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Discussion: One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation. Plast Reconstr Surg 2016; 138:490. [PMID: 27465171 DOI: 10.1097/prs.0000000000002366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiang C, Lin P, Fu X, Shu J, Li H, Hu X, He J, Ding M. Three-dimensional contrast-enhanced magnetic resonance angiography for anterolateral thigh flap outlining: A retrospective case series of 68 patients. Exp Ther Med 2016; 12:1067-1074. [PMID: 27446322 DOI: 10.3892/etm.2016.3387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 07/14/2015] [Indexed: 11/06/2022] Open
Abstract
Flap transfer is increasingly used for repairing limb defects secondary to trauma or tumor, and appropriate preoperative planning plays a critical role. The present study aimed to examine the use of three-dimensional (3D) contrast-enhanced magnetic resonance angiography (CE-MRA) in evaluating the blood supply distribution and perforating branch pattern of anterolateral thigh (ALT) flaps. Bilateral donor lower limbs were scanned in 68 patients (136 limbs) using a Siemens Avanto 1.5 T magnetic resonance imaging scanner with a 3D fast low-angle shot sequence, following the thin-slab maximum intensity projection (TS-MIP) technique. The lateral femoral circumflex artery (LFCA) was visualized in all patients: 101 limbs (101/136, 74.3%) were type I; 20 limbs (20/136, 14.7%) were type II; 3 limbs (3/136, 2.2%) were type III; and 12 limbs (12/136, 8.8%) were type IV. Tertiary branches were identified in 94 limbs (94/136, 69.1%). Donor flaps were outlined according to MRA TS-MIP findings in 4 patients. All flaps survived uneventfully following the transfer. In donor flap outlining, 3D CE-MRA with the TS-MIP technique allowed an accurate, direct visualization of the branching pattern and distribution profile of the LFCA supplying the ALT flap.
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Affiliation(s)
- Chunjing Jiang
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Ping Lin
- Department of Hand-Foot Surgery, Jinhua Municipal Central Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Xiaoyan Fu
- Department of Medical Sciences, Jinhua College of Profession and Technology, Jinhua, Zhejiang 321007, P.R. China
| | - Jiner Shu
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Huimin Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Xiaogang Hu
- Department of Hand-Foot Surgery, Jinhua Municipal Central Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Jianrong He
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Mingxing Ding
- Department of Medical Sciences, Jinhua College of Profession and Technology, Jinhua, Zhejiang 321007, P.R. China
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Lambeaux perforants fins prélevés dans le plan du fascia superficialis : principe et technique opératoire. ANN CHIR PLAST ESTH 2015; 60:214-20. [DOI: 10.1016/j.anplas.2014.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022]
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Toyserkani NM, Sørensen JA. Medial sural artery perforator flap: a challenging free flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015; 38:391-396. [PMID: 26412942 PMCID: PMC4577532 DOI: 10.1007/s00238-015-1110-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
Background Oral and extremity defect reconstruction can often require a flap that is thin, and traditionally, the radial forearm free flap has been used, however, this has significant donor site morbidity. Over the last decade, the medial sural artery perforator (MSAP) flap has emerged as a possible alternative with lower donor site morbidity. We present our experiences and review the literature regarding this promising but challenging flap. Methods The study was a retrospective case series in a university hospital setting. All patients who had a MSAP flap performed at our institution were included until March 2015, and their data was retrieved from electronic patient records. Results In total, ten patients were reconstructed with a MSAP flap for floor of mouth (eight) and lower extremity (two) defect reconstruction. The median flap dimensions were as follows: 10 cm (range 7–14 cm), width 5 cm (range 3.5–8 cm), thickness 5 mm (range 4–8 mm), and pedicle length 10 cm (range 8–12 cm). In one case, the procedure was abandoned because of very small perforators and another flap was used. In two cases, late onset of venous congestion occurred which could not be salvaged. There were no donor site complaints. Conclusions The MSAP flap is an ideal flap when a thin free flap is needed with lower donor site morbidity than alternative solutions. There seems to be a higher rate of late onset of venous thrombosis compared with more established flaps. Therefore, this flap should be monitored more closely for venous problems and we recommend performing two venous anastomoses when using this flap. Level of Evidence: Level IV, therapeutic study.
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Affiliation(s)
- Navid Mohamadpour Toyserkani
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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Reconstruction of calvarial and scalp defects using anterolateral thigh free flaps: A case series. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Acartürk TO, Maldonado AA, Ereso A. Intraoral reconstruction with “thinned” peroneal artery perforator flaps: An alternative to classic donor areas in comorbid patients. Microsurgery 2014; 35:399-402. [DOI: 10.1002/micr.22366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Tahsin Oğuz Acartürk
- Department of Plastic Surgery; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Andrés A. Maldonado
- Department of Plastic Surgery and Burns; University Hospital of Getafe; Madrid Spain
| | - Alex Ereso
- Department of Plastic Surgery; University of Pittsburgh Medical Center; Pittsburgh PA
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Hsu H, Chen PR, Chien SH, Lee JT. Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions. Otolaryngol Head Neck Surg 2014; 151:791-6. [DOI: 10.1177/0194599814549731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.
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Affiliation(s)
- Honda Hsu
- Division of Plastic Surgery, Buddhist Dalin Tzu Chi Hospital, Dalin, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Peir-Rong Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Sou-Hsin Chien
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Plastic Surgery, Buddhist Taichung Tzu Chi General Hospital, Taichung, Taiwan
| | - Jiunn-Tat Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Plastic Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Karmiris NI, Nicolaou M, Khan MS. Primary thinning of the anterolateral thigh flap in Caucasians is a safe technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lee JT, Chen PR, Hsu H, Wu MS, Cheng LF, Huang CC, Chien SH. The proximal lateral lower leg perforator flap revisited: Anatomical study and clinical applications. Microsurgery 2014; 35:115-22. [DOI: 10.1002/micr.22264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/26/2014] [Accepted: 04/03/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Jiunn-Tat Lee
- Division of Plastic Surgery; Buddhist Tzu Chi General Hospital; Hualien Taiwan
- School of Medicine, Tzu Chi University; Hualien Taiwan
| | - Peir-Rong Chen
- School of Medicine, Tzu Chi University; Hualien Taiwan
- Department of Otolaryngology; Buddhist Tzu Chi General Hospital; Hualien Taiwan
| | - Honda Hsu
- School of Medicine, Tzu Chi University; Hualien Taiwan
- Division of Plastic Surgery; Buddhist Dalin Tzu Chi Hospital, Tzu Chi University; Dalin Taiwan
| | - Meng-Si Wu
- Division of Plastic Surgery; Buddhist Tzu Chi General Hospital; Hualien Taiwan
| | - Li-Fu Cheng
- Division of Plastic Surgery; Buddhist Tzu Chi General Hospital; Hualien Taiwan
- School of Medicine, Tzu Chi University; Hualien Taiwan
| | - Chieh-Chi Huang
- School of Medicine, Tzu Chi University; Hualien Taiwan
- Division of Plastic Surgery; Buddhist Dalin Tzu Chi Hospital, Tzu Chi University; Dalin Taiwan
| | - Sou-Hsin Chien
- School of Medicine, Tzu Chi University; Hualien Taiwan
- Division of Plastic Surgery; Buddhist Taichung Tzu Chi Hospital; Taichung Taiwan
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Wang X, Yan G, Zhang G, Li J, Liu J, Zhang Y. Functional tongue reconstruction with the anterolateral thigh flap. World J Surg Oncol 2013; 11:303. [PMID: 24274671 PMCID: PMC3879093 DOI: 10.1186/1477-7819-11-303] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A retrospective study was conducted to evaluate the advantages of anterolateral thigh (ALT) flap in tongue reconstruction. METHOD From September 2008 to February 2012, patients receiving ALT flap tongue reconstruction were included in the study. Patients undergoing ALT flap were compared with those undergoing similar surgery with radial forearm flap (RFF). The medical records of the included patients were reviewed, and a questionnaire was used to assess acceptability of the surgery. RESULTS All flaps (both ALT and RFF) were successful In the ALT group, most patients were satisfied with the appearance of the reconstructed tongue and the intelligibility of their speech, and there were fewer complications with this technique compared with the RFF. CONCLUSION The ALT flap is an ideal method for tongue reconstruction. The thickness and volume of the ALT flap can be adjusted based on the individual extent of the defect, and it can not only provide bulk but also ensure mobility, and it has other advantages also, including a long pedicle and low donor site morbidity.
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Affiliation(s)
| | | | | | | | | | - Yang Zhang
- School of Stomatology, China Medical University, No, 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China.
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Ooi A, Wong CH, Ong YS. Combined use of liposuction and arthroscopic shaver in lower-limb fasciocutaneous flap contouring. J Plast Reconstr Aesthet Surg 2013; 66:538-42. [DOI: 10.1016/j.bjps.2012.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/03/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
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Militsakh ON, Sanderson JA, Lin D, Wax MK. Rehabilitation of a parotidectomy patient-A systematic approach. Head Neck 2012; 35:1349-61. [DOI: 10.1002/hed.23095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/10/2022] Open
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Sun G, Lu M, Hu Q, Tang E, Yang X, Wang Z. Clinical application of thin anterolateral thigh flap in the reconstruction of intraoral defects. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:185-91. [PMID: 22901660 DOI: 10.1016/j.oooo.2012.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 03/10/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the clinical features and therapeutic efficacy of intraoral defect reconstruction with thin anterolateral thigh flaps. METHODS A total of 34 patients underwent simultaneous tumor resection and intraoral defect reconstruction with free thin anterolateral thigh flaps. RESULTS There were 16 male and 18 female patients; the ratio of males to females was 0.9:1; the mean age was 55.4 years. In these 34 patients, 26 flaps were musculocutaneous perforators (76.5%) and 8 flaps were septocutaneous perforators (23.5%). Partial loss of flap occurred in 2 patients (5.9%). CONCLUSIONS The free thin anterolateral thigh flap was the ideal soft tissue flap in intraoral defect reconstruction. This thin flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.
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Affiliation(s)
- Guowen Sun
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Nanjing University Medical Center, Nanjing University, Stomatological Hospital of Nanjing, Nanjing, People's Republic of China.
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Outcomes of anterolateral thigh free flap thinning using liposuction following lower limb trauma. J Plast Reconstr Aesthet Surg 2012; 65:474-81. [DOI: 10.1016/j.bjps.2011.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/24/2011] [Accepted: 11/06/2011] [Indexed: 11/19/2022]
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