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Gabryszewski M, Kasielska-Trojan A, Sitek A, Antoszewski B. Variability of anterolateral thigh flap perforator locations - clinical implications. POLISH JOURNAL OF SURGERY 2023; 96:36-40. [PMID: 38348979 DOI: 10.5604/01.3001.0053.9856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> The anterolateral thigh flap is an example of a free flap widely applied for reconstruction of tissues within various areas of the body.</br> <b><br>Aim:</b> The aim of the study was to determine the most common locations of the ALT flap perforators in men and women as well as to clarify any potential differences in the location of the vessel in male vs. female subjects.</br> <b><br>Material and method:</b> In years 2021-2022, a study was conducted at the Plastic, Reconstructive, and Aesthetic Surgery Clinic in a group of 90 volunteers (45 women and 45 men, a total of 180 lower extremities) to determine the location of the anterolateral thigh flap perforator against the flap surface using a portable Doppler probe.</br> <b><br>Results:</b> Variable locations were revealed for the anterolateral thigh flap perforator within the study. In women, the perforator is located more distally from the anterior superior iliac spine, most frequently within the inferolateral quadrant, while being located closer to the anterior superior iliac spine, and most frequently within the superolateral quadrant, in men. No perforator was found in 3.3% of the examined limbs. No statistically significant differences were observed between the course of the perforators within the left and right lower limbs in individual patients.</br> <b><br>Conclusions:</b> The location of the ALT flap perforator is subject to sexual dimorphism, which facilitates the investigation area being narrowed down to the well-defined locations of its most frequent occurrence when planning anterolateral thigh flap reconstructive procedures.</br>.
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Affiliation(s)
- Mateusz Gabryszewski
- Individual Course of Study - Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Poland
| | - Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Poland
| | - Aneta Sitek
- Department of Anthropology, University of Lodz, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Poland
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Chakraborty PK, Patel S, Mulla MF, Kulkarni MM, Sheikh RA, Shukla AK. Comparison of Different Reconstruction Flap for Maxillofacial Region: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S252-S255. [PMID: 37654262 PMCID: PMC10466590 DOI: 10.4103/jpbs.jpbs_475_22] [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: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Large chunks of the tissue are sacrificed during the surgical procedures for the treatment if oral cancers. Our goal was to assess the viability of "Buccal reconstruction using the anterolateral thigh (ALT) flaps, platysma myocutaneous (PM), and radial forearm free (RFF)". Material and Methods Sixty subjects were included in this investigation, and they were divided into 3 groups. The follow-up as accompanied for six months. Comparisons were made for the time for the operations, reduction in the width of the mouth opening and the survival rates of the flaps. The data that was collected for the above two parameters and compared for the significance using the ANOVA, keeping P < 0.05 as significant. Results In the subjects with the PM, the width of the mouth opening reduced comparatively greater than that of the subjects who received other two flaps. The reduction in the mouth opening in the PM was significantly greater compared to that of the ALT and RFF. Survival was greater for the groups ALT and RFF compared to PM. Time of the surgery was the greatest for the ALT and least for the PF. Conclusion The observations point to the fact that the PF requires more time than that of the other two flaps. The survival was however better for the ALT and RFF. Further research is suggested for suggesting an appropriative flap design.
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Affiliation(s)
- Pallavi Khan Chakraborty
- Department of Head and Neck Oncosurgery, Netaji Subhas Chandra Bose Cancer Hospital, Kolkata, West Bengal, India
| | - Smit Patel
- Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Misbah Farheen Mulla
- Department of Oral and Maxillofacial Surgery, SMBT Dental College and Hospital, Sangamner, Ahmed Nagar, Maharashtra, India
| | | | | | - Anuj Kishor Shukla
- Department of Dentistry, Government Medical College, Ratlam, Madhya Pradesh, India
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Kim J, Shin Y, Jeong W. Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: A meta-analysis. Microsurgery 2021; 42:89-96. [PMID: 34652038 DOI: 10.1002/micr.30831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/01/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Numerous studies have compared electrical devices used for flap surgery, but the results are inconsistent. This research was performed to evaluate the efficacy of two different types of electric devices: electrocautery and ultrasonic shears. METHODS The PubMed, Embase, and Scopus databases were searched systematically. A total of 505 cases were included in this study, including 209 electrocautery and 296 harmonic scalpel cases. The following information was retrieved from the included studies: the first author of the article, publication year, flap type, flap harvest time, drain volume, bleeding volume and postoperative complications. Hematoma, infection, flap necrosis and wound dehiscence were considered postoperative complications. The Q statistic for heterogeneity and the I2 index were calculated. If I2 < 50%, we used a fixed-effects model; if I2 > 50%, we employed a random-effects model in our meta-analysis. RESULTS A total of eight studies which met the inclusion criteria were included and reviewed systematically for a meta-analysis. The harmonic scalpel yielded a statistically significantly more favorable flap harvest time and drain volume than did electrocautery. The Harmonic scalpel led to a shorter flap harvest time by 26.29 min (95% CI = -39.38 to -13.2; p < .00001) and smaller drain volume by 58.76 ml (95% CI = -105.27 to -12.25; p = .01) on average. However, there were no significant differences in the bleeding volume or incidence rates of infection, flap necrosis and wound dehiscence. CONCLUSION The Harmonic scalpel method yields better outcomes in terms of the flap harvest time and drain volume than does the conventional electrocautery method. Therefore, the Harmonic scalpel is a better option for cauterization and dissection in flap surgery.
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Affiliation(s)
- Jaehoon Kim
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Youngmin Shin
- Department of Oromaxillofacial Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
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Moltedo NF, Wu SC, Lin CH, Yang JCS, Kuo SCH, Chien PC, Hsieh HY, Hsieh CH. Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity-score-matched patient cohorts. Microsurgery 2020; 40:679-685. [PMID: 33464653 DOI: 10.1002/micr.30635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction. METHODS A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications. RESULTS Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well-balanced pairs of propensity-score-matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026). CONCLUSION This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity-score-matched cohorts.
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Affiliation(s)
- Nicolas Flores Moltedo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Cen-Hung Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Spencer C H Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Peng-Chen Chien
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Hsiao-Yun Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
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Use of Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in Orthopedic Oncology: What are the Outcomes? Indian J Orthop 2020; 55:246-255. [PMID: 34122775 PMCID: PMC8149556 DOI: 10.1007/s43465-020-00208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes. MATERIALS AND METHODS Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation. RESULTS The average flap dimension was 14 cm × 12 cm. The mean follow-up was 11 months (4-28 months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above‑knee amputation. CONCLUSION The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.
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The vascularized fascia lata free flap: an anatomical study and clinical considerations. Eur Arch Otorhinolaryngol 2020; 277:1733-1739. [PMID: 32100132 PMCID: PMC7198631 DOI: 10.1007/s00405-020-05861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
Purpose Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap. Methods We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined. Results Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo- or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6–60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm2. In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL. Conclusion We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.
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Fuzzard SK, Mah E, Choong PFM, Grinsell D. Lymphoedema rates in pedicled anterolateral thigh flaps for coverage of irradiated groin defects. ANZ J Surg 2019; 90:135-138. [PMID: 31840376 DOI: 10.1111/ans.15576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limb salvage surgery in conjunction with adjuvant radiotherapy is the preferred treatment for soft tissue sarcoma. This study aims to determine if ipsilateral pedicled anterolateral thigh (ALT) flap reconstruction of groin defects post soft tissue sarcoma resection results in acceptable rates of lymphoedema, while also providing good soft tissue cover and minimal donor site morbidity. METHODS A retrospective chart audit was conducted with ethics approval, obtaining a case series of 16 patients operated on at a single institution by the senior surgeon. Patients who underwent ipsilateral pedicled ALT flap coverage of irradiated groin defects following soft tissue sarcoma resection were included. Comparative six-point limb circumference measurements were utilized to diagnose lymphoedema, with a difference of 10% when compared to the non-operative side being deemed significant. RESULTS Lymphoedema was noted in three patients (18.8%) with an average follow-up period of 40.9 (range 8-59) months. CONCLUSION Previously published lymphoedema rates in sarcoma limb salvage surgery of 15.5-30% are comparable to the rates obtained in this cohort. Lymphoedema rates do not appear to be higher in patients undergoing ipsilateral pedicled ALT flap reconstruction, thus making it a useful soft tissue coverage technique in this cohort.
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Affiliation(s)
- Sibon K Fuzzard
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Eldon Mah
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Damien Grinsell
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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Cherubino M, Stocco C, Ronga M, Tamborini F, Maggiulli F, Di Giovanna D, Campisi C, Di Summa P, Valdatta L. Comparisons of fascio‐cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery 2019; 40:452-459. [DOI: 10.1002/micr.30515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life SciencesUniversity of Insubria Varese Italy
| | - Chiara Stocco
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery UnitUniversity of Trieste Trieste Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences “Vincenzo Tiberio”University of Molise Campobasso Italy
| | - Federico Tamborini
- Division of Plastic and Reconstructive Surgery, Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life SciencesUniversity of Insubria Varese Italy
| | - Francesca Maggiulli
- Division of Plastic and Reconstructive Surgery, Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life SciencesUniversity of Insubria Varese Italy
| | - Danilo Di Giovanna
- Division of Plastic and Reconstructive Surgery, Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life SciencesUniversity of Insubria Varese Italy
| | - Corrado Campisi
- Plastic, Reconstructive and Aesthetic Surgery, Lymphatic Surgery and MicrosurgeryICLAS, GVM Care & Research Rapallo Genoa Italy
| | - Pietro Di Summa
- Department of Plastic and Hand SurgeryCentre Hospitalier Universitaire Vaudois (CHUV) Lausanne Switzerland
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life SciencesUniversity of Insubria Varese Italy
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Kocabalkanlı A, Cihan-Üstündağ G, Naesens L, Mataracı-Kara E, Nassozi M, Çapan G. Diclofenac-Based Hydrazones and Spirothiazolidinones: Synthesis, Characterization, and Antimicrobial Properties. Arch Pharm (Weinheim) 2017; 350. [DOI: 10.1002/ardp.201700010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ayşe Kocabalkanlı
- Faculty of Pharmacy; Department of Pharmaceutical Chemistry; Istanbul University; Istanbul Turkey
| | - Gökçe Cihan-Üstündağ
- Faculty of Pharmacy; Department of Pharmaceutical Chemistry; Istanbul University; Istanbul Turkey
| | - Lieve Naesens
- Department of Microbiology and Immunology; Rega Institute for Medical Research; KU Leuven; Leuven Belgium
| | - Emel Mataracı-Kara
- Faculty of Pharmacy; Department of Pharmaceutical Microbiology; Istanbul University; Istanbul Turkey
| | - Mebble Nassozi
- Faculty of Pharmacy; Department of Pharmaceutical Chemistry; Istanbul University; Istanbul Turkey
| | - Gültaze Çapan
- Faculty of Pharmacy; Department of Pharmaceutical Chemistry; Istanbul University; Istanbul Turkey
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Hulika N, Naru RR, Azhagamuthu, Inamdar B, Chandra A. Contralateral Pedicled Anterolateral Thigh Flap (ATL) for Upper Thigh Defect in the Era of Free ATL? World J Plast Surg 2016; 5:194-7. [PMID: 27579280 PMCID: PMC5003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Narendra Hulika
- Corresponding Author: Narendra Hulikal, MD; Professor of Department of Surgical oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, 517501, India, E-mail:
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Wang X, Yan G, Zhang G, Li J, Liu J, Zhang Y. Functional tongue reconstruction with the anterolateral thigh flap. World J Surg Oncol 2013; 11:303. [PMID: 24274671 PMCID: PMC3879093 DOI: 10.1186/1477-7819-11-303] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A retrospective study was conducted to evaluate the advantages of anterolateral thigh (ALT) flap in tongue reconstruction. METHOD From September 2008 to February 2012, patients receiving ALT flap tongue reconstruction were included in the study. Patients undergoing ALT flap were compared with those undergoing similar surgery with radial forearm flap (RFF). The medical records of the included patients were reviewed, and a questionnaire was used to assess acceptability of the surgery. RESULTS All flaps (both ALT and RFF) were successful In the ALT group, most patients were satisfied with the appearance of the reconstructed tongue and the intelligibility of their speech, and there were fewer complications with this technique compared with the RFF. CONCLUSION The ALT flap is an ideal method for tongue reconstruction. The thickness and volume of the ALT flap can be adjusted based on the individual extent of the defect, and it can not only provide bulk but also ensure mobility, and it has other advantages also, including a long pedicle and low donor site morbidity.
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Affiliation(s)
| | | | | | | | | | - Yang Zhang
- School of Stomatology, China Medical University, No, 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China.
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