Free Anterolateral Thigh Versus Vastus Lateralis Muscle Flaps for Coverage of Lower Extremity Defects in Chronic Wounds.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
entrez:
17
6
2020
pubmed:
17
6
2020
medline:
15
5
2021
Statut:
ppublish
Résumé
The thigh has been called the reconstructive warehouse. The anterolateral thigh (ALT) and vastus lateralis (VL) flaps are popular options for free tissue transfer in lower extremity reconstruction. We sought to review the largest experience of these flaps in the chronic wound population. We retrospectively reviewed patients who underwent lower extremity reconstruction using ALT or VL flaps by a single surgeon between 2012 and 2018. Fifty ALT and 34 VL flaps were identified. Comorbidities were similar between groups with the exception of body mass index (ALT, 26.8; VL, 30.1; P = 0.0121). There was also a significant difference rate of independent ambulation preoperatively (ALT, 98.0%; VL, 85.3%; P = 0.0375). An adjunct was needed for recipient site coverage in 31.5% (19/50) of ALT patients and 100% (34/34) of VL patients. Of the patients who received skin grafts, delayed placement was more frequent in the ALT (53.3%) versus VL cohort (18.2%) (P = 0.0192). Median graft take and the rate of skin graft revision were not statistically different. Flap success rates were similar: ALT, 92.0%; and VL, 94.1%. Overall complication rates were not significantly different: ALT, 26.0%; and VL, 38.2%. Infectious complications were also comparable. Subsequent debulking procedures were performed on 8.0% of ALT flaps and 11.8% VL flaps (P = 0.7092). Limb salvage rates were similar between both cohorts (ALT, 82.0%; VL, 88.2%). Ambulation rate was significantly higher for the ALT cohort at 92.0% compared with 73.5% for the VL cohort (P = 0.0216). Median follow-up was similar for both groups. We present the largest comparison study of ALT and VL flaps in lower extremity salvage. Complication rates, flap success, and limb salvage were similar between the 2 cohorts. Despite a high prevalence of osteomyelitis in both cohorts, there was no difference in infectious complications. Although the need for skin grafting remains an inherent disadvantage of the VL flap, a significant proportion of ALT recipients also needed an adjunct for recipient site coverage. Ambulation rate was significantly greater in the ALT group. However, flap type was no longer significant for ambulation when controlling for preoperative ambulatory status.
Identifiants
pubmed: 32539286
doi: 10.1097/SAP.0000000000002335
pii: 00000637-202007001-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S54-S59Références
Lin CH, Wei FC, Lin YT, et al. Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg. J Trauma. 2006;60:1032–1036.
Kuo YR, Jeng SF, Kuo MH, et al. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site. Plast Reconstr Surg. 2001;107:1766–1771.
Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg. 2002;109:2216–2218.
Kimata Y, Uchiyama K, Sakuraba M, et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg. 2000;106:584–489.
Spyriounis PK, Lutz BS. Versatility of the free vastus lateralis muscle flap. J Trauma. 2008;64:1100–1105.
Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir. 2002;34:239–244.
Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37:149–159.
Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 1993;92:421–428.
Zhou G, Qiao Q, Chen GY, et al. Clinical experience and surgical anatomy of 32 free anterolateral thigh flap transplantations. Br J Plast Surg. 1991;44:91–96.
Demirkan F, Chen HC, Wei FC, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg. 2000;53:30–36.
Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109:2219–2226; discussion 2227-2230.
Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004;26:759–769.
Wei FC, Mardini S. Flaps and Reconstructive Surgery. 2nd ed. New York: Elsevier; 2017.
Seth AK, Iorio ML. Super-thin and Suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg. 2017;33:466–473.
Chana JS, Chen HC, Sharma R, et al. Use of the free vastus lateralis flap in skull base reconstruction. Plast Reconstr Surg. 2002;111:568–574.
Wolff KD, Grundmann A. The free vastus lateralis flap: an anatomic study with case reports. Plast Reconstr Surg. 1992;89:476–477.
Lutz BS. Beauty of skin-grafted free muscle flaps in head and neck reconstruction. Microsurgery. 2006;26:177–181.
Stranix JT, Lee ZH, Jacoby A, et al. Forty years of lower extremity take-backs: flap type influences salvage outcomes. Plast Reconstr Surg. 2018;141:1282–1287.
Chan JK, Harry L, Williams G, et al. Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg. 2012;130:284e–295e.
DeFazio MV, Hung RW, Han KD, et al. Lower extremity flap salvage in thrombophilic patients: managing expectations in the setting of microvascular thrombosis. J Reconstr Microsurg. 2016;32:431–444.
Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg. 2009;123:571–577.
Casey WJ 3rd, Rebecca AM, Smith AA, et al. Vastus lateralis motor nerve can adversely affect anterolateral thigh flap harvest. Plast Reconstr Surg. 2007;120:196–201.
Demirtas Y, Kelahmetoglu O, Cifci M, et al. Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery. 2010;30:24–31.
Orseck MJ, Smith CR, Kirby S, et al. Early ambulation after microsurgical reconstruction of the lower extremity. Ann Plast Surg. 2018;80(6S suppl 6):S362–S364.
Nelson JA, Kim EM, Serletti JM, et al. A novel technique for lower extremity limb salvage: the vastus lateralis muscle flap with concurrent use of the vacuum-assisted closure device. J Reconstr Microsurg. 2010;26:427–431.
Kaminsky AJ, Li SS, Copeland-Halperin LR, et al. The vastus lateralis free flap for lower extremity gustilo grade III reconstruction. Microsurgery. 2017;37:212–217.
Lee MJ, Yun IS, Rah DK, et al. Lower extremity reconstruction using vastus lateralis myocutaneous flap versus anterolateral thigh Fasciocutaneous flap. Arch Plast Surg. 2012;39:367–375.
Hollenbeck ST, Woo S, Komatsu I, et al. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg. 2010;125:924–934.
Toia F, D'Arpa S, Brenner E, et al. Segmental anatomy of the vastus lateralis: guidelines for muscle-sparing flap harvest. Plast Reconstr Surg. 2015;135:185e–198e.
Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications. Ann Plast Surg. 2014;72:246–252.
Salgado CJ, Mardini S, Jamali AA, et al. Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plast Reconstr Surg. 2006;118:1401–1411.
Economides JM, DeFazio MV, Golshani K, et al. Systematic review and comparative meta-analysis of outcomes following pedicled muscle versus fasciocutaneous flap coverage for complex periprosthetic wounds in patients with total knee arthroplasty. Arch Plast Surg. 2017;44:124–135.