Reconstruction of post-burn anterior neck contractures using a butterfly design free anterolateral thigh perforator flap

Evaluating the clinical efficacy of the anterolateral thigh flap in lower limb reconstruction surgeries: a systematic review and meta-analysis

OBJECTIVE

To comprehensively assess the clinical efficacy of the anterolateral thigh flap in lower limb reconstruction (LLR) surgeries and explore its application value via a meta-analysis.

METHODS

Published articles on the efficacy of anterolateral thigh flap in LLR were retrieved in English databases such as PubMed, Web of Science, Embase, and The Cochrane Library, which were searched from their inception to November 2023. The search terms included "anterolateral thigh flaps", "lower extremity", "free muscle" and "reconstruction". Subsequently, data extraction of eligible studies was carried out, and data analysis was conducted using RevMan 5.3 software.

RESULTS

The final selection comprised 12 appropriate studies, encompassing a total of 577 patients. Meta-analysis demonstrated that negligible differences existed in the length of hospital stay among patients treated with different types of flaps (mean difference (MD) =-0.10, 95% confidence interval (CI) =-0.400.20, P>0.05). Additionally, the occurrence of complications differed slightly (Risk difference (RD) =-0.02, 95% CI=-0.090.05, P>0.05). The incidence of secondary surgeries also demonstrated non-significant differences (RD=-0.04, 95% CI=-0.11-0.04, P>0.05). Nevertheless, patients who underwent anterolateral thigh flap transplantation exhibited a drastic decrease in donor site morbidity (Odds ratio (OR) =0.22, 95% CI=0.10-0.49, P<0.05).

CONCLUSION

The clinical efficacy of the anterolateral thigh flap in LLR surgeries shows no significant differences in hospital stay, complication rates, or the need for secondary surgeries compared to other flaps. However, using anterolateral thigh flap in LLR significantly reduces donor site morbidity.

Reconstruction of a septic femoral triangle fistula with a pedicled DIEP flap: A case report and mini-review

Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases.

Post-burn deformity of the orofacial complex region: An Orthodontic approach

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A Comparison of Handheld Doppler and Indocyanine Green Angiography for Perforator Localization

BACKGROUND

The preoperative identification of perforators is critical to the success of perforator flaps. Several technologies, including handheld Doppler (HHD) and indocyanine green angiography (ICGA), facilitate this process; however, each technology comes with unique downsides. This study directly compares the performance of HHD and ICGA in preoperative perforator identification and measures the effects of flap thickness and body mass index (BMI) on perforator localization.

METHOD

Data from preoperative HHD and ICGA assessments were compared with the criterion standard of intraoperative perforator localization. Sensitivity, specificity, accuracy, and positive predictive values were calculated for both and correlated with flap thickness and BMI.

RESULTS

Thirty flaps were transferred in 30 patients across 15 different donor sites. Indocyanine green angiography had higher sensitivity, accuracy, and positive predictive value (79.2%, 74.2%, and 87.5%, respectively) than HHD (55.6%, 46.6%, and 69.4%, respectively). Perforators detected by ICGA were used as flap pedicles in 21 cases compared with 13 with HHD. There were no correlations between HHD or ICGA performance and patient BMI (both P > 0.05). Increasing flap thickness was negatively correlated with the accuracy of ICGA ( P = 0.001) but not HHD ( P > 0.05).

CONCLUSIONS

Indocyanine green angiography was more sensitive, specific, and accurate than HHD in identifying perforators across various donor sites; however, its performance suffered in thicker flaps, whereas HHD did not. Patient BMI was not correlated with the performance of either technology. Additional research can further delineate the interrelationships of flap thickness and technologies for perforator localization.

Reconstruction of Postburn Mild Anterior Neck Contracture With a Free Thin Anterolateral Thigh Flap

In this article, we describe reconstruction of a McCauley's Grade I postburn anterior neck contracture with extensive scarring in a 34-year-old woman using a free thin anterolateral thigh (ALT) flap. To our knowledge, this is the first case of reconstruction of Grade I neck contracture using a thin ALT flap that has been reported. By selecting the correct patient, adhering to recommended standards of microvascular technique, and implementing appropriate postoperative nursing care, we achieved a near-normal neck contour in this patient in a single-staged procedure.

Supraclavicular Flap for Severe Post-burn Neck Contracture in Children

The neck is essential and vital for all head movements and performing daily functional activities. The second-degree deep dermal and full-thickness burns causing anterior neck contracture restricts movement and if untreated develop deformities, in the oral cavity, eyes, posture, and chin growth and development, especially in children. Neck contracture results in kyphoscoliosis, lower lip seal resulting in impaired vision, balance, swallowing, feeding, and speech as well as social stigma, depression, and embarrassment. The treatment for post-burn anterior neck contractures is contracture release and reconstruction with skin grafts (split and full-thickness), axial pattern flaps, perforator propeller flaps, microvascular free flaps, tissue expansion, prefabrications, and skin substitutes. In addition to functional and esthetic recovery, post-surgery social and vocational rehabilitation is essential for children. We report a ten-year-old boy with severe anterior neck post-burn contracture managed with unilateral supraclavicular flap and residual areas with a split-thickness skin graft.