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Liang W, Chen HF, Jeng SF, Shih HS. Pushing the Limits of Reach for the Pedicled Anterolateral Thigh Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5727. [PMID: 38596578 PMCID: PMC11000755 DOI: 10.1097/gox.0000000000005727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 04/11/2024]
Abstract
The pedicled anterolateral thigh flap, although tremendously versatile, may be limited in reach, especially in challenging clinical cases. Traditional methods to extend its reach may remain insufficient or unavailable. We describe two modifications to the conventional pedicled flap to extend its reach to the limits, namely (1) selecting a distal perforator supplemented by the nonsizeable perforator harvest technique, and (2) the double-pivot technique adding an additional rotation to the flap à la propeller perforator flap. The increased reach not only improves reconstructive success, but also opens up new applications for this workhorse flap.
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Affiliation(s)
- Weihao Liang
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hsing-Fu Chen
- Department of Plastic and Reconstructive Surgery, E-Da Hospital, Kaohsiung City, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Seng-Feng Jeng
- Department of Plastic and Reconstructive Surgery, E-Da Hospital, Kaohsiung City, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Hsiang-Shun Shih
- Department of Plastic and Reconstructive Surgery, E-Da Hospital, Kaohsiung City, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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2
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Giannas E, Kavallieros K, Nanidis T, Giannas J, Tekkis P, Kontovounisios C. Re-Do Plastic Reconstruction for Locally Advanced and Recurrent Colorectal Cancer Following a beyond Total Mesorectal Excision (TME) Operation-Key Considerations. J Clin Med 2024; 13:1228. [PMID: 38592018 PMCID: PMC10932044 DOI: 10.3390/jcm13051228] [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: 12/13/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Innovation in surgery and pelvic oncology have redefined the boundaries of pelvic exenteration for CRC. However, surgical approaches and outcomes following repeat exenteration and reconstruction are not well described. The resulting defect from a second beyond Total Mesorectal Excision (TME) presents a challenge to the reconstructive surgeon. The aim of this study was to explore reconstructive options for patients undergoing repeat beyond TME for recurrent CRC following previous beyond TME and regional reconstruction. MEDLINE and Embase were searched for relevant articles, yielding 2353 studies. However, following full text review and the application of the inclusion criteria, all the studies were excluded. This study demonstrated the lack of reporting on re-do reconstruction techniques following repeat exenteration for recurrent CRC. Based on this finding, we conducted a point-by-point discussion of certain key aspects that should be taken into consideration when approaching this patient cohort.
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Affiliation(s)
- Emmanuel Giannas
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (E.G.); (K.K.); (P.T.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Konstantinos Kavallieros
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (E.G.); (K.K.); (P.T.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Theodoros Nanidis
- Department of Plastic Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK;
| | - John Giannas
- Department of Plastic and Reconstructive Surgery, Euroclinic, 115 21 Athens, Greece;
- Department of Plastic and Reconstructive Surgery, The London Welbeck Hospital, London W1G 83N, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (E.G.); (K.K.); (P.T.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
- Department of Surgery, The Royal Marsden Hospital, London SE3 6JJ, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (E.G.); (K.K.); (P.T.)
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
- Department of Surgery, The Royal Marsden Hospital, London SE3 6JJ, UK
- 2nd Surgical Department Evaggelismos, Athens General Hospital, 115 21 Athens, Greece
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3
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Yeo M. Anterolateral Thigh Flap Reconstruction of Full Thickness Lateral Abdominal Wall Defect from Desmoid Tumour. Case Rep Surg 2024; 2024:1908212. [PMID: 38264711 PMCID: PMC10805552 DOI: 10.1155/2024/1908212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/21/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Desmoid tumours are benign but locally aggressive mesenchymal neoplasms that occur most commonly in the abdomen, with the potential to invade surrounding structures causing significant morbidity. Lateral abdominal wall defects are known to be more challenging and less frequently encountered compared to ventral abdominal wall defects. Asymmetric forces caused by contraction of remnant rectus and contralateral oblique muscles increase the risk of herniation postoperatively. We report a case of a challenging abdominal wall reconstruction after desmoid tumour resection in a 62-year-old male patient who presented to our hospital with a progressively enlarging left upper back lump of 6 months duration. A venous supercharged pedicled anterolateral thigh flap was combined with PROLENE® mesh for reconstruction, and the patient recovered well with good functional and aesthetic outcomes at 2-year follow-up. The pedicled anterolateral thigh flap with venous supercharging can be effectively used for the reconstruction of extensive lateral abdominal wall defects.
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Affiliation(s)
- Melissa Yeo
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
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4
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Onuma H, Fuse Y, Karakawa R, Yano T, Yoshimatsu H. The Pedicled Anterolateral Thigh Flap for Donor Site Closure after a Large Superficial Circumflex Iliac Artery Perforator Flap Harvest. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5115. [PMID: 37448764 PMCID: PMC10337709 DOI: 10.1097/gox.0000000000005115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is useful for covering defects in the extremities because its pedicle size can match many recipient options. However, when harvesting a large flap, skin grafting of the donor site is not highly recommended because of the mobility of the hip joint and occasional lymphorrhea. Here, we present a case of a successful reconstruction of a defect in the lower leg after sarcoma resection, using a large SCIP flap. A 58-year-old man underwent resection of a large soft tissue tumor in the lower leg, resulting in a 16 × 14 cm defect. A 25 × 14 cm SCIP flap was harvested from the groin, and the superficial circumflex iliac artery and the superficial circumflex iliac vein were anastomosed to the saphenous artery and the great saphenous vein, respectively, in an end-to-end fashion. For coverage of the groin donor site, a 25 × 8 cm pedicled anterolateral thigh (ALT) flap was harvested from the ipsilateral lateral thigh and was pulled through a subcutaneous tunnel to the groin. The additional operative time for pedicled ALT flap elevation and transfer was approximately 15 minutes. With this pedicled ALT flap, the donor site of the SCIP flap could be closed directly over a drain. The follow-up at 3 months showed complete survival of both flaps, and the patient was able to walk with a cane. The pedicled ALT flap allows for direct closure of the donor site after a large SCIP flap harvest.
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Affiliation(s)
- Haruka Onuma
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuma Fuse
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Karakawa
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Yano
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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5
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Guillier D, Guiotto M, Cherix S, Raffoul W, di Summa PG. Lymphatic flow through (LyFT) ALT flap: an original solution to reconstruct soft tissue loss with lymphatic leakage or lower limb lymphedema. J Plast Surg Hand Surg 2023; 57:216-224. [PMID: 35189063 DOI: 10.1080/2000656x.2022.2039680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The lympho-venous shunt using the distal vein of ALT flap pedicle allowed at the same time the coverage of the inguinal defects and to perform lymphovenous shunt into a run-in vein of the descending branch of the lateral circumflex femoral pedicle, draining the lymph through the flap pedicle. Surgical technique, complications and final outcomes (both clinical and lymphoscintigraphic) are reported. METHODS Five patients (45.8 y.o.[22-70]) with groin soft tissue loss with lymphatic leakage or lower limb lymphedema, benefited of the described technique. The ALT flap was used to cover the defect and, at the same time, we could perform a lymphovenous shunt between afferent lymphatics to the thigh and the descending branch of the lateral circumflex femoral pedicle, distal to the perforator nourishing the flap. Clinical and lymphoscintigraphic assessment of the limbs, cease of lymphorrhea or cellulitis/lymphangitis episodes, eventual downstaging of physiologic/physical therapy were recorded. LYMphatic Quality Of Life in leg (LYMQoLLeg) and patient satisfaction were evaluated. RESULTS Average flap size was 88.8cm2 (range 84-126). The mean number of multi-lymphovenous anastomosis (MLVA) performed was 1.8 (range 1-3) per patient with 1-3 lymphatics shunted into each vein. Only one hemato-seroma requiring surgical revision. Mean improvement of perometer values was 48.2% (range 27.7-67.7) with an average follow-up of 13.6 months (range 12-17). Lymphoscintigraphy showed disappearing of the lymphatic leak and lymphedema with a high satisfaction of LYMQoL score. DISCUSSION The combination of pedicle flap with lympho-venous bypass as lymphatic derivation concept, improving the chronic morbidity scenarios of lymphatic complications.
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Affiliation(s)
- David Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery-University Hospital, Dijon, France.,Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Martino Guiotto
- Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Stephane Cherix
- Department of Orthopaedics and Traumatology, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pietro G di Summa
- Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
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Geber B, Landscheidt K, Goertz O, Hernekamp JF. Die gestielte DIEP-Lappenplastik zur Weichteilrekonstruktion eines großen Leistendefektes nach komplikativer gefäßchirurgischer Vorversorgung. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Fritz C, Meroni M, Tartanus J, Fuchs B, Scaglioni MF. Pedicled double-paddle vertical posteromedial thigh flap for double-layer closure and reconstruction of upper thigh defect after sarcoma resection: A case report. Microsurgery 2022; 42:722-727. [PMID: 35946575 DOI: 10.1002/micr.30948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022]
Abstract
Large soft tissue defects in the anterior upper thigh region represent a challenging problem in reconstructive surgery. Sarcomas are rather commonly localized in this area and they may reach extensive dimensions before surgery. The debulking procedures must be radical, which often leads to a displacement of major neurovascular structures. In the present work, we report the use of a pedicled double-paddle vertical posteromedial thigh (vPMT) flap to reconstruct a 16 cm × 8 cm soft tissue defect with exposure of the superficial and deep femoral vessels after resection of a myxoid liposarcoma. The vPMT flap was based on two perforators of the profunda femoris artery. Therefore, the cutaneous island could be split into two islands measuring 12 cm × 6 cm and 9 cm × 6 cm, which were exploited to fill the dead space below and over the vessels, reaching a satisfactory volume restoration and tension-free skin closure. The further post-operative course was uneventful. The perforator dissection might be complex and requires a good experience, however, we believe that in similar cases the pedicled double-paddle vPMT flap can be a valid solution when other options are not feasible. Moreover, this allows avoiding a free microsurgical transfer and fulfills the dictum of replacing "like-with-like tissue". No characterizations of the employment of a pedicled chimeric vPMT flap for locoregional multilayer reconstruction are available so far.
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Affiliation(s)
- Caroline Fritz
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Justyna Tartanus
- Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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8
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Shah AA, Lozano-Calderon SA, Berner EA, Austen WG, Winograd JM, Park HY, Bernthal NM, Crawford BM, Hornicek FJ. Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes. J Surg Oncol 2022; 126:978-985. [PMID: 35809223 DOI: 10.1002/jso.27006] [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: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Adequate coverage of the soft tissue defects from wide resection of sacropelvic malignancies remains challenging. The vastus lateralis flap has been described for coverage in the setting of trauma and infection. This flap has not been described for coverage of sacropelvic tumor defects. METHODS This is a retrospective cohort study of adult patients who underwent wide resection of a primary sacropelvic malignancy with reconstruction employing a pedicled vastus lateralis flap at two tertiary care centers. Patient demographics, tumor staging, and rate of complications were assessed. RESULTS Twenty-eight patients were included, with a median age of 51 years. The most common primary tumor was chondrosarcoma followed by chondroblastic osteosarcoma. The median follow-up was 1.1 years. There were 10 cases of wound infection requiring re-operation and three cases of flap failure. CONCLUSIONS We describe a pedicled vastus lateralis flap for coverage of defects after wide resection of sacropelvic malignancies. A large proportion of our cohort had independent risk factors for wound complications. Even with a cohort with high baseline risk for wound complications, we show that the use of a pedicled vastus lateralis flap is a safe reconstructive option with a wound complication rate in line with the literature.
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Affiliation(s)
- Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Emily A Berner
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William G Austen
- Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan M Winograd
- Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brooke M Crawford
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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9
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王 丹, 刘 元, 陈 威, 臧 梦, 朱 珊, 陈 博, 李 杉. [Clinical application of computed tomographic angiography in predicting the vascular pedicle length of the proximally-based anterolateral thigh flap]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:322-328. [PMID: 35293174 PMCID: PMC8923919 DOI: 10.7507/1002-1892.202111002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the reliability and effectiveness of prediction of the pedicle length of the proximally-based anterolateral thigh (pALT) flap which was used to repair the defects following the resection of various malignant tumors using computed tomographic angiography (CTA). METHODS The clinical data of 12 patients who met the selection criteria by using pALT flap to repair wounds left after malignant tumor resection between June 2015 and December 2020 were retrospectively analyzed. There were 5 males and 7 females; the age ranged from 16 to 80 years, with an average age of 54.4 years. After tumor resection, the soft tissue defect ranged from 15 cm×5 cm to 30 cm×12 cm; defect sites included 4 cases of lower abdomen, 3 cases of groin, 2 cases of thigh, and 3 cases of buttocks. Preoperative CTA was used to obtain the location information of the descending branch of the lateral femoral circumflex artery and its perforators by maximum density projection, and the length of the pedicle of pALT flap was estimated. Fasciocutaneous flap (5 cases) or myocutaneous flap (7 cases) were cut during operation to repair the defect, and the size of flap ranged from 20 cm×7 cm to 30 cm×12 cm. The donor site of thigh was directly sutured (11 cases) or repaired with skin graft (1 case). Bland-Altman analysis was used to detect the consistency between the pALT flap vascular pedicle length estimated by CTA and the pALT flap vascular pedicle length actually obtained during operation. RESULTS One case had distal blood supply disturbance of the flap and was repaired with skin graft after debridement; the remaining 11 flaps survived. All donor and recipient incisions healed by first intention. All 12 cases were followed up 1-12 months, with an average of 4.3 months. One patient died of pelvic tumor recurrence at 6 months after operation, and no tumor recurrence was found in the other patients. Preoperative CTA estimated that the length of pALT flap vascular pedicle was 9.3-24.7 cm, with an average of 14.7 cm; the actual length of pALT flap vascular pedicle was 9.5-25.0 cm, with an average of 14.8 cm. Bland-Altman analysis showed that there was no significant difference between the pALT flap vascular pedicle length estimated by CTA before operation and the pALT flap vascular pedicle length actually obtained during operation, and the average difference was 0.1 (95% consistency limit: -0.89, 0.74), indicating that they had good consistency. CONCLUSION CTA can be accurately used to localize the perforator and predict the possible pedicle length of the pALT flap. When performing a pALT flap surgery, preoperative CTA is helpful for surgeons to make a preliminary assessment of the difficult of the operation. The time for exploration of perforators and dissection of the vascular pedicle, and complications can be reduced, and the safety of the operation can be improved.
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Affiliation(s)
- 丹莹 王
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 元波 刘
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 威威 陈
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 梦青 臧
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 珊 朱
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 博 陈
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 杉珊 李
- 中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心(北京 100144)Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
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10
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Reconstruction of Pelvic Exenteration Defect with Free Anterolateral Thigh Flap: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3774. [PMID: 34667704 PMCID: PMC8517310 DOI: 10.1097/gox.0000000000003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
The pedicled anterolateral thigh flap, with or without the vastus lateralis muscle, has been described for pelvic exenteration defect reconstruction. However, its use as a free flap for this type of defect is not routinely followed. To reconstruct an extensive pelvic defect in the presence of two ostomies, we describe a free anterolateral thigh flap with deep inferior epigastric pedicles as recipient vessels.
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11
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Acartürk TO, Bengür FB. Individually Tailored Approach to Reconstruction of Complex Defects Using Versatility of the Lateral Circumflex Femoral Artery System-Based Pedicled Flaps. J Plast Reconstr Aesthet Surg 2021; 75:199-209. [PMID: 34645586 DOI: 10.1016/j.bjps.2021.08.035] [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: 07/09/2020] [Revised: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Lateral circumflex femoral artery (LCFA) system is one of the most versatile donor sites in the body. We present our experience with pedicled flaps from the LCFA system, including different components for a wide variety of etiologies and locations. Twenty-three consecutive pedicled flaps were performed on 22 patients (10 females and 12 males; age 4-71 years) between 2007 and 2015 by a single surgeon. Flap size, type, and composition were tailored according to the requirements of the defects, including (1) location; (2) surface area; (3) depth; (4) number of defects; (5) presence of exposed critical structures; (6) presence of exposed foreign bodies; (7) prior use of other options; (8) history of radiation; and (9) other comorbidities. Defect locations were 10 abdominal wall (including groin and pubis), 9 ischio-gluteo-trochanteric and 4 perineal. Defect sizes ranged from 6 × 6 to 30 × 35 cm. Maximum depth of wounds ranged between 7 and 18 cm. The flap sizes ranged from 9 × 6 to 38 × 20 cm. Two flaps were fasciocutaneous perforator, 4 were myocutaneous with "muscle sparing" vastus lateralis, 10 were myocutaneous with "segmental" vastus lateralis, 5 were myocutaneous "tri-muscle," 1 was "tri-muscle," and 1 was rectus femoris only. Donor sites were closed primarily in 20 cases and with split thickness skin grafting in 3 cases. All flaps survived completely without any partial loss or congestion. Pedicled flaps from the LCFA system can be tailored individually for a wide variety of etiologies and locations. Muscles can be harvested and used as "muscle sparing," "segmental," and "tri-muscle" to accommodate the requirements of the defects.
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Affiliation(s)
| | - Fuat Barış Bengür
- University of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
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12
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Zoccali C, Baldi J, Attala D, Scotto di Uccio A, Cannavò L, Scotto G, Luzzati A. 3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up. J Clin Med 2021; 10:jcm10163539. [PMID: 34441834 PMCID: PMC8397106 DOI: 10.3390/jcm10163539] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/25/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration.
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Affiliation(s)
- Carmine Zoccali
- Oncological Orthopaedics Department, IRCCS—Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (J.B.); (D.A.)
- Correspondence: ; Tel.: +39-338-6355040; Fax: +39-06-52662778
| | - Jacopo Baldi
- Oncological Orthopaedics Department, IRCCS—Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (J.B.); (D.A.)
| | - Dario Attala
- Oncological Orthopaedics Department, IRCCS—Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (J.B.); (D.A.)
| | - Alessandra Scotto di Uccio
- Hepato-Biliary and Organ Transplant Unit, School of General Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Luca Cannavò
- Oncological and Reconstructive Surgery Unit, IRCCS—Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (L.C.); (G.S.); (A.L.)
| | - Gennaro Scotto
- Oncological and Reconstructive Surgery Unit, IRCCS—Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (L.C.); (G.S.); (A.L.)
| | - Alessandro Luzzati
- Oncological and Reconstructive Surgery Unit, IRCCS—Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (L.C.); (G.S.); (A.L.)
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Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background
Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction.
Methods
We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications.
Results
Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months).
Conclusions
Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites.
Level of evidence: Level IV, therapeutic study.
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Scomacao I, Vijayasekaran A, Fahradyan V, Aliotta R, Drake R, Gurunian R, Djohan R. The Anatomic Feasibility of a Functional Chimeric Flap in Complex Abdominal Wall Reconstruction. Ann Plast Surg 2021; 86:557-561. [PMID: 33939653 DOI: 10.1097/sap.0000000000002490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch. METHODS Ten fresh cadavers were dissected with a designed chimeric thigh flap including ALT and RF flaps. Anterolateral thigh was designed and raised with the lateral femoral cutaneous nerve integrated, and the descending branch of the lateral circumflex femoral artery was preserved. Rectus femoris was elevated and the common pedicle was dissected up to the femoral origin. Accompanying motor nerve branches were carefully dissected to their femoral origin. RESULTS Twenty RF flaps were dissected and 9 were harvested as a true chimeric flap with ALT. The mean number of neurovascular bundles associated with RF flap was 2.11 ± 0.47, and the mean primary motor nerve average length was 9.40 ± 2.42 cm. The common vascular bundle in all 9 chimeric flaps was ligated, and the flap was rotated toward the abdomen pedicled only by primary motor nerve of the RF muscle. Nerve length was adequate for reach up to xiphoid area in all 20 flaps. CONCLUSIONS This study demonstrates the feasibility of the chimeric ALT/RF muscle free flap pedicled only by the motor nerve branch, with adequate flap rotation. Even with the limitations in a live patient, this flap would be an excellent option for FAWR in the right patient.
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Affiliation(s)
- Isis Scomacao
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Vahe Fahradyan
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Rachel Aliotta
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Richard Drake
- Department of Anatomic and Laboratory Sciences, Cleveland Clinic Foundation, Cleveland, OH
| | - Raffi Gurunian
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Risal Djohan
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
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15
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Zhu S, Zang M, Xu B, Chen B, Li S, Han T, Liu Y. Defect Reconstruction Using the Propeller Flaps Based on the Perforators Derived From the Lateral Circumflex Femoral Artery System. Ann Plast Surg 2021; 86:450-457. [PMID: 32694459 DOI: 10.1097/sap.0000000000002467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although propeller flaps are a useful option for soft tissue defect reconstruction, reports based on the perforators of the lateral circumflex femoral artery (LCFA) are rare. We aimed to present our experience in defect reconstruction using the propeller flaps based on perforators from different branches of LCFA and apply these flaps in soft tissue defect reconstruction of the lower extremities. METHODS Twenty nine patients (32 flaps) underwent defect reconstruction using propeller flaps based on the perforator of the LCFA. Defects were located from the groin to the proximal leg. According to the source vessels from which the perforator originated, flaps were categorized into types I, II, III and IV, which represented perforators from the transverse, descending, oblique, and rectus femoris branches, respectively. Type II flaps were subdivided into types IIa and IIb flaps based on antegrade and reverse flows of the descending branch. RESULTS Flap sizes ranged from 12 × 6 cm to 30 × 15 cm (average, 22.69 × 9.19 cm) with the length of the vascular pedicle ranging from 3 to 7 cm (average, 4.86 cm). Flaps were rotated from 60° to 180° (average, 144.06°). There were 3 type I, 10 type IIa, 4 type IIb, 13 type III and, and 2 type IV flaps. Twenty-nine flaps survived after surgery. Total flap necrosis and venous congestion of the distal flap portion occurred in 1 and 2 patients, respectively. CONCLUSIONS Reconstruction using propeller flaps based on perforators of the LCFA is a safe, reliable, and versatile option for defect reconstruction of the lower extremities; however, it requires meticulous surgical dissection and patience.
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Affiliation(s)
- Shan Zhu
- From the Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, People's Republic of China
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Jakubietz R, Jakubietz M, Vater A, Kocot A, Kübler H, Kalogirou C. Complex Soft Tissue Defects in Operative Urology: Pedicled Perforator Flaps of the Anterior Lateral Thigh for Tissue Reconstruction of the Lower Trunk. Urol Int 2021; 105:477-482. [PMID: 33535223 DOI: 10.1159/000512057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Complex soft tissue defects involving the lower abdomen, perineum, and groin (LAPG) represent reconstructive challenges following urologic surgery. Consequently, these often require an interdisciplinary approach involving plastic surgery. While pedicled flaps from the lower abdomen are a reliable option, previous placement of colostomies and urinary urostomies renders these flap types unavailable. Here, the pedicled anterolateral thigh perforator (ALT) flap represents a reliable pedicled alternative which can harvest from the thigh. MATERIALS AND METHODS A retrospective data analysis of pedicled perforator flaps harvested from the thigh to reconstruct soft tissue defects was conducted. Seven patients treated in the urology department with soft tissue defects following tumor resection, infection, and dehiscence were included. RESULTS In all patients, the ALT flap was utilized successfully to reconstruct soft tissue defects up to 450 cm2 in size. All flaps survived. In 1 case, prolonged wound healing was observed. All defects were adequately addressed with no recurrence of dehiscence or fistula formation. CONCLUSIONS Pedicled perforator flaps represent a valid option for the soft tissue reconstruction of the lower abdomen and perineum when a pedicled rectus abdominis flap is no longer available. This flap is, therefore, a good option in an interdisciplinary approach to soft tissue reconstruction, especially following urologic surgery, which is predominantly performed in the LAPG region.
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Affiliation(s)
- Rafael Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians Medical Center of Würzburg, Würzburg, Germany,
| | - Michael Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians Medical Center of Würzburg, Würzburg, Germany
| | - Adrian Vater
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians Medical Center of Würzburg, Würzburg, Germany
| | - Arkadius Kocot
- Department of Urology and Paediatric Urology, Julius-Maximilians Medical Center of Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology and Paediatric Urology, Julius-Maximilians Medical Center of Würzburg, Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology and Paediatric Urology, Julius-Maximilians Medical Center of Würzburg, Würzburg, Germany
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Haque SA, Georgiou A, Woollard A. Pedicled ipsilateral anterolateral thigh (ALT) with flow-through to a secondary contralateral-free ALT flap for coverage of large thigh, trochanteric, and gluteal area defects: A case report. Microsurgery 2021; 41:276-279. [PMID: 33452821 DOI: 10.1002/micr.30706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/08/2020] [Accepted: 12/31/2020] [Indexed: 11/10/2022]
Abstract
Reconstruction of the trochanteric area can be difficult in extensive defects postsarcoma resection. It requires a robust flap. In reconstructing the upper thigh, trochanteric, and gluteal area, a pedicled anterolateral thigh (ALT) flap is a good option. If the defect extends further than the pivot point of a single pedicled ALT, this can be used a flow-through for a secondary free flap. Here we describe a case of a 66-year-old gentleman with a 25 cm × 15 cm defect in the trochanteric and gluteal area where a single pedicled ALT was insufficient for coverage and hence a second ALT from the contralateral leg is anastomosed to the distal runoff of the descending branch of the lateral circumflex femoral vessel of the pedicled ALT, using it as the flow-through donor vessel. This method requires less time if a second free flap is required and a smaller range of dissection, and it also facilitates anastomosis, as the vessel can be brought to the surface for anastomosis while supine before inset. The patient healed with no complications and received radiotherapy to the area. On 1-year follow-up, the area has healed well despite some contraction secondary to the radiotherapy. Using the pedicled ALT as a flow-through for a second free flap is a useful adjunct to large defects in the gluteal and trochanteric area, which is a difficult area to reconstruct with limited donor vessels.
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Affiliation(s)
- Shameem A Haque
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Andreas Georgiou
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Alexander Woollard
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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18
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Vijayasekaran A, Gibreel W, Carlsen BT, Moran SL, Saint-Cyr M, Bakri K, Sharaf B. Maximizing the Utility of the Pedicled Anterolateral Thigh Flap for Locoregional Reconstruction: Technical Pearls and Pitfalls. Clin Plast Surg 2020; 47:621-634. [PMID: 32892805 DOI: 10.1016/j.cps.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The pedicled anterolateral thigh (PALT) flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully understood. In addition, most of the available literature has focused on the utility of the free anterolateral thigh flap with less emphasis on the PALT flap. Moreover, flap design concepts to maximize its utility and reach and optimize outcomes have not been comprehensively described. In an effort to address this knowledge gap, the authors sought to review their institution's experience with the PALT flap for locoregional reconstruction.
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Affiliation(s)
- Aparna Vijayasekaran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Waleed Gibreel
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Baylor Scott & White Health, Scott & White Memorial Hospital, MS-01-E443, 2401 South 31st Street, Temple, TX 76508, USA
| | - Karim Bakri
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Basel Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Madsen CB, Sørensen JA. Versatility of the pedicled anterolateral thigh flap for surgical reconstruction, a case series. JPRAS Open 2020; 25:52-61. [PMID: 32642534 PMCID: PMC7334399 DOI: 10.1016/j.jpra.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background The pedicled anterolateral thigh flap is a versatile flap that offers many advantages. These include a long and reliable pedicle that enables a wide arch of rotation, the possibility to harvest a large skin area, raising the flap with underlying fascia and muscle and minimal donor site morbidity. Methods From 2009 to 2018 nine patients were reconstructed with a pedicled anterolateral thigh flap. The flap was applied for coverage of knee infections, trochanteric defects, an abdominal defect, a gluteal defect, and a defect of the inguinal region. The patient group consisted of five males and four females. The age range was 30–90 years with a mean age of 61 years. Results Flap size ranged from 10 x 5 cm (50 cm2) to 15 x 30 cm (450 cm2) with a mean size of 222 cm2. We experienced no flap loss. The donor site was closed directly in seven out of nine patients, and the remaining two patients were closed by split-thickness skin grafting. Satisfactory aesthetic and functional outcome was achieved in all patients. Conclusion Our experience illustrates the versatility in the clinical application of the pedicled anterolateral thigh flap. The many advantages of the flap, such as the long and reliable pedicle, a large area of skin that can be harvested, the potential to supercharge the flap and the minimal donor site morbidity highlights the diversity of defects that can be reconstructed using this flap.
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Affiliation(s)
- Christoffer Bing Madsen
- Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Penthouse 2. floor, 5000 Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Corresponding author at: Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Penthouse 2. floor, 5000 Odense C, Denmark.
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Penthouse 2. floor, 5000 Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Pelvic/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as a First-line Option? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2733. [PMID: 32440406 PMCID: PMC7209827 DOI: 10.1097/gox.0000000000002733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
Background: Abdominoperineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author’s (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for reconstruction of soft tissue defects following APR and pelvic exenteration. Methods: Patients who underwent pelvic/perineal reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate. Results: A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49–71 years) and 24.9 kg/m2 (IQR: 24.2–26.7 kg/m2) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn’s disease, and 1 (4.3%) with Paget’s disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient. Conclusions: The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/perineal reconstruction.
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Garrido Ríos S, Bustos Martínez G, Olaizola Zubicarai MI, Fernández de Misa Cabrera R, A Garrido Ríos A. Dermatofibrosarcoma Protuberans in the Abdominal Wall: Reconstruction with an Anterolateral Thigh Flap. Cir Esp 2020; 98:630-632. [PMID: 32156415 DOI: 10.1016/j.ciresp.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sofía Garrido Ríos
- Servicio de Cirugía Plástica, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España.
| | - Gema Bustos Martínez
- Servicio de Cirugía Plástica, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | | | - Ricardo Fernández de Misa Cabrera
- Servicio de Dermatología, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España
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Groin defect reconstruction with perforator flaps: Considerations after a retrospective single-center analysis of 54 consecutive cases. J Plast Reconstr Aesthet Surg 2019; 72:1795-1804. [DOI: 10.1016/j.bjps.2019.05.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
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23
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Peripheral Pruning: A Safe Approach to Thinning Extra-Large Anterolateral Thigh Flaps. Ann Plast Surg 2019; 80:S164-S167. [PMID: 29553978 DOI: 10.1097/sap.0000000000001401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thinning of anterolateral thigh (ALT) flaps has been described to achieve optimal contouring. Previous studies caution against thinning large flaps owing to the risk of vascular compromise leading to partial or total flap necrosis. This study aims to demonstrate a reliably safe method for thinning extra-large (>240 cm) flaps. METHODS A retrospective review of 53 consecutive ALT flaps performed at a single institution was completed. Of these flaps, 18 (34%) were thinned primarily by sharp excision of sub-Scarpa's fat along the periphery of the flap using loupe magnification. A central cuff of fat is left to surround and protect the perforator. RESULTS There were 53 total flaps in our series. Eighteen of the flaps were thinned by peripheral pruning. Eleven (61%) of the flaps reconstructed defects of the lower extremity, whereas 4 (22%) reconstructed upper extremity defects and 3 (17%) reconstructed scalp defects (Table 1). The mean size of the thinned flap group was 35% larger than the nonthinned group (n = 18, 261 cm ± 109 cm vs n = 35, 192 cm ± 146 cm). Ten thinned flaps (55%) were extra large, with flap areas over 240 cm. The average amount of excised fat weighed 41 g ± 18 g. The average body mass index in the thinned flap group was 28.8 kg/m, which is classified as overweight. The average body mass index in the nonthinned flap group was 24.6 kg/m, which is classified as normal weight (Table 2). There were no cases of partial flap necrosis in the thinned flap group. A single case of total flap loss occurred in the thinned flap group secondary to hematoma formation during administration of therapeutic heparin for a mechanical heart valve. There were no other complications in the thinned flap group. CONCLUSIONS This is the first study to demonstrate a reliable technique for primary thinning of extra-large ALT flaps in the Western population. No complications related to thinning were observed. Peripheral pruning of sub-Scarpa's fat is a safe and reliable method of thinning extra-large ALT flaps without increasing the risk of flap necrosis.
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Song D, Li Z, Zhou X, Zhang Y, Peng X, Zhou B, Lü C. [Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:712-716. [PMID: 31197998 DOI: 10.7507/1002-1892.201901005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection. Methods Between September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly. Results All wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites. Conclusion Pedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
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25
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Sörelius K, Schiraldi L, Giordano S, Oranges CM, Raffoul W, DI Summa PG. Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique. In Vivo 2019; 33:1-9. [PMID: 30587595 DOI: 10.21873/invivo.11431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes. MATERIALS AND METHODS A systematic literature search was performed according to the PRISMA statement between 1996-2016. RESULTS A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n=255, 31%), and vascular surgery (n=538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n=166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n=513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%. CONCLUSION Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Luigi Schiraldi
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pietro G DI Summa
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Complex Open Abdominal Wall Reconstruction: Management of the Skin and Subcutaneous Tissue. Plast Reconstr Surg 2019; 142:125S-132S. [PMID: 30138280 DOI: 10.1097/prs.0000000000004887] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Optimal skin and soft tissue management in complex open abdominal wall reconstruction is an integral element of the operation to achieve optimal outcomes. Failure to provide stable, well-vascularized soft tissue coverage over the hernia repair can jeopardize the reconstruction through association with nonhealing wounds, mesh exposure, and even possible hernia recurrence. The literature has shown that careful attention to the skin and soft tissue, especially when part of a multidisciplinary approach to complex abdominal wall reconstruction, improves patient outcomes significantly.
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Kotick JD, Sandelin RS, Klein RD. Deep Inferior Epigastric Perforator Free Flaps for Use in Complicated Groin Wound Repair: A Case Report of Severe Groin Scar Contracture and Review of Pedicled and Free Flaps in Groin Wound Repair. J Hand Microsurg 2017; 9:101-106. [PMID: 28867912 DOI: 10.1055/s-0037-1604475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
Abstract
The use of pedicled and free flaps for tissue transfer and coverage has become a common practice in modern plastic surgery. An area that presents considerable challenge for tissue coverage is the groin. Defects in this area are complicated by issues such as prior surgery; scar contracture; extension of the defect beyond the borders of the groin; radiation damage; high probability of infection; and involvement of vital underlying structures, the genitalia, and perineal and perianal area. Therefore, the choice of donor site and flap usage is often difficult. Multiple methods of tissue transfer closure have been reported in the literature for repair of such defects and are reviewed in the following text. Here the authors present the case of a 30-year-old Caucasian woman born with a congenital giant hairy nevus of her left lower back, buttock, posterior thigh, and flank, who underwent wide local excision and skin grafting as a newborn. After several operations, the closure broke down and was left to heal by secondary intention. She has since developed excessive scar tissue leading to pain with ambulation secondary to scar contracture involving her labia majora. In this report, the wound was repaired with a free DIEP flap with excellent result and resolution of all symptoms.
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Affiliation(s)
- James D Kotick
- Department of Plastic, Reconstructive, and Hand Surgery, Tufts Medical School, Boston, Massachusetts, United States
| | - Roger S Sandelin
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
| | - Richard D Klein
- Department of Microvascular and Reconstructive Surgery, MD Anderson Cancer Center Orlando, Orlando, Florida, United States
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Management of skin and subcutaneous tissue in complex open abdominal wall reconstruction. Hernia 2017; 22:293-301. [PMID: 28871371 DOI: 10.1007/s10029-017-1662-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Open abdominal wall reconstruction is often a complex endeavor, usually performed on patients with multiple risk factors and co-morbidities. METHODS In this article, we review soft tissue management techniques that can optimize the skin and subcutaneous tissue, with the goal of reducing surgical-site occurrences. RESULTS Regardless of the hernia repair technique used, outcomes can be highly dependent on the appropriate management of the skin and subcutaneous tissue. Indeed, dehiscence and surgical-site infection can jeopardize the entire reconstruction, especially in cases where synthetic mesh might become exposed and/or infected, setting up a "vicious cycle" (Holihan et al. in J Am Coll Surg 221:478-485, 2015). CONCLUSION Multidisciplinary cooperation between the general and plastic surgeon is useful in cases of tenuous blood supply to the abdominal skin, in cases of redundant, marginal or excessive skin, and in cases of deficient skin.
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Vijayasekaran A, Gibreel W, Carlsen BT, Moran SL, Saint-Cyr M, Bakri K, Sharaf B. Maximizing the Utility of the Pedicled Anterolateral Thigh Flap for Locoregional Reconstruction: Technical Pearls and Pitfalls. Clin Plast Surg 2017; 44:371-384. [PMID: 28340669 DOI: 10.1016/j.cps.2016.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The pedicled anterolateral thigh (PALT) flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully understood. In addition, most of the available literature has focused on the utility of the free anterolateral thigh flap with less emphasis on the PALT flap. Moreover, flap design concepts to maximize its utility and reach and optimize outcomes have not been comprehensively described. In an effort to address this knowledge gap, the authors sought to review their institution's experience with the PALT flap for locoregional reconstruction.
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Affiliation(s)
- Aparna Vijayasekaran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Waleed Gibreel
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Baylor Scott & White Health, Scott & White Memorial Hospital, MS-01-E443, 2401 South 31st Street, Temple, TX 76508, USA
| | - Karim Bakri
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Basel Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Scaglioni MF, Franchi A, Giovanoli P. Pedicled chimeric sensitive fasciocutaneous anterolateral thigh (ALT) and vastus lateralis muscle (VLM) flap for groin defect reconstruction: A case report. Microsurgery 2017; 38:423-426. [DOI: 10.1002/micr.30157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Mario F. Scaglioni
- Department of Plastic and Hand Surgery; University Hospital Zurich; Zurich Switzerland
| | - Alberto Franchi
- Department of Plastic and Hand Surgery; University Hospital Zurich; Zurich Switzerland
| | - Pietro Giovanoli
- Department of Plastic and Hand Surgery; University Hospital Zurich; Zurich Switzerland
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Kok ASY. Metachronous carcinoma of rectum with reconstruction of a full-thickness abdominal wall defect using a pedicled anterolateral thigh flap. J Surg Case Rep 2016; 2016:rjw048. [PMID: 27161142 PMCID: PMC4861139 DOI: 10.1093/jscr/rjw048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Reconstruction of large, complex defects of the abdominal wall after resection of malignant tumors can be challenging. The transfer of an anterolateral thigh (ALT) flap is a feasible and effective option. However, no report has been published on the use of ALT flap after metachronous colonic tumor resection so far. We present an original case of resection of metachronous carcinoma of rectum with reconstruction of the abdominal wall defect using an ALT flap harvested with its aponeurosis. The postoperative course was uncomplicated. Functional and esthetic results were satisfactory. There was no postoperative incisional hernia or tumor recurrence. We conclude that abdominal wall defects of large sizes can be successfully reconstructed using an appropriately designed ALT flap; a simple, single-stage effective reconstruction.
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Scaglioni MF, Enrique Carrillo Jimenez L, Kuo YR, Chen YC. Pedicled posteromedial thigh (PMT) flap: A new alternative for groin defect reconstruction. Microsurgery 2015; 37:339-343. [PMID: 26608474 DOI: 10.1002/micr.30008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/14/2015] [Accepted: 11/05/2015] [Indexed: 11/07/2022]
Abstract
The posterior medial thigh is mainly vascularized by the profunda femoris artery (PFA), which nourishes the adductor magnus muscle and overlying skin, to supply a number of perforators that can potentially be used as pedicles for local perforator flaps. Here we present two cases utilizing the pedicled posteromedial thigh flap (PMT) to reconstruct the groin defects. Two patients underwent resection for metastatic malignant melanoma resulting in large defects of the groin with exposure of major inguinal vessels; the dimensions of the skin defects were 15 cm × 5 cm and 16 cm × 6 cm, two ipsilateral pedicled PMT flaps were designed to cover the defects. The pedicled PMT flaps were based on perforators arising from the PFA and were transposed through a submuscular tunnel into the defect. The postoperative course was uneventful and the wounds were reconstructed successfully. The pedicled PMT flap may be an option for reconstruction of groin defects and could be incorporated into the armamentarium of the reconstructive microsurgeon. © 2015 Wiley Periodicals, Inc. Microsurgery 37:339-343, 2017.
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Affiliation(s)
- Mario F Scaglioni
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Leonardo Enrique Carrillo Jimenez
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Chou Chen
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Rotation arc of pedicled anterolateral thigh flap for abdominal wall reconstruction: How far can it reach? J Plast Reconstr Aesthet Surg 2015; 68:1417-24. [DOI: 10.1016/j.bjps.2015.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/18/2015] [Accepted: 06/12/2015] [Indexed: 11/21/2022]
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35
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Warbrick-Smith J, Bowen N, Drew PJ. Peri-stomal abdominal wall augmentation: Novel use of a pedicled antero-lateral thigh flap. J Plast Reconstr Aesthet Surg 2015; 68:e203-4. [PMID: 26375460 DOI: 10.1016/j.bjps.2015.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Warbrick-Smith
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, Wales, SA6 6NL, United Kingdom.
| | - N Bowen
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, Wales, SA6 6NL, United Kingdom
| | - P J Drew
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, Wales, SA6 6NL, United Kingdom
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Reconstruction of Radiated Gluteal Defects following Sarcoma Resection with Pedicled Sensate Tensor Fascia Lata Flaps. Case Rep Oncol Med 2015; 2015:971037. [PMID: 26339516 PMCID: PMC4539060 DOI: 10.1155/2015/971037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/19/2015] [Accepted: 07/26/2015] [Indexed: 11/18/2022] Open
Abstract
Sarcomas of the gluteal region often result in sizable defects following resection that are challenging to reconstruct due to their location, particularly in patients who have received radiation therapy. Reconstruction of these defects has been seldom discussed in the literature. We present two patients with large radiated gluteal defects following sarcoma resection, of which one patient received neoadjuvant radiation and the other received intraoperative radiation therapy. As a result of the resection and radiation, local tissues and recipient vessels were unsuitable for use in reconstruction. A pedicled tensor fascia lata (TFL) flap was therefore performed in both cases, which resulted in durable sensate reconstruction with good functional outcomes and no complications. We believe the pedicled TFL flap represents an important option for the reconstruction of oncologic gluteal defects that provides well-vascularized and sensate tissue from outside the zone of radiation without the need for microsurgical techniques.
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Fernandez-Alvarez JA, Barrera-Pulido F, Lagares-Borrego A, Narros-Gimenez R, Gacto-Sanchez P, Gomez-Cia T. Coverage of supraumbilical abdominal wall defects: The tunnelled-pedicled ALT technique. Microsurgery 2015; 37:119-127. [PMID: 26109324 DOI: 10.1002/micr.22437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/08/2015] [Accepted: 05/19/2015] [Indexed: 11/11/2022]
Abstract
Abdominal wall defects are a challenge for reconstructive surgeons. Although the utility of anterolateral thigh perforator (ALT) flap has been well established for lower abdominal wall reconstruction, pedicled ALT flap is usually not considered for supraumbilical defects in the most recent algorithms. The purpose of this paper is to report the results of a tunneled pedicled ALT flap for reconstruction of supraumbilical defect from a series of patients. From July 2009 to September2014, six patients underwent delayed abdominal wall coverage using pedicled ALT flaps and reinforcement with polypropylene meshes. Defects occurred after surgical complications and abdominal trauma. Flaps were tunneled beneath the rectus femoris and sartorius muscles to increase the pedicle length. The size of the skin islands ranged from 22-29 × 10-14 cm. All flaps survived and the healing of the wounds was successful. Partial dehiscence of donor site occurred in one patient, and small wound dehiscence due to minimal distal necrosis was observed in another patient. No functional problems were reported in donor site, and no complications occurred in 6-68 months of follow-up. The tunneled pedicled ALT flap may provide a reliable alternative method for abdominal wall reconstruction, including supraumbilical defects. © 2015 Wiley Periodicals, Inc. Microsurgery 37:119-127, 2017.
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Affiliation(s)
| | - Fernando Barrera-Pulido
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
| | - Araceli Lagares-Borrego
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
| | - Rocio Narros-Gimenez
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
| | | | - Tomas Gomez-Cia
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
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38
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Bodin F, Dissaux C, Romain B, Rohr S, Brigand C, Bruant-Rodier C. Complex abdominal wall defect reconstruction using a latissimus dorsi free flap with mesh after malignant tumor resection. Microsurgery 2015; 37:38-43. [PMID: 26037038 DOI: 10.1002/micr.22434] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Extended and full-thickness abdominal wall defects are commonly reconstructed using free flaps. Published surgical outcomes involving the latissimus dorsi (LD) free flap procedure are limited and are less numerous than those with free flaps involving the thigh. The aim of this report was to describe the immediate and long-term evaluation of complex abdominal wall reconstruction using a LD free flap with mesh. PATIENTS AND METHODS Between 2005 and 2013, nine patients with extended malignant tumors of the abdominal wall underwent surgeries. After the surgical resection, the mean defect size was 385 cm2 (range: 190-650 cm2 ). Full-thickness abdominal wall reconstruction was performed with a combination of LD free flaps and meshes. The immediate and long-term outcomes were assessed regarding the complications, sustainable strength of the abdominal wall and cancer recurrence. RESULTS The meshes measured 927 cm2 in average (range: 500-1036 cm2 ). Eight Parietex Composite® and 1 Bard Collamend Implant® were used. No donor site complications occurred, and complete LD flap survival was achieved without partial necrosis or thrombosis. One obese patient who received a porcine dermis mesh developed an eventration four days postoperatively and exhibited a limited amount of abdominal skin necrosis around the flap. Two patients died from cancer evolution. After a mean follow-up of 60.4 months (range: 29-94 months), clinical evaluation of the abdomen revealed 2 patients without anomalies, 4 cases of abdominal bulging without functional discomfort and 1 case of major abdominal distension. CONCLUSIONS Complex abdominal reconstruction with LD free flap and mesh allows extended satisfactory coverage with a low incidence of flap and donor site complications. However, patients should be advised of the significant risk of abdominal bulging. © 2014 Wiley Periodicals, Inc. Microsurgery 37:38-43, 2017.
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Affiliation(s)
- Frédéric Bodin
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Dissaux
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Benoît Romain
- Department of General Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Serge Rohr
- Department of General Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General Surgery, Strasbourg Academic Hospital, Strasbourg, France
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40
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Lin CH, Zelken J, Hsu CC, Lin CH, Wei FC. The distally based, venous supercharged anterolateral thigh flap. Microsurgery 2015; 36:20-8. [DOI: 10.1002/micr.22380] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/24/2014] [Accepted: 12/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Jonathan Zelken
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung Medical College and Chang Gung University; Taipei Taiwan
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Zelken JA, AlDeek NF, Hsu CC, Chang NJ, Lin CH, Lin CH. Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps. Microsurgery 2014; 36:104-14. [DOI: 10.1002/micr.22354] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/25/2014] [Accepted: 11/07/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Jonathan A. Zelken
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Nidal F. AlDeek
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
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Khansa I, Janis JE. Modern reconstructive techniques for abdominal wall defects after oncologic resection. J Surg Oncol 2014; 111:587-98. [DOI: 10.1002/jso.23824] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/09/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ibrahim Khansa
- Department of Plastic Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Jeffrey E. Janis
- Department of Plastic Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
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Contedini F, Negosanti L, Pinto V, Oranges CM, Sgarzani R, Lecce F, Cola B, Cipriani R. Reconstruction of a complex pelvic perineal defect with pedicled anterolateral thigh flap combined with bilateral lotus petal flap: A case report. Microsurgery 2014; 35:154-7. [DOI: 10.1002/micr.22304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Federico Contedini
- Division of Plastic Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Luca Negosanti
- Division of Plastic Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Valentina Pinto
- Division of Plastic Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Carlo Maria Oranges
- Division of Plastic Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Rossella Sgarzani
- Division of Plastic Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Ferdinando Lecce
- Division of Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Bruno Cola
- Division of Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
| | - Riccardo Cipriani
- Division of Plastic Surgery; S.Orsola-Malpighi University Hospital; Bologna Italia
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Alternatives to commonly used pelvic reconstruction procedures in gynecologic oncology. Gynecol Oncol 2014; 134:172-80. [DOI: 10.1016/j.ygyno.2014.04.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 04/26/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022]
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Propeller flaps: a review of indications, technique, and results. BIOMED RESEARCH INTERNATIONAL 2014; 2014:986829. [PMID: 24971367 PMCID: PMC4058175 DOI: 10.1155/2014/986829] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022]
Abstract
In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors' experience. Details about surgical technique are provided, together with tips to avoid and manage complications.
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Trans-vastus Intermedius Transfer of the Pedicled Anterolateral Thigh Flap for Posterior Thigh Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 1:e81. [PMID: 25289275 PMCID: PMC4174101 DOI: 10.1097/gox.0000000000000024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Abstract
SUMMARY Proximal, posterior thigh wounds from oncologic or traumatic defects can be difficult wounds to reconstruct if local flap options have been sacrificed during the trauma or oncologic resection. Free flap options to cover these defects are also difficult because of the lack of convenient recipient vessels in the region. The authors present 2 cases (oncologic and traumatic) wherein a myocutaneous anterolateral thigh (ALT) flap was harvested and tunneled from the anterior muscle compartment to the posterior muscle compartment of the thigh through a medially based transmuscular tunnel, decreasing the required pedicle distance to the wound. This technique of transmuscular tunneling of the ALT flap expands the indications and utility of the ALT flap to cover posterior thigh wounds.
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48
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Discussion: The anterolateral thigh flap for groin and lower abdominal defects: a better alternative to the rectus abdominis flap. Plast Reconstr Surg 2014; 133:169-170. [PMID: 24374676 DOI: 10.1097/01.prs.0000437227.92681.a2] [Citation(s) in RCA: 3] [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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50
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Delayed Soft Tissue Reconstruction with a Horizontal Rectus Abdominis Musculocutaneous Flap following Hip Exarticulation. Case Rep Surg 2013; 2013:670304. [PMID: 24024062 PMCID: PMC3760115 DOI: 10.1155/2013/670304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/22/2013] [Indexed: 11/17/2022] Open
Abstract
Coverage of large soft tissue defects at the hip region constitutes a challenge for plastic surgeons. We report the case of a 43-year-old female with necrotizing fasciitis of the right thigh, necessitating hip exarticulation and substantial debridement of necrotic tissue. An ipsilateral horizontal rectus abdominis myocutaneous (HRAM) flap was used to cover the defect. The reconstruction was carried out after the attempt of local tissue rearrangement. In light of the successful outcome, we propose that this flap be considered in the future planning of soft tissue reconstruction at the hip region.
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