A challenge in soft tissue reconstruction: The use of pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap in reconstructing a huge full thickness lateral trunk defect

Liu, Yi; Jimeno, Z.K.L.; Ramesh, Alampalli; Sasidaran, L.; Pan, Feng; Lah, Nik Amin Sahid Nik

doi:10.1016/j.amsu.2021.102933

Cited by 1 publication

(1 citation statement)

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“…For what concerns abdominal wall reconstruction, the antero‐lateral thigh represents an incomparable flaps bank, offering a great variety of flaps, based on the LCFA system, that can be used to resurface suprapubic and lower abdominal defects (Boukovalas et al, 2018). Vastus lateralis muscle or musculocutaneous flap remains our workhorse flap: it can be harvested with a very large skin paddle, it has a long and constant pedicle with a wide arch of rotation, it allows a simultaneous two‐team approach, it is relatively distant from the defect site, where pre‐existing incisions may preclude harvesting local abdominal‐based flaps, and provides some lifeboat options based on the lateral circumflex femoral artery (LCFA) system in case of intraoperative flap failure (Jakubietz et al, 2021; Yi et al, 2021). Moreover, a muscle‐sparing approach is also possible and allows to harvest the superficial partition of the muscle, with the intermediate and the deep ones left intact during the dissection (D'Arpa et al, 2016; Toia et al, 2015).…”

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confidence: 99%

Soft tissue reconstruction of the trunk with pedicled perforator and musculocutaneous flaps: A single‐center comparative retrospective study

Cammarata,

Toia,

Maltese

et al. 2023

Microsurgery

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BackgroundSoft tissue trunk reconstruction is often challenging. Although free microvascular flaps are a feasible option in case of extensive defects involving deep structures, pedicled flaps represent a good alternative, especially if harvested and dissected with a “microsurgical” approach. The aim of this study is to evaluate the feasibility of trunk reconstruction with the use of pedicled flaps, according to the application of our reconstructive algorithm, and to compare it to other reconstructive methods.Patients and MethodsFrom January 2017 to December 2021, we retrospectively analyzed patients who underwent soft tissue reconstruction of the trunk with pedicled flaps at the authors' institution. Patient's demographic, clinical and surgical characteristics and postoperative complications were recorded and analyzed by descriptive statistics. A comparative analysis was made between the study group and two other groups who underwent reconstruction of trunk defects with free flaps and skin grafts, respectively, at the authors' institution.ResultsForty‐seven patients were included in the study. Patients' age ranged between 36 and 82 years (mean: 57.8 years). Twenty‐eight patients were male, while 19 patients were female. In 76.6% of patients (36 out of 47), reconstructive procedures were performed to repair defects resulting from cancer resection. Reconstruction of superficial defects was always achieved with perforator flaps (n = 25). In case of full‐thickness defects, reconstruction was carried out with musculocutaneous flaps (n = 22); latissimus dorsi and vastus lateralis were the most used flaps for chest and abdominal wall reconstruction, respectively. In our series, we observed only one case of total flap loss requiring re‐operation under general anesthesia. Minor complications occurred in 8.5% of cases (4 out of 47 patients). We observed two cases of partial flap necrosis and two cases of wound dehiscence. In the skin grafts group (n = 53), the mean age was 54.5 years (range 39–85) and 56% of patients were male (n = 30). In 66% of cases (n = 30) the defect resulted from oncological resection. The overall complication rate was 18.8% (n = 10). In the free flaps group (n = 10), the mean age was 49.0 years (range 29–77) and 60% of patients (n = 6) were male. In 70% of cases (n = 7) the defect was caused by oncological resection. Complications occurred in two patients (20%).No statistically significant differences were found in terms of overall complication rate between the study group and the two comparative groups (p = .48). A significant correlation was found between the reconstructive method and the type and size of the defect, with reconstruction through free flaps being associated with larger (344.0 vs. 220.4 cm2) (p = .04) and full‐thickness defects (80.0% vs. 46.8%) (p < .01) if compared to pedicled flaps.ConclusionsIn the new era of microsurgery, pedicled flaps represent a valid alternative to free flaps for the majority of soft tissue defects of the trunk. In our series, no statistically significant differences in terms of complications were found between reconstructions of similar defects achieved with pedicled and free flaps, and free flap use was limited to extensive full‐thickness defects. In addition, the rate of postoperative complications with pedicled flaps found in our cohort was lower than the rate reported in the literature.

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