Versatility of the lateral circumflex femoral artery sparing perforator-based anterolateral thigh flaps in loco-regional thigh reconstruction after skin cancer, melanoma, and sarcoma resection.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
revised:
30
08
2021
received:
23
12
2020
accepted:
28
10
2021
pubmed:
13
11
2021
medline:
7
7
2022
entrez:
12
11
2021
Statut:
ppublish
Résumé
The anterolateral thigh (ALT) flap represents a workhorse in reconstructive microsurgery but its use in a free style fashion as perforator-based flap has yet to be popularized. We describe our experience with lateral circumflex femoral artery (LCFA) sparing perforator-based ALT flaps for thigh reconstruction after oncological resection in a case series of 24 consecutive patients. Twenty-four patients underwent thigh reconstruction with 25 perforator-based ALT flaps between 2014 and 2020. Defect etiology was related to skin cancer, melanoma, and sarcoma resection in 3, 7, and 14 cases respectively. Mean defect size was 15 × 8 cm. Six months postoperatively, patients were asked to rate on a 5-point Likert scale the aesthetic and functional outcomes of the reconstructive procedure. Eight flaps were advanced in a V-Y fashion (33.3%), whether 16 flaps (66.7%) were rotated in a propeller fashion. The average flap size was 19 × 8 cm, while mean operative time was 197.2 min. Donor sites were always closed by primary intention. Minor complications were registered in 5 cases and managed conservatively. Overall patients' satisfaction was high, with mean aesthetic and functional ratings of 4.46 and 4.21 respectively. LCFA sparing perforator-based ALT flaps proved to be a versatile and reproducible solution to address thigh reconstruction after oncological resection according to the different topographical sub-units involved.
Sections du résumé
BACKGROUND
BACKGROUND
The anterolateral thigh (ALT) flap represents a workhorse in reconstructive microsurgery but its use in a free style fashion as perforator-based flap has yet to be popularized. We describe our experience with lateral circumflex femoral artery (LCFA) sparing perforator-based ALT flaps for thigh reconstruction after oncological resection in a case series of 24 consecutive patients.
METHODS
METHODS
Twenty-four patients underwent thigh reconstruction with 25 perforator-based ALT flaps between 2014 and 2020. Defect etiology was related to skin cancer, melanoma, and sarcoma resection in 3, 7, and 14 cases respectively. Mean defect size was 15 × 8 cm. Six months postoperatively, patients were asked to rate on a 5-point Likert scale the aesthetic and functional outcomes of the reconstructive procedure.
RESULTS
RESULTS
Eight flaps were advanced in a V-Y fashion (33.3%), whether 16 flaps (66.7%) were rotated in a propeller fashion. The average flap size was 19 × 8 cm, while mean operative time was 197.2 min. Donor sites were always closed by primary intention. Minor complications were registered in 5 cases and managed conservatively. Overall patients' satisfaction was high, with mean aesthetic and functional ratings of 4.46 and 4.21 respectively.
CONCLUSIONS
CONCLUSIONS
LCFA sparing perforator-based ALT flaps proved to be a versatile and reproducible solution to address thigh reconstruction after oncological resection according to the different topographical sub-units involved.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
428-432Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Bekarev, M., Goch, A. M., Geller, D. S., & Garfein, E. S. (2018). Distally based anterolateral thigh flap: An underutilized option for peri-patellar wound coverage. Strategies Trauma Limb Reconstruction, 13(3), 151-162.
Brunetti, B., Barone, M., Tenna, S., Salzillo, R., Segreto, F., & Persichetti, P. (2020). Pedicled perforator-based flaps: Risk factor analysis, outcomes evaluation and decisional algorithm based on 130 consecutive reconstructions. Microsurgery, 40(5), 545-552.
Brunetti, B., Morelli Coppola, M., Tenna, S., & Persichetti, P. (2019). The lateral thigh perforator propeller flap: A reliable backup plan for Locoregional reconstruction in case of missing or unreliable anterolateral thigh perforators. Plastic and Reconstructive Surgery, 143(1), 248e-249e.
Brunetti, B., Tenna, S., Aveta, A., Segreto, F., & Persichetti, P. (2013). Free-style local perforator flaps: Versatility of the v-y design to reconstruct soft-tissue defects in the skin cancer population. Plastic and Reconstructive Surgery, 132(2), 451-460.
Brunetti, B., Tenna, S., Poccia, I., & Persichetti, P. (2017). Propeller flaps with reduced rotational angles: Clinical experience on 40 consecutive reconstructions performed at different anatomical sites. Annals of Plastic Surgery, 78(2), 202-207.
Cadenelli, P., Bordoni, D., Radaelli, S., & Marchesi, A. (2015). Proximally based anterolateral-thigh (ALT) flap for knee reconstruction: An advancement propeller perforator flap. Aesthetic Plastic Surgery, 39(5), 752-756.
Friji, M. T., Suri, M. P., Shankhdhar, V. K., Ahmad, Q. G., & Yadav, P. S. (2010 Apr). Pedicled anterolateral thigh flap: A versatile flap for difficult regional soft tissue reconstruction. Annals of Plastic Surgery, 64(4), 458-461.
Gravvanis, A. I., Tsoutsos, D. A., Karakitsos, D., Panayotou, P., Iconomou, T., Zografos, G., Karabinis, A., & Papadopoulos, O. (2006). Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee. Microsurgery, 26(6), 432-438.
Hudson, C. S., & Huang, A. T. (2020). Perforator-based propeller flaps for reconstruction of massive anterolateral thigh donor site wounds. Head & Neck, 42(12), E49-E52.
Iida, T., Yoshimatsu, H., & Koshima, I. (2017). Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Annals of Plastic Surgery, 79(4), 385-389.
Kosutic, D. (2020). Distal perforator-only propeller (D-POP) anterolateral thigh flap for reconstructions around the knee: 4-year experience. Journal Of Plastic Reconstructive & Aesthetic Surgery, 73(4), 758-763.
Namgoong, S., Yoon, Y. D., Yoo, K. H., Han, S. K., Kim, W. K., & Dhong, E. S. (2018). Alternative choices for anterolateral thigh flaps lacking suitable perforators: A systematic review. The Journal of Reconstructive Microsurgery, 34(7), 465-471.
Neligan, P. C., & Lannon, D. A. (2010). Versatility of the pedicled anterolateral thigh flap. Clinics in Plastic Surgery, 37(4), 677-681.
Thomas, W. W., Calcagno, H. E., Azzi, J., Petrisor, D., Cave, T., Barber, B., Miles, B., Gomez, E. D., Cannady, S., Bhadkamkar, M., Hanasono, M. M., & Wax, M. K. (2020). Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap. Laryngoscope, 130(2), 343-346.
Vijayasekaran, A., Gibreel, W., Carlsen, B. T., Moran, S. L., Saint-Cyr, M., Bakri, K., & Sharaf, B. (2017). Maximizing the utility of the Pedicled anterolateral thigh flap for Locoregional reconstruction: Technical pearls and pitfalls. Clinics in Plastic Surgery, 44(2), 371-384.
Wong, C. H., Goh, T., Tan, B. K., & Ong, Y. S. (2013). The anterolateral thigh perforator flap for reconstruction of knee defects. Annals of Plastic Surgery, 70(3), 337-342.
Yu, P., & Youssef, A. (2006). Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plastic and Reconstructive Surgery, 118(4), 928-933.
Zhang, Y. X., Hayakawa, T. J., Levin, L. S., Hallock, G. G., & Lazzeri, D. (2016). The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plastic and Reconstructive Surgery, 137(3), 1018-1030.
Zhu, S., Zang, M., Xu, B., Chen, B., Li, S., Han, T., & Liu, Y. (2020). Defect reconstruction using the propeller flaps based on the perforators derived from the lateral circumflex femoral artery system. Annals of Plastic Surgery, 86, 450-457.