Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon

Beule, Tom De; Deun, Wouter Van; Vranckx, Jan; Dobbelaere, Bart de; Maleux, Geert; Heye, Sam

doi:10.1259/bjr.20150920

Cited by 18 publications

(18 citation statements)

References 10 publications

(8 reference statements)

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“…For this reason, preoperative CTA is frequently an essential part of the preoperative assessment in many reconstructive settings (e.g., lower extremity trauma), especially since most literature reports higher rates of insufficient vasculature, up to 16% (►Table 6). [26][27][28] Excluding that one instance (which was excluded from analysis), all of our patients' studies (58 of 59 or 98.3%) had suitable perforators on CTA. It is possible that because many of our patients were relatively healthy and undergoing nontrauma related reconstructions (i.e., transgender men undergoing phalloplasty), that there were less perturbations to normal vascular anatomy than are present in most other studies.…”

Section: Discussionmentioning

confidence: 99%

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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Abstract Background The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof. Patients and Methods Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected. Results A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m2. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection. Conclusion ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.

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Section: Discussionmentioning

confidence: 99%

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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“…Anatomical studies have reported the presence of an oblique branch in the ALT flap in only 34% of cases 9,12 ; therefore, a branch-based chimeric ALT flap cannot be definitely dissected in a specific patient. A preoperative study of the anatomy of the LCFA using ultrasound or other imaging techniques should be performed to help design the flap 13,14 . Alternative surgical plans should be made preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification

Yao

Liu

2020

Sci Rep

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Reconstruction of composite oral and maxillofacial defects using free flaps is challenging. The key to such delicate reconstruction lies in the evaluation of the defect. However, few reports have described the clinical classification of these difficult defects. In this study, we proposed a classification method and developed different reconstructive solutions using free flap techniques according to this classification. This classification method was established based on two parameters (the elements and distribution of the missing tissues). Among the 17 patients with composite oral and maxillofacial defects included in this study, 8 patients presented with type A defects, one patient presented with a type B defect, and the other 8 patients presented with type C defects. No type D defects were observed in this study. Three types of free flaps were used to reconstruct the respective types of composite defects. Perforator-based ALT flaps were used to reconstruct Type A defects. Branch-based ALT flaps were used to reconstruct Type B defects. For Type C defects, two reconstructive solutions were used, including a well-designed fibular flap and a perforator-based ALT flap with or without a metal plate for bony reconstruction. All flaps survived after surgery. This classification system may help select and design specific free flaps for reconstructing composite oral and maxillofacial defects.Composite oral and maxillofacial defects after ablative oncological surgery, such as typical through-and-through oral defects, are challenging clinical problems for plastic and reconstructive surgeons. Multiple factors, including different related anatomical sites, multiple types of missing tissues, and sometimes even two separate defects, often cause these composite defects to be variable and complicated to reconstruct. Understanding the features or patterns of these composite defects may provide a framework to describe these defects and help plan the reconstructive algorithm. However, as we know, few studies have reported the classification of composite oral and maxillofacial defects.Surgical reconstruction for these composite defects is quite difficult because multiple types of tissue from different anatomic sites are missing 1,2 . Reconstruction of these complicated defects not only requires restoring the anatomy but also replacing the exact amount and types of missing tissue. The application of free flaps to reconstruct composite oral and maxillofacial defects has been well reported in the literature 3-7 . However, few studies have discussed choosing different reconstructive solutions and designing free flaps based on a classification of composite oral and maxillofacial defects.In the present study, we reviewed a series of patients with composite oral and maxillofacial defects and proposed a new classification method based on the elements and distribution of the missing tissues. Three types of reconstructive solutions using a free flap technique were developed accordingly. The reconstructive results using free flaps based on thi...

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“…ALT flap technique also showed some limitations. The anatomic variations of this surgical area, including complete absence of identifiable perforators and bulky oral component, especially female patients, which thereby make it not the best-practice ( 18 , 19 ). In this present study, the thickness of subcutaneous fat was nearly up to 50 millimeters in one of patient’s thigh (Fig.…”

Section: Discussionmentioning

confidence: 99%

Maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle

Wang¹,

Xu²,

Zhu³

et al. 2018

Med Oral

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BackgroundMaxillary reconstruction using various pedicled and free-tissue transfer techniques with bone graft or without bone graft has some drawbacks. In this study, we demonstrate maxillary reconstruction using femoris rectus muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle through the modified lateral lip-submandibular approach.Material and MethodsNine patients suffering from maxillary defects secondary to maxillary cancer ablation, who underwent maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle, were enrolled into this study between November 2015 and August 2017.ResultsAll patients who underwent the maxillary reconstruction using femoris rectus muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle presented satisfactory postoperative function, with adequate mouth opening, optimal esthetic outcome and no restrictions on the diet. Every rectus femoris muscle flaps mucosalized well within five weeks. No donor site functional impairment or complications were observed.ConclusionsThe technique is a feasible and acceptable technique for the maxillary reconstructions. It is safe, quick and simple to harvest. It also presents an optimal esthetic and satisfactory functional outcome with the advantage of low morbidity of the donor site. Combined with the three-dimension reconstruction, this technique can improve the postoperative outcomes. Key words:Rectus femoris muscle flap, sagittal mandibular ramus, coronoid process graft.

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Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon

Cited by 18 publications

References 10 publications

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification

Maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle

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