A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles

Hu, Rui; Ren, Yulin; Li, Yan; Xiao, Zhihong; Ding, Fan; Li, Fan; Han, Qi; Cheng, Wenjun; Kan, Wusheng

doi:10.1016/j.injury.2015.06.046

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…Along this major longitudinal axis of the dense collagenous tissue, the fiber bundles show a slight undulating appearance in the ITB based on the biomechanical requirements of the fibrous tissue [2,3,5]. This robust ITB tissue is known to be a useful and easy-to-harvest autograft for ligament, tendon, and labrum reconstruction [5,8,9,10,11] and attracts increasing interest for various tissue engineering purposes. Advantages of ITB tissue for the purpose of surgical defect reconstruction include the high density of connective tissue fibers and the ease of surgical harvest.…”

Section: Introductionmentioning

confidence: 99%

Migrating Myofibroblastic Iliotibial Band-Derived Fibroblasts Represent a Promising Cell Source for Ligament Reconstruction

Schwarz

Gögele

Ondruschka

et al. 2019

IJMS

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The iliotibial band (ITB) is a suitable scaffold for anterior cruciate ligament (ACL) reconstruction, providing a sufficient mechanical resistance to loading. Hence, ITB-derived fibroblasts attract interest for ligament tissue engineering but have so far not been characterized. This present study aimed at characterizing ITB fibroblasts before, during, and after emigration from cadaveric ITB explants to decipher the emigration behavior and to utilize their migratory capacity for seeding biomaterials. ITB and, for comparison, ACL tissues were assessed for the content of alpha smooth muscle actin (αSMA) expressing fibroblasts and degeneration. The cell survival and αSMA expression were monitored in explants used for cell isolation, monolayer, self-assembled ITB spheroids, and spheroids seeded in polyglycolic acid (PGA) scaffolds. The protein expression profile of targets typically expressed by ligamentocytes (collagen types I–III, elastin, lubricin, decorin, aggrecan, fibronectin, tenascin C, CD44, β1-integrins, vimentin, F-actin, αSMA, and vascular endothelial growth factor A [VEGFA]) was compared between ITB and ACL fibroblasts. A donor- and age-dependent differing percentage of αSMA positive cells could be detected, which was similar in ITB and ACL tissues despite the grade of degeneration being significantly higher in the ACL due to harvesting them from OA knees. ITB fibroblasts survived for several months in an explant culture, continuously forming monolayers with VEGFA and an increased αSMA expression. They shared their expression profile with ACL fibroblasts. αSMA decreased during the monolayer to spheroid/scaffold transition. Using self-assembled spheroids, the migratory capacity of reversible myofibroblastic ITB cells can be utilized for colonizing biomaterials for ACL tissue engineering and to support ligament healing.

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Section: Introductionmentioning

confidence: 99%

Migrating Myofibroblastic Iliotibial Band-Derived Fibroblasts Represent a Promising Cell Source for Ligament Reconstruction

Schwarz

Gögele

Ondruschka

et al. 2019

IJMS

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“…Various reconstructive procedures are available for the treatment of extensive soft tissue injuries of the ankle. 5,11,14 Depending on the extent of the remaining normal tissue, surgeons should choose the most appropriate procedures. To achieve full functional recovery, it is important to stabilize the ankle without limiting the range of motion.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report

Sakurai

Fukushi

Mizu-uchi

et al. 2019

Foot & Ankle Orthopaedics

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Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 Â 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities.

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“…The ITB is a broad, thick sheet of fascia that has been harvested as a free, non-vascularized graft for shoulder and Achilles ligament reconstruction. 15,16 As a proximally based pedicled flap, the ITB has been employed in conjunction with tensor fascia lata for trochanteric ulcer coverage or with the anterolateral thigh flap for abdominal wall reconstruction. 17,18 As a distally based pedicled flap, it has been used for knee ligament reconstruction (without specific attention to its vascular supply) and as a fasciocutaneous flap for popliteal fossa resurfacing (published in Chinese).…”

Section: Discussionmentioning

confidence: 99%

Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations

Wong

Higgins

2016

J reconstr Microsurg

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Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery.

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A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles

Cited by 20 publications

References 34 publications

Migrating Myofibroblastic Iliotibial Band-Derived Fibroblasts Represent a Promising Cell Source for Ligament Reconstruction

Migrating Myofibroblastic Iliotibial Band-Derived Fibroblasts Represent a Promising Cell Source for Ligament Reconstruction

Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report

Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations

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