defects. The overall success rate was 96%. Among 70 free ALT flaps, 11 were elevated as cutaneous ALT septocutaneous vessel flaps. Fifty-seven were harvested as cutaneous ALT myocutaneous "true" perforator flaps. Two flaps were used as fasciocutaneous perforator flaps based on independent skin vessels. Fifty-four ALT flaps were used for lower extremity reconstruction, 11 flaps were used for upper extremity reconstruction, 3 flaps were used for trunk reconstruction, and 1 flap was used for head and neck reconstruction. Total flap failure occurred in 3 patients (4.28% of the flaps), and partial failure occurred in 5 patients (7.14% of the flaps). The three flaps that failed completely were reconstructed with a free radial forearm flap, a latissimus dorsi flap and skin grafting, respectively. Among the five flaps that failed partially, three were reconstructed with skin grafting, one with a sural flap, and one with primary closure. The free ALT flap has become the workhorse for covering defects in most clinical situations in our center. It is a reliable flap with consistent anatomy and a long, constant pedicle diameter. Its versatility, in which thickness and volume can be adjusted, leads to a perfect match for customized reconstruction of complex defects.