1. Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: Long term recovery and functional outcomes.
- Author
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di Summa PG, Sapino G, Cherubino M, De Santis G, Durand S, Zaugg P, Bauquis O, and Raffoul W
- Subjects
- Adult, Ankle Injuries diagnosis, Ankle Injuries surgery, Cohort Studies, Fascia Lata surgery, Female, Graft Survival physiology, Hospitals, University, Humans, Injury Severity Score, Knee Injuries diagnosis, Knee Injuries surgery, Male, Middle Aged, Myocutaneous Flap blood supply, Prognosis, Range of Motion, Articular physiology, Recovery of Function, Retrospective Studies, Risk Assessment, Soft Tissue Injuries diagnosis, Switzerland, Tendon Transfer methods, Thigh surgery, Tissue and Organ Harvesting methods, Wrist Injuries diagnosis, Wrist Injuries surgery, Young Adult, Fascia Lata transplantation, Myocutaneous Flap transplantation, Plastic Surgery Procedures methods, Soft Tissue Injuries surgery, Wound Healing physiology
- Abstract
Background: We evaluated composite anterolateral thigh (ALT) flaps including vascularized fascia lata (FL), for stable soft tissue coverage and tendons restoration at various joint levels in a one-stage procedure., Methods: We performed a retrospective investigation including 21 "functional" ALT flaps between November 2006 and December 2016. In all patients included, FL was shaped to anatomical reproduce a tendon structure. Functional analysis included range of motion and force assessment. Functional scores were established according to Chen classification, DASH, and LEFS score. Defects resulted from tumor excision, trauma, burn, or infection-debridement and were distributed in four main anatomical districts: knee (seven cases), ankle (six cases), forearm-elbow (four cases), and hand-wrist level (three cases)., Results: Nineteen flaps were raised as free flaps, while two as distally-based propeller flaps. Average follow-up was 38 months. Major complication requiring the harvest of a second flap was seen in two patients, whereas three flaps presented superficial necrosis and was treated in an outpatient regimen. We observed 81% of total ROM recovery compared to contralateral sides with 89% recovered articular stability. Best articulation outcomes were present in elbow reconstruction, while ankle reconstructions showed less articularity. Hospital stay was significantly reduced in hand and wrist functional reconstruction when compared with reconstruction at the ankle level (P < 0.05)., Conclusion: The ALT flap extended to vascularized FL provides a particularly effective and resistant tissue that can be folded to reconstruct and support tendinous structures. This can restore functional and structural integrity after complex defects in a single stage procedure., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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