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Zhang S, Zhang S, Zou J, Jiang T, Chen L, Gong Z. Reconstruction of Complex Oral and Maxillofacial Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Multiple Paddle Flaps. J Craniofac Surg 2024:00001665-990000000-02017. [PMID: 39374423 DOI: 10.1097/scs.0000000000010782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/19/2024] [Indexed: 10/09/2024] Open
Abstract
PURPOSE This study aimed to use reconstructive methods for complex oral and maxillofacial defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) multiple paddle flaps. PATIENTS AND METHODS The authors performed a retrospective case series of 33 patients who underwent oral and maxillofacial defect reconstruction using the ALT multiple paddle flaps. The design and harvest of the flaps, methods for defects reconstruction, and reconstructive efficacy are described. RESULTS All 33 patients were men, with a mean age of 49.5 years. Of the flaps, triple skin paddles plus muscle paddles were included in 3 cases, triple skin paddles were included in 1 case, 2 skin paddles plus muscle paddles were included in 29 cases. The skin paddles measured 3×5 cm to 10×16 cm. Postoperatively, all flaps survived completely. Parotid salivary fistula and orocutaneous fistula occurred in 1 patient of each, thigh wound infection and effusion occurred in 1 and 2 patients, respectively. All patients were followed up for ~2 to 93 months; most patients' oral functions and appearance were acceptable, and thigh motor dysfunction was not observed. CONCLUSIONS With separate skin paddles for defects of different positions, individualized muscle flap for dead spaces, combination of different skin paddles for larger defects, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT multiple paddle flaps are an ideal candidate for complex oral and maxillofacial defects reconstruction.
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Affiliation(s)
- Shuai Zhang
- Department of Stomatology, The Second Xiangya Hospital, Central South University
- Department of Otolaryngology, Xiangya Hospital, Central South University
| | - Shanshan Zhang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyuan Zou
- Department of Stomatology, The Second Xiangya Hospital, Central South University
| | - Tiancheng Jiang
- Department of Stomatology, The Second Xiangya Hospital, Central South University
| | - Lin Chen
- Department of Stomatology, The Second Xiangya Hospital, Central South University
| | - Zhaojian Gong
- Department of Stomatology, The Second Xiangya Hospital, Central South University
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2
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Yin J, Wang L, Wang Z, Shi Y, Xiong P, He Y, Qin X. Gender Disparities and Ultrasonographic Evaluation of Anatomic Features of Anterolateral Thigh Flap (ALT) in Individuals with Diverse BMI: A Retrospective Clinical Study. JPRAS Open 2024; 41:420-427. [PMID: 39262614 PMCID: PMC11387518 DOI: 10.1016/j.jpra.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 09/13/2024] Open
Abstract
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.
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Affiliation(s)
- Jianxin Yin
- Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 200011, Shanghai, China
| | - Lei Wang
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, 14195, Berlin, Germany
| | - Zhouyang Wang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
| | - Yanni Shi
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 200011, Shanghai, China
| | - Yue He
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
| | - Xingjun Qin
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
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Goudot G, Berkane Y, de Clermont-Tonnerre E, Guinier C, Filz von Reiterdank I, van Kampen A, Uygun K, Cetrulo CL, Uygun BE, Dua A, Lellouch AG. Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study. Front Physiol 2022; 13:1063240. [PMID: 36589429 PMCID: PMC9797596 DOI: 10.3389/fphys.2022.1063240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap. Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery. Results: The MV-Flow mode allowed a better follow-up of the saphenous artery's collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations. Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.
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Affiliation(s)
- Guillaume Goudot
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States,Hôpital Européen Georges-Pompidou, Assistance Publique—Hôpitaux de Paris (APHP), Université Paris-Cité, Paris, France,*Correspondence: Guillaume Goudot,
| | - Yanis Berkane
- Hôpital Européen Georges-Pompidou, Assistance Publique—Hôpitaux de Paris (APHP), Université Paris-Cité, Paris, France,Shriners Children’s Boston, Boston, MA, United States,Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France
| | - Eloi de Clermont-Tonnerre
- Shriners Children’s Boston, Boston, MA, United States,Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory Center for Transplantation Sciences, Massachusetts General Hospital Harvard Medical School, Boston, MA, United States
| | - Claire Guinier
- Shriners Children’s Boston, Boston, MA, United States,Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory Center for Transplantation Sciences, Massachusetts General Hospital Harvard Medical School, Boston, MA, United States
| | - Irina Filz von Reiterdank
- Shriners Children’s Boston, Boston, MA, United States,Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory Center for Transplantation Sciences, Massachusetts General Hospital Harvard Medical School, Boston, MA, United States,Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Antonia van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States,University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Korkut Uygun
- Shriners Children’s Boston, Boston, MA, United States,Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Curtis L. Cetrulo
- Shriners Children’s Boston, Boston, MA, United States,Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory Center for Transplantation Sciences, Massachusetts General Hospital Harvard Medical School, Boston, MA, United States
| | - Basak E. Uygun
- Shriners Children’s Boston, Boston, MA, United States,Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexandre G. Lellouch
- Shriners Children’s Boston, Boston, MA, United States,Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory Center for Transplantation Sciences, Massachusetts General Hospital Harvard Medical School, Boston, MA, United States,Department of Plastic, Reconstructive and Aesthetic Surgery, Groupe Almaviva Santé, Clinique de l’Alma, IAOPC, Paris, France
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Kalra GS, Gupta S, Kalra S. Pedicle First Anterior Approach to Harvest Anterolateral Thigh Flap—Review of 304 Cases. Indian J Plast Surg 2022; 55:272-276. [PMID: 36325079 PMCID: PMC9622332 DOI: 10.1055/s-0042-1756128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Although considered as a workhorse flap, the anterolateral thigh (ALT) flap has a steep learning curve that makes it difficult for microsurgeons to perform it early in their practice. In over 85% of patients, the perforator takes an intramuscular course making it difficult for beginners to safely secure the perforator dissection. In this technique, the pedicle is dissected first, utilizing the proximal incision by palpating the groove in between vastus lateralis and rectus femoris on the anterior aspect and extending the incision from 2 to 3 cm distal to the inguinal ligament to the flap markings caudally. Exposing the pedicle first makes it easier to proceed toward the skin perforator due to its easy identification and larger size at its origin.
Patients and Methods
This retrospective study was conducted from 2005 to 2020 in which 304 ALT flaps were performed by the pedicle first technique. Flap harvest time, incidence of injury to the skin perforator during harvest, flap re-exploration rates, and postoperative complications including incidence of flap necrosis, infection, and bleeding were the parameters that were measured.
Results
This study included a total of 304 patients of which 220 were male (72.3%). The average flap harvest time was 26 ± 3.2 minutes. Adverse events included perforator injury (
n
= 1), flap re-exploration (
n
= 15), and complete flap loss (
n
= 8). The last eight patients were reconstructed secondarily with ALT flap from the opposite side and free latissimus dorsi flap (
n
= 2).
Conclusion
The pedicle first technique makes ALT flap harvest easy, safe, and faster for plastic surgeons. The chances of injury to the skin perforator are markedly less thereby reducing postoperative complications.
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Affiliation(s)
- GS Kalra
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, Rajasthan, India
| | - Samarth Gupta
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, Rajasthan, India
| | - Sushrut Kalra
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, Rajasthan, India
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Wu K, Gong Z, Wu H, Mao Y, Zhang S. Evaluating the role of low molecular heparin to prevent anterolateral thigh flap compromise in 2460 head and neck defect cases. J Oral Maxillofac Surg 2022; 80:944-948. [DOI: 10.1016/j.joms.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/18/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
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Gong Z, Zhang S, Chen C, Zhi Y, Zi M. Reconstruction of Complex Lateral Skull Base Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Flap. Front Oncol 2021; 11:743370. [PMID: 34631580 PMCID: PMC8493093 DOI: 10.3389/fonc.2021.743370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Complex lateral skull base defects resulting from advanced or recurrent oral cancer resection are continuously challenging reconstructive surgeons. This study aimed to use reconstructive methods for lateral skull base defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) flaps. Patients and Methods We performed a retrospective case series of 37 patients who underwent lateral skull base defect reconstruction using the ALT/anteromedial thigh (AMT) flap between March 2016 and May 2021 at the Second Xiangya Hospital. The design and harvest of the flaps, methods for defect reconstruction, and reconstructive efficacy are described. Results Of the 37 patients, 3 were women and 34 were men, with a mean age of 51.7 years. Among the defects, 26 were through-and-through defects and were reconstructed using ALT chimeric flaps, double ALT flaps, folded ALT flap, combined ALT chimeric flaps and AMT flaps, or combined ALT chimeric flaps and pectoralis major flaps; the large lateral skull base dead spaces were filled with muscle tissues or fatty tissues. Postoperatively, 38 of the 39 ALT/AMT flaps survived completely, and the remaining flap experienced partial necrosis. Venous compromise occurred in one patient who was salvaged after operative exploration. Oral and maxillofacial wound infections occurred in two patients, salivary fistula in three patients, and thigh wound effusion in three patients. The wounds healed gradually in all patients after repeated dressing changes. Thirty-three patients were followed up for approximately 3–60 months; their oral functions and appearance were acceptable, and thigh motor dysfunction was not observed. Conclusions With the convenient flap design and muscle flap harvest, large and individualized tissue supply, feasible combination with other flaps, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT flap is an appropriate choice for complex lateral skull base defect reconstruction.
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Affiliation(s)
- Zhaojian Gong
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Zhang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | - Chang Chen
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Zhi
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Moxin Zi
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
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Gong Z, Zhang S, Li P, Liu J, Xu Y. Femoral artery-nourished anteromedial thigh flap: A new perspective in oral and maxillofacial defect reconstruction. Oral Oncol 2021; 117:105295. [PMID: 33887634 DOI: 10.1016/j.oraloncology.2021.105295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility and efficacy of the femoral artery (FA)-nourished anteromedial thigh (AMT) flap for reconstructing oral and maxillofacial defects. PATIENTS AND METHODS The authors analyzed a retrospective case series of 13 patients who underwent the reconstruction of oral and maxillofacial defects with the FA-nourished AMT flap. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported. RESULTS Of the 13 patients, 12 were men, and 1 was woman, with an average age of 52.2 years. Of these FA-supplied AMT flaps, 7 were singly used, 5 were combined with the anterolateral thigh (ALT) flap or its chimeric flaps, and 1 was separately used with the ALT flap. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. CONCLUSIONS The FA-nourished AMT flap can also be used to reconstruct some common oral and maxillofacial defects, especially as a new alternative to the ALT flap. In addition, this flap can be combined with the ALT flap or its chimeric flaps or separately used with the ALT flap for the reconstruction of complex defects.
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Affiliation(s)
- Zhaojian Gong
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Shanshan Zhang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Panchun Li
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jiang Liu
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yuming Xu
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
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Chimeric Anterolateral Thigh and Rectus Femoris Flaps for Reconstruction of Complex Oral and Maxillofacial Defects. J Craniofac Surg 2020; 32:1841-1844. [DOI: 10.1097/scs.0000000000007228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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