Search

Aim Method Results Conclusions Total pelvic exenteration (TPE) can be complicated by empty pelvis syndrome (EPS), and none of the currently available procedures completely mitigate this problem. The aim of this study was to evaluate the feasibility and effectiveness of a pedicled anterolateral thigh (p‐ALT) flap for preventing EPS.All cases of TPE at the National Cancer Center Hospital in Tokyo between 2008 and 2022 were retrospectively reviewed. The main indication for TPE was colorectal cancer, with some other malignancies. Background factors, surgical outcomes and postoperative complications were compared between patients who underwent primary suture closure (the PC group) and those who underwent p‐ALT flap reconstruction (the flap group).A total of 114 patients underwent TPE during the study period. Twenty patients in whom a different procedure was performed or a different flap was used for reconstruction were excluded, leaving 94 for analysis (PC group, n = 54; flap group, n = 40). There was no significant between‐group difference in patient characteristics. Severe pelvic abscess developed in 12 patients (22.2%) in the PC group and 2 (5%) in the flap group. Multivariable analysis identified a significantly lower risk of severe pelvic abscess in the p‐ALT flap reconstruction (OR 0.07, 95% CI 0.01–0.58, p = 0.01). EPS‐related readmissions were more common in the PC group [37.0% (20/54) vs. 25% (10/40)].The risk of severe pelvic abscesses and readmission for EPS was significantly lower after perineal reconstruction with a p‐ALT flap. Perineal reconstruction with this flap is a feasible and effective method in TPE. [ABSTRACT FROM AUTHOR]

The optimal sequence of microvascular clamping during free flap transfer is yet to be established. Many surgeons are reluctant to perform temporary declamping and subsequent reclamping during microvascular anastomosis; however, we generally anastomose the artery first and temporarily declamp it before performing venous anastomosis to confirm arterial patency and ensure proper alignment of the flap veins. Herein, we aimed to retrospectively investigate the efficacy and safety of this temporary revascularization method in 126 patients who underwent microvascular head and neck reconstruction. A total of 127 free flaps were transferred, with the anterolateral thigh flap (49 flaps) being the most frequently used. The internal jugular vein was the most frequently used recipient vein and end-to-side anastomoses to it were performed in 112 patients. Intraoperative reanastomosis was required because of arterial thrombosis in 5 cases (4.0%), arterial and venous thrombosis in 1 case (0.8%), injury to the flap artery distal to the anastomotic site in 1 case (0.8%), and venous twisting in 1 case (0.8%). Postoperatively, all the flaps survived without microvascular compromise. Vascular kinking or twisting of the vascular pedicle is a major cause of free flap failure. However, it is difficult to place empty vessels accurately during clamping. Nonetheless, temporary revascularization engorges the flap vein before venous anastomosis and minimizes the risk of venous kinking and twisting. According to our results, reclamping did not increase the risk of arterial thrombosis. [ABSTRACT FROM AUTHOR]

Introduction Due to the worldwide growing number of transgender individuals openly identifying themselves, including in Iran, these individuals need more attention and support. This study compares patient satisfaction and quality of life after female-to-male gender confirmation surgery using an anterolateral thigh (ALT) flap and radial forearm free flap (RFFF). Materials and Methods This study included 49 patients who underwent phalloplasty from 2014 to 2019 using two different methods. The two groups' outcomes and quality of life were investigated and compared 1 year after the operation. Results The mean age of the patients in this study was 32.7 years. Among patients, 44.9% underwent revision operations, and 38.8% had residual protective sensations after 1 year. In terms of quality of life after surgery, the general shape of the phallus, cold and heat sensation, sense of touch, the body of glans and shaft, color and size of the phallus, sexual pleasure in patients and their partners, and the relationship between the number of anastomosed nerves and sexual satisfaction, there was no statistically significant difference between the two groups. The ALT group had statistically significantly higher rates of orgasms compared to the RFFF group. Conclusion The outcomes of the two phalloplasty surgery methods (ALT and RFFF) are similar in different aspects, such as the quality of life. [ABSTRACT FROM AUTHOR]

Introduction Due to the worldwide growing number of transgender individuals openly identifying themselves, including in Iran, these individuals need more attention and support. This study compares patient satisfaction and quality of life after female-to-male gender confirmation surgery using an anterolateral thigh (ALT) flap and radial forearm free flap (RFFF).

Background: The anterolateral thigh (ALT) flap plays a crucial role in reconstructive surgeries, providing versatile and reliable soft-tissue coverage. Flap thickness is a critical determinant of tissue volume and quality. Vascular factors, including the vascular diameter of the perforators and the length of the vascular pedicle, significantly influence flap viability and postrepair outcomes. To enhance preoperative assessment, this study integrated gender and body mass index (BMI) to analyze the anatomical characteristics of ALT flaps. Methods: This study used somatic penetrating ultrasonography to examine bilateral ALT flaps in patients. This study analyzed the relationship between gender and ALT flap thickness, vascular diameter of the perforators, and vascular pedicle length. Chi-square test was used to assess variations in age and gender. Multiple t-tests compared flap thickness, vascular diameter, and pedicle length between men and women in different BMI groups. Results: A total of 158 patients were included in this study from January 2018 to December 2022. In BMI < 24 and BMI ≥ 24.0 groups, males had lower ALT flap thickness than females (p < 0.0001 in each subgroup). Similarly, the vascular diameter of the perforators followed the same trend, with females having larger vascular diameters than males in BMI < 24 and BMI ≥ 24.0 groups. In terms of vascular pedicle length, males had longer pedicle length than females in both BMI < 24 and BMI ≥ 24.0 groups (p < 0.05 in each subgroup). Conclusions: Females demonstrate greater ALT flap thickness and larger vascular diameter of the perforators than males, whereas males have a longer length of the vascular pedicle.

Abstract Objective To evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept. Methods From December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot. Results The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases. Conclusion The application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.

Objective: To evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept. Methods: From December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot. Results: The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases. Conclusion: The application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use. [ABSTRACT FROM AUTHOR]

Present study is a comparative evaluation of the financial impact on choice of flap, clinical results as well as post resection quality of life assessment of cancer patients reconstructed with anterolateral thigh(ALT) flap and pectoralis major myo-cutaneous(PMMC) flap. Ethical clearance was obtained from institutional ethical committee. In this non-randomised, prospective study design among 49 oral squamous cell carcinoma cases, 39 cases were reconstructed using PMMC flap and 10 using ALT flap from year 2020 to 2022. These 2 flaps were compared in terms of parameters like time utilised for reconstruction, hospital stay, overall survival and Washington University Quality of Life index(UW-QOL) for head and neck cancer. Patients were followed regularly for post-operative complications. The University of Washington Quality of Life score (UW-QOL) questionnaire, version 4, was completed at six months post-operatively. Obtained data was statistically analysed using IBM® SPSSⓇ. Washington University Quality of Life index scores and esthetics are better with Antero-lateral thigh flap, with less overall post-operative complications. On the other hand Pectoralis myocutaneous flap has less surgical time and more salvage potential. Despite of Antero-lateral thigh flap having Good Washington University Quality of Life index scores, lesser post-operative complications and better esthetics; scale of developing nations is still tipping towards economical, less time consuming and less technique sensitive Pectoralis major myocutaneous flap. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect of using a distally based anterolateral thick flap (dALT) to repair lateral knee joint defects. Methods From July 2021 to July 2022, Department of Plastic and Cosmetic Surgery, Zhongnan Hospital of Wuhan University using a retrospective observational study method. We documented and observed the treatment process of 15 patients who underwent full-thickness skin defect repair of the knee joint with a distally based anterolateral thigh flap after previous treatments. We analyzed the effectiveness of this treatment approach. Results All 15 cases showed good blood supply to the flaps post-surgery. In one case, most of the flap survived, but a small portion of the distal edge became necrotic. This was managed with dressing changes, leading to delayed healing. Six months post-discharge, the patient's wound had healed stably, with a satisfactory appearance, and there were no significant restrictions in movement or function of the left lower limb. In another case, the flap largely survived post-treatment, but a small portion around the edge became necrotic. Similarly, this was managed with dressing changes, leading to delayed healing. Three months post-surgery, the flap area had healed well, and the skin's protective function was intact. In the remaining 13 patients, only one complication of postoperative hematoma occurred within one week after treatment. Healing of hematoma after drainage. Conclusion The transplantation of the distally based anterolateral thigh flap is an effective surgical method for reconstructing lateral defects of the knee, reducing complications. [ABSTRACT FROM AUTHOR]

Background: The concept of reserve flow perfusion for free flap reconstruction has been demonstrated in various applications in the literature. As it relates to the anterolateral thigh (ALT) free flap, the reserve flow principle has been primarily described to either augment or "supercharge" a large ALT to optimize skin perforator supply or lengthen the vascular pedicle. Methods: We report a case of a 77‐year old male with chronic renal failure who had extensive atherosclerosis of the proximal descending lateral circumflex femoral artery (LCFA) where arterial anastomosis was unable to be performed. Results: We were able to circumvent this limitation by establishing reserve flow perfusion solely through the distal end of the descending LCFA. We describe our technique within the context of current literature on the topic of reverse flow perfusion in free flap reconstruction. Conclusion: This report uniquely describes applying the distally based, reverse arterial flow principle in an ALT flap to circumvent an atherosclerotic proximal pedicle. [ABSTRACT FROM AUTHOR]

Simple Summary: Although several techniques exist for reconstructing partial hypopharyngeal defects following a total laryngectomy, no international consensus has been reached to date. As a result, there currently are large differences between institutions with regard to the flap types used to perform these reconstructions. The aim of this systematic review and meta-analysis was to examine the complication rates and functional results of commonly used reconstructive techniques for hypopharyngeal defects. Pectoralis major myofascial flaps showed promising results compared to free-flap reconstructions, with similar rates of fistulas, strictures and flap failure. In contrast, pectoralis major myocutaneous flaps had a significantly higher fistula rate (34%) in comparison to other flap types (range: 7–17%), whereas no differences were observed for strictures, flap failure or oral intake. Free flaps and pectoralis major myofascial flaps should be considered the preferred methods for the reconstruction of partial hypopharyngeal defects following total laryngectomy. Background: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. Methods: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Results: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23–47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Conclusion: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation. [ABSTRACT FROM AUTHOR]

Background: Advanced surgical interventions are required to treat malignancies in the anterior skull base (ASB). This study investigates the utility of endoscopic endonasal and transcranial surgery (EETS) using a high‐definition three‐dimensional exoscope as an alternative to traditional microscopy. Methods: Six patients with carcinomas of varying histopathologies underwent surgery employing the EETS maneuver, which synchronized three distinct surgical modalities: harvesting of the anterolateral thigh flap, initiation of the transnasal technique, and initiation of the transcranial procedure. Results: The innovative strategy enabled successful tumor resection and skull base reconstruction without postoperative local neoplastic recurrence, cerebrospinal fluid leakage, or neurological deficits. Conclusion: The integration of the exoscope and EETS is a novel therapeutic approach for ASB malignancies. This strategy demonstrates the potential of the exoscope in augmenting surgical visualization, enhancing ergonomics, and achieving seamless alignment of multiple surgical interventions. This technique represents a progressive shift in the management of these complex oncological challenges. [ABSTRACT FROM AUTHOR]

Background: Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. Case Report: The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient's progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. Results: The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient's feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient's ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. Conclusion: This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management. [ABSTRACT FROM AUTHOR]

Head and neck reconstruction, particularly tongue reconstruction, remains a formidable challenge. However, crafting a three-dimensional structure from a basic flap necessitates precise dimensions to avoid excess or insufficiency. At the same time, the tongue also has to be accommodated inside the oral cavity to prevent protrusion or repeated injuries due to tooth bites. This study aims to showcase the practicality of employing Pythagoras's formula in both preoperative and intraoperative settings to the required flap dimensions for partial and hemiglossectomy tongue defects. Between 2020 and 2022, we have undertaken 53 tongue reconstructions to address defects resulting from partial or hemiglossectomies. Among these cases, 51 were managed with free radial artery flaps, while in two we utilized anterolateral thigh flaps for reconstruction. Our study excluded cases involving minor tongue defects amenable to primary closure. By treating the length of the tongue defect as the hypotenuse, Pythagoras's formula is applied to calculate the optimal length and width of a free microvascular flap. The tongue reconstruction is performed, and microvascular anastomosis is carried out in the neck. An addition was made for associated buccal mucosa defects, if any. All flaps survived without any complications like bleeding, wound dehiscence, and partial or complete flap necrosis. Tongue movement was adequate, with good swallowing and good speech. The application of Pythagoras's formula provides a dependable method for determining flap size pre- and intraoperatively in cases of partial or hemiglossectomy tongue defects, leading to favorable functional and aesthetic results. [ABSTRACT FROM AUTHOR]

Objective To explore the identification method of "descending branch trap" in the operation of anterolateral thigh flap, and the clinical effect of the "perforator layer-by-layer stripping method" in the treatment of "descending branch trap". Methods Retrospective analysis from April 2021 to June 2022, 245 patients with skin and soft tissue defects repaired with anterolateral thigh flap were treated at Suzhou Ruihua Orthopedic Hospital. There were 41 cases of "descending branch trap" counted, including 29 male and 12 female aged between 20 and 86 years. The cut area of the flap ranged from 11.0 cm×4.0 cm~40.0 cm×10.0 cm. Before surgery, a color ultrasound was routinely performed to locate the perforators of the lateral thigh. During surgery, the "perforator layer-by-layer stripping method" with the perforator as the center was used to carefully dissect the musculocutaneous perforator, and the frequency of "descending branch trap", the caliber and position of the perforator, the length of the vascular pedicle, and the cutting time of the flap were recorded, and the survival of the flap after surgery was counted. Results All patients was followed up for 4 to 10 months. The occurrence rate of "descending branch trap" in this group was 16.7%, the caliber of perforators were 0.3~1.0 mm, with an average of 0.58 mm, the length of the vascular pedicle was measured during operation, the length of vascular pedicle was the 5.0~22.0 cm, the average length of the vascular pedicle was 11.5 cm, and the time of skin flap cutting was 13~93 min, with an average of 41.2 min. The flaps were removed successfully in 41 cases. After the operation, 1 patient had an arterial crisis and 1 patient had a venous crisis, which survived after timely exploration. The other flaps survived smoothly. The donor area of the thigh healed in the first stage, and the wound healing time from the skin flap to the recipient area was 10~45 days. At the last follow-up, the color and texture of the flap were good and the sensation was partially recovered. All the donor areas were linear scars, with no discomfort such as scar contracture and pain, and no other serious complications. The skin flap comprehensive evaluation scale was used to evaluate, the total score was 100 points, and the score was 76~92 points, of which 15 cases were excellent, 21 cases were good, 5 cases were fair, and the excellent and good rate was 87.8%. Conclusion To identify and treat the "descending branch trap" during the operation of the anterolateral thigh flap, to improve the understanding of the "descending branch trap", and to use the "perforator layer-by-layer stripping method" to identify and dissect the source artery of the musculocutaneous perforator. It can effectively deal with the "descending branch trap" and improve the success rate of skin flap extraction. [ABSTRACT FROM AUTHOR]

Introduction: Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection. Aim: The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses. Case study: We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection. Results and discussion: This resulted in a large chest wall defect that is re-constructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage. Conclusions: The radical resection allows for excellent overall survival and better quality of life. [ABSTRACT FROM AUTHOR]

Anterolateral thigh (ALT) flaps have several anatomical variations and clinical uses. Here, a simplified classification and economical application are introduced. A total of 168 ALT flap reconstructions performed between January 2013 and December 2016 were reviewed. Vascular anatomy of the flaps was classified into 5 types: type I (single perforator from the transverse branch), type II (single perforator from the descending branch), type III (multiple perforators from the transverse branch), type IV (multiple perforators from the descending branch), and type V (multiple perforators from both branches). Furthermore, flaps harvested via preservation of the proximal perforator were compared with those that were not. Vascular classification revealed that type IV (50.0%) and type V (32.1%) flaps were the most commonly used. Of these, 50.0% of type IV and 79.6% of type V were harvested as proximal-perforator-preserving distal ALT flaps. The proximal-perforator-preserving group had a smaller flap size (104.4 ± 84.3 cm2 versus 145.9 ± 94.1 cm2, p = 0.003), shorter reconstruction time (266.3 ± 76.1 min versus 302.0 ± 103.0 min, p = 0.013), and fewer donor-site complications (2.4% versus 13.3%, p = 0.009) than the traditional group, whereas the flap success rate was comparable (96.5% versus 96.4%) between them. Five cases received a second ALT flap from the same donor site after 3 failures and 2 metachronous defects. Multiple perforators in ALT flaps allow the harvesting of 2 ALT flaps from the same donor-site metachronously. Our classification and applications can improve efficiency while reducing donor-site morbidity. [ABSTRACT FROM AUTHOR]

The distally based anterolateral thigh (dALT) flap is associated with a high incidence of venous congestion. This study aimed to investigate factors associated with vascular compromise to improve the outcomes. We retrospectively analyzed 41 dALT flap reconstructions performed between November 2010 and February 2023. The dALT flap was classified into type I, II, or III based on the origin (the descending, oblique, or transverse branch) of the chosen perforator. The distance from the pivot point to the superolateral patella, pedicle length, flap reach, complications, and loss rates were analyzed to identify different dALT flap characteristics. The type Ⅰ flap had a shorter pedicle length (type Ⅰ vs. type Ⅱ, p = 0.000; type Ⅰ vs. type Ⅲ, p = 0.000) that primarily reached closer regions (distal third of the thigh anterior/lateral knee). Pedicle lengths were similar between type Ⅱ and Ⅲ flaps (p = 1.000), most of which reached more distal regions (medial/posterior knee or proximal third of the leg). However, the type Ⅲ flaps had a higher complication rate and flap loss rate, although no significant differences were observed (complication rate, p = 0.094; flap loss rate, p = 0.071). To achieve more desirable outcomes using the dALT flap, preoperative assessment of flap pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary. [ABSTRACT FROM AUTHOR]

Background The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses.

Abstract Background Total hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described. Case presentation A 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation. Conclusion We address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication.

Background The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses. Methods This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study. Results Mean age was 50.2 (range, 16–75) years and mean BMI was 24.68 ± 4.02 (range, 16.5–34.7) kg/m 2. The subfascial flap thickness was significantly thinner in male patients (16.07 ± 2.77 mm) than in female patients (24.07 ± 3.93 mm; p < 0.05), whereas no significant difference was found between male (4.28 ± 1.15 mm) and female patients (4.85 ± 1.09 mm) regarding superficial fat flap thickness (p = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients (r = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later. Conclusion The appropriate ALT flap plane should be selected considering the gender and BMI of the patient. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the efficacy of anchored sutures (AS) in securing the anterolateral thigh (ALT) flap during oral and oropharyngeal reconstructions, and its impact on the occurrence of orocutaneous fistula (OCF). Materials and Methods: A retrospective study was performed on patients who underwent ALT flap reconstruction in our department in the year 2022. The patients were divided into two groups based on whether the AS technique was used. The incidence of OCF was compared between the two groups, and AS-related complications were reported. Fisher's exact test was employed to assess the differences in baseline characteristics and the incidence of OCF between the two groups. Results: The study included 214 patients, with 156 in the conventional suture (CS) group and 58 in the AS group. The incidence of OCF in the AS group was significantly lower compared to that in the CS group (P = 0.039). However, there was a weak correlation between OCF and the AS technique (φ = -0.149). Among the 58 cases in the AS group, three (5.17%) experienced AS-related granuloma (ASRG) as complications. Conclusion: The use of ALT flap reconstruction with the AS technique reduces the incidence of OCF; however, ASRG may be a potential complication. Clinical relevance: This study demonstrates the effectiveness of AS technique in securing ALT flaps, leading to a decreased risk of OCF in oral and oropharyngeal defect reconstruction. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Oral squamous cell carcinoma (oSCC) commonly affects the tongue. Surgical reconstruction contributes to improvements in quality of life. Therefore, we conducted this systematic review to compare the quality of life among patients who underwent glossectomy and then reconstructed with radial-free forearm flap (RFFF) versus anterolateral thigh flap (ALTF) in terms of functional outcome, flap survival, complications, donor site morbidity, and esthetic outcome. Methods: This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without specifying a time frame. Results: As a result of reviewing literature, 95 articles were screened by full-text resulting in 36 articles which met our inclusion/exclusion criteria. However, only 14 articles were included in the quantitative synthesis (meta-analysis). Out of the 36 articles, 24 studies were excluded from the meta-analysis due to the inclusion of one arm (RFFF or ALTF), and 3 articles were excluded due to the lack of the primary outcomes. Conclusions: Our results show evidence of lower donor site morbidity and a better esthetic outcome for ALTF compared to RFFF. Speech and swallowing were both affected following tongue reconstruction. Level of evidence: Not gradable. [ABSTRACT FROM AUTHOR]

A leftover narrow strip of the posterior pharyngeal wall may form after laryngopharyngectomy, and whether to retain it during reconstruction remains debated owing to the differing views on the incidence of leakage and strictures. This study aimed to ascertain whether this remnant posterior pharyngeal wall is advantageous or disadvantageous to surgeons performing pharyngoesophageal reconstruction. We reviewed the data of patients with circumferential or near-circumferential pharyngoesophageal defects following oncological laryngopharyngectomy who underwent reconstructive surgery utilizing the anterolateral thigh flap. They were then categorized into two groups: circumferential and near-circumferential. Thereafter, their demographics, operative findings, and postoperative outcomes were compared. Forty patients (20 in each group) with an average age of 57.2 ± 6.7 years (range: 40–72) were enrolled in the study. All flaps except one survived. During a mean follow-up of 41.1 ± 24.6 (range: 6–95) months, the stricture rate was significantly lower in the near-circumferential group (one vs. nine [from 17 patients who had resumed oral intake postoperatively] patients in the near-circumferential and circumferential groups, respectively, p = 0.002). Oral intake was viable in all patients with near-circumferential defects but only in 11 patients with circumferential defects (p = 0.003). The near-circumferential group had fewer strictures and better tolerance of oral nutrition, supporting the incorporation of the residual posterior pharyngeal wall via near-circumferential reconstruction instead of discarding it to facilitate circumferential reconstruction. [ABSTRACT FROM AUTHOR]

Objective: The medial sural artery perforator (MSAP) flap has gained popularity in head and neck reconstruction primarily as a less morbid alternative to the radial forearm free flap (RFFF). However, no direct comparison of thickness exists among the MSAP, RFFF, and anterolateral thigh (ALT) flaps, which together represent the commonly utilized nonosseus‐free flaps in head and neck reconstruction. Thus, this study aimed to compare these flap sites and identify predictors of thickness that will aid in reconstructive surgical planning. Study Design: Cross‐sectional study. Setting: Tertiary referral hospital. Methods: The thickness of skin and subcutaneous tissue at the RFFF, MSAP, and ALT donor sites were measured in 54 adult patients using Doppler ultrasound. General linear models were generated to identify predictors of flap thickness. Results: The mean thickness of the RFFF, MSAP, and ALT flaps was 3.8 ± 2.2 mm, 7.4 ± 3.8 mm, and 9.6 ± 4.7 mm. Body mass index (BMI) was the only statistically significant contributing factor (p <.0001, coefficient: 0.15) for the RFFF. MSAP was affected by age (p =.006, coefficient = 0.06), female gender (p <.0001, coefficient = 3.2), and BMI (p <.001, coefficient = 0.25), while the ALT was affected by female gender (p =.0005, coefficient = 3.3) and BMI (p <.0001, coefficient = 0.35). Thus, the ratio of increase for flap thickness with respect to BMI is 3:5:7 for the RFFF, MSAP, and ALT flaps, respectively. Conclusion: The MSAP is about twice the thickness of the RFFF and 2 mm thinner than the ALT; however, 22% of patients had thicker MSAP than ALT flaps. As the strongest predictors of flap thickness, female gender, and BMI may be taken into consideration during surgical planning for reconstruction. [ABSTRACT FROM AUTHOR]

The oblique branch of the lateral circumflex femoral artery, a short branch of the deep femoral artery, is highly prevalent (32–46%) and is usually considered a normal variant, although this is still controversial. This study aimed to evaluate whether the oblique branch of the lateral circumflex femoral artery is a variant. We reviewed medical record data of patients with skin and soft tissue defects of the extremities who underwent flap repair using free anterolateral thigh (ALT) flaps at our hospital in 2019. The anatomical characteristics of the flaps were examined intraoperatively by high-frequency color Doppler ultrasound. A total of 153 ALT flaps from 146 patients were included. Among the branches, 232 (73.7%) were oblique branches, and 83 (26.4%) were descending branches. Of the 232 oblique branches, 141 (60.8%) were from septocutaneous branches, and the other 83 (39.2%) were from musculocutaneous branches. In addition, 20 (24.1%) descending branches were from septocutaneous branches, and the other 63 (75.9%) were from musculocutaneous branches. Analyzing the prevalence of the oblique branch in septocutaneous branches, more than half of the patients had oblique branches rather than descending branches. The high proportion of oblique branches from septocutaneous branches (median: 100 (0−100) vs. 0 (0−50), p = 0.002) supports the understanding that the oblique branch is a normal anatomical element rather than a variant. The main type was the intramuscular branches, which required significantly less time for flap harvesting. The oblique branch may be the preferred vascular pedicle for free ALT flaps. [ABSTRACT FROM AUTHOR]

Extensive chest wall tumor resection and reconstruction possess a formidable challenge and require good collaboration between thoracic and reconstructive surgeons. In this article, we reviewed our experience in six consecutive cases requiring complex chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata with a minimum 24 months follow-up postoperatively. Six patients with a mean age of 54 were diagnosed to have locally advanced malignant (n = 5) and benign (n = 1) tumors. They underwent wide local excision with a mean of six ribs resected, and the average size of the soft tissue defect was 389cm2. The integrity of the thoracic cage was restored by using titanium rib plates. Fascia lata was harvested along with free anterolateral thigh fasciocutaneous flap to achieve near airtight closure of pleural space for soft tissue coverage. Two patients required early flap exploration with successful flap salvage. One flap failure was reported on postoperative day 11 due to a mechanical cause and a redo surgery was required. With an average stay of 3 days in the intensive care unit, no perioperative pulmonary complications were recorded. Complex oncological chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata yielded satisfactory aesthetic and physiological functional outcomes.

Paediatric complex wounds pose a challenge to the reconstructive surgeon due to the intricacy of reconstructive options required. Developments in microsurgery and microsurgical technique have brought free tissue transfer ever closer to the comfort zone of the reconstructive surgeon for reconstruction of paediatric traumatic complex wounds. We present our experience of microsurgical reconstruction in Lebanon for complex traumatic wounds in paediatric patients under the age of 10 years using the free anterolateral thigh (ALT) flap. The ALT flap has proven its value as a safe, adaptable, and aesthetically acceptable reconstructive option in paediatric complex trauma. [ABSTRACT FROM AUTHOR]

Background: Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods: All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results: Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion: We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction. [ABSTRACT FROM AUTHOR]

1) To describe the authors' technique of anterolateral thigh (ALT) phalloplasty with staged skin graft urethroplasty and 2) to report the surgical outcomes and complications of this technique in a preliminary patient cohort. Following IRB (Institutional Review Board) approval, retrospective chart review identified all patients undergoing primary three-stage ALT phalloplasty by the senior authors. Stage I involves single tube, pedicled ALT transfer. Stage II involves vaginectomy, pars fixa urethroplasty, scrotoplasty, and opening the ALT ventrally and construction of a urethral plate with split-thickness skin graft. Stage III involves tubularization of the urethral plate to create the penile urethra. Data collected included patient demographics, intraoperative details, postoperative courses, and complications. Twenty-four patients were identified. Twenty-two patients (91.7%) underwent ALT phalloplasty prior to vaginectomy. All patients underwent staged split-thickness skin grafting for the penile urethra reconstruction. Twenty-one patients (87.5%) achieved standing micturition at the time of data collection. Eleven patients (44.0%) experienced at least 1 urologic complication requiring additional operative intervention, most commonly urethrocutaneous fistulae (8 patients, 33.3%), and urethral strictures (5 patients, 20.8%). ALT phalloplasty with split-thickness skin grafting for urethral lengthening is an alternative technique to achieve standing micturition with an acceptable complication rate in gender-affirming phalloplasty. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described. Case presentation: A 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation. Conclusion: We address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication. [ABSTRACT FROM AUTHOR]

Extensive composite defects involving the lip and cheek present difficult reconstructive challenges in view of functional recovery like oral competence, articulation, speech and mastication. This study presents our results of reconstructing through and through cheek defect with the use of free anterolateral thigh (ALT) flaps. All the patients with carcinoma of buccal mucosa and cheek who underwent through and through cheek resection and reconstructed with free composite pedalled anterolateral thigh flap between March 2019 to March 2020 were included in the study. We have assessed the post-operative functional outcome using University of Washington Quality of Life Questionnaire at the end of 12 months duration. We have excluded lost to follow-up and flap failure patients. Fifty patients were matched our inclusion criteria. Mean age was 43 years. Male to female ratio was 4.6:1. Stage 3 disease was in 8 patients and stage 4 disease was in 42 patients. Average size of the flap required was 15 × 7.5 cm, maximum was 24 × 11 cm. Oral competence was good in 74% patients. 80% patients were able to take semisolid diet, 8% were on liquid diet and 12% were dependent on RT feed. Average physical function (70.47 ± 19.09), social-emotional sub-score (81.72 ± 16.63) and composite scores (76.09 ± 17.86) were good and within acceptable range. Chewing (53 ± 29.29) and swallowing (64 ± 21.57) scored poorly among 12 domains. For extensive through and through cheek defects bipedelled ALT provides good functional outcome. In view of advance disease status extensive resection would be responsible for bone and mucosal loss affecting chewing and swallowing. [ABSTRACT FROM AUTHOR]

Radical tumor ablation or severe trauma can result in challenging tissue defects. The split anterolateral thigh free flap has been promoted as an ideal option for complex defects. We aimed to evaluate whether this flap could be performed without major morbidity. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to assess this hypothesis. An illustrative case about pharyngeal reconstruction is discussed, and the role of free split anterolateral thigh free flaps in modern reconstructive surgery is evaluated. The systematic search of literature yielded 221 studies with 7 articles about free anterolateral thigh flaps fully split in two separate flaps based on one pedicle. Favorable outcomes in a total of 31 patients were described. Tissue defects were mainly located at extremities, chest wall, lip, and cheek. A low complication incidence was reported in all studies, in terms of flap loss, donor site morbidity, and general wound healing problems. The flap was utilized for pharyngeal reconstruction and simultaneous neck resurfacing, which allowed a more convenient way of flap monitoring in the present case. Being technically a rather demanding flap variant, splitting the anterolateral thigh free flap has still become an accepted technique among microsurgeons. Currently, literature suggests that it can be performed without major complications for reconstructing extremities and the head and neck area. Rearrangement of the flap units in pharyngeal reconstruction increases the flap's versatility as it allows neck resurfacing and external monitoring of buried inaccessible flaps. [ABSTRACT FROM AUTHOR]

Anterolateral thigh (ALT) flap is the workhorse for reconstruction in head and neck post cancer excision. Chimeric multi-paddle flaps are useful for composite defects involving skin, mucosa, and soft tissue. The nerve to vastus lateralis (VL) runs along the pedicle, frequently interdigitating with it or the perforators. Sometimes, the nerve may be preserved during harvest but needs to be sacrificed frequently, leading to increased donor site morbidity. We recommend a simple technique to preserve the nerve, wherein the skin paddles or chimeric components are divided in-situ and manipulated around it without causing injury. This technique was used in 27 cases over 5 years. All involved nerves, perforators and pedicles were preserved. The technique can be extended to any flap harvest with multiple perforators with nerves in proximity, when multiple skin islands are desired.

Extensive soft tissue defects pose a great deal of challenge to the reconstructive surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh (ALT) flaps for soft tissue reconstruction of defects following tumor excision, trauma and post burn. A retrospective review of 19 patients undergoing ALT Flaps for various reasons from Dec 2018 to Jan 2021 was performed to determine perioperative factors, demographic profile, complications and outcomes. The mean age of the study population was 47.2 years. The male to female ratio was 2.16:1 (68.5 % male, 31.5% females). The etiology of soft tissue defect was post-tumor resection-47.36%, truam-36.8%, post burn reconstruction-10.5%. The defect sites were most commonly leg-31.5%, upper extremity-26.3%, buccal mucosa-15.7%, scalp-10.5%, tongue-10.5%, breast-5.2%. Flaps were harvested from right thigh in 52% of cases and left thigh in 58% of the cases. Donor site was closed primarily in 11 cases (57.8%), SSG coverage was done for 8 cases (42.8%). The minimum hospital stay post op was 12 days, maximum being 45 days. Postoperative complications were seen in 36.8% of the cases. Partial flap necrosis occurred in 3 cases (15.7%), complete necrosis in 1 case (5.2%), donor site morbidity was seen in 3 cases (15.7%). In the post-operative period hematoma and infection occurred in 3 cases. ALT Flap in experienced hands provide reliable coverage of large soft tissue defects with excellent aesthetic and functional outcomes with minimal donor site morbidity. [J Med Allied Sci 2023; 13(1):26-32]

Introduction: Large chunks of the tissue are sacrificed during the surgical procedures for the treatment if oral cancers. Our goal was to assess the viability of “Buccal reconstruction using the anterolateral thigh (ALT) flaps, platysma myocutaneous (PM), and radial forearm free (RFF)”. Material and Methods: Sixty subjects were included in this investigation, and they were divided into 3 groups. The follow-up as accompanied for six months. Comparisons were made for the time for the operations, reduction in the width of the mouth opening and the survival rates of the flaps. The data that was collected for the above two parameters and compared for the significance using the ANOVA, keeping P < 0.05 as significant. Results: In the subjects with the PM, the width of the mouth opening reduced comparatively greater than that of the subjects who received other two flaps. The reduction in the mouth opening in the PM was significantly greater compared to that of the ALT and RFF. Survival was greater for the groups ALT and RFF compared to PM. Time of the surgery was the greatest for the ALT and least for the PF. Conclusion: The observations point to the fact that the PF requires more time than that of the other two flaps. The survival was however better for the ALT and RFF. Further research is suggested for suggesting an appropriative flap design.

We present a rare case of a forearm radiation ulcer. Recently, technological advances in intravascular treatments involving X-ray radiography have enabled the application of this treatment in more patients. This has caused more frequent problems due to radiation ulcers. Here we report the case of a 54-year-old man who developed an ulcer on his left forearm six months after placing a stent graft to treat an abdominal aortic aneurysm. A radiation ulcer was diagnosed because of the distance between the position of the ulcer and pigment deposition in the lateral abdominal region and because of the following pathological findings: coagulative necrosis and fibrinoid degeneration and narrowing of the lumen in the small blood vessels. The ulcer was treated by debridement (skin defect size, 22 × 10 cm), followed by reconstruction with an anterolateral thigh flap (23 × 12 cm). Cosmetic and functional improvements were observed, with the latter indicated by an increased range of motion. Levels of evidence: V

A bronchial stump blow-out is a serious complication following pneumonectomy/lobectomy. A blown-out stump requires well-vascularized tissue for healing and successful closure. We illustrate the use of the free anterolateral thigh flap in two patients. For patient 1, a chimeric anterolateral thigh flap was used to seal the bronchial stump following an upper lobectomy for tuberculous bronchiectasis. For patient 2, an anterolateral thigh flap was used to seal the main bronchial stump that had blown-out following pneumonectomy for actinomyces lung abscess. The latissimus dorsi muscle was unavailable in both cases due to a previous thoracotomy. Patient 1 had a persistent bronchial leak post-operatively, which resolved after anti-tuberculous treatment. Patient 2 recovered uneventfully and was discharged 14-days post-operatively. Their follow-ups were 13 years and 4 months respectively. In conclusion, the free anterolateral thigh flap is an alternative option to seal a blown-out bronchial stump in the absence of the latissimus dorsi muscle flap.

This study describes the benefits of using neurosurgical scalp hooks in harvesting an anterolateral thigh flap. Typically, scalp hooks retracting the surgical field are connected to cloth forceps with rubber bands, extending the surgical field to flat. A surgeon can use scalp hooks to retract multiple arbitrary points in any direction by retracting them with their fingers. Thus, the expanded operative field is much flatter than that retracted with fingers. As the dissection progresses, the hooks can be adjusted to maintain flatness. This technique allows easy, single-person harvesting of various musculocutaneous or perforator flaps. Furthermore, assistant surgeons can concentrate on cooperating safely in the flat surgical field. Potential limitations include needlestick injury, compression of vascular pedicles with rubber bands, and clamping skin with cloth forceps.