Anterolateral thigh osteomyocutaneous flap in head and neck: Lessons learned

Abstract

Background Concerns regarding iatrogenic femur fracture may deter adoption of the anterolateral thigh osteomyocutaneous (ALTO) flap as an alternative reconstructive technique for large composite defects of the head and neck. We describe the evolution of our experience with this flap and the lessons learned in femur management. Methods Records from a prospective database (July 2009–January 2020) were reviewed to identify patients with composite osseous free tissue reconstructions. Venous thromboembolic events (VTE), femur fracture, estimated blood loss (EBL), procedure time, blood transfusions, and length of stay (days) were compared for ALTO flaps prior to and after the adoption of intramedullary fixation protocol. Results ALTO represented 10.5% (n = 23) of total osseus (n = 219) flaps. For large composite reconstructions with either ALTO flap, double flap (n = 2), or subscapular mega flaps (n = 14), ALTO flaps were most frequently used (59%, n = 23/59). There were no differences in operative time prior to and after implementation of prophylactic fixation [median (range): 5.4 (1.7–19.2) vs. 5.8 (1.7–15.0), p = .574]. Additionally, there were no differences in VTE, femur fracture, EBL, blood transfusion, or length of stay (p > .05) with adoption of prophylactic intramedullary fixation. Conclusions The ALTO flap represents a useful tool to consider in the armamentarium of reconstructive options for large through and through defects of the head and neck. In our experience, the ALTO flap is a reasonable alternative to subscapular or double flap reconstructions and especially in the setting of unusable fibular flaps or when bone need exceeds that available from the scapula.

Ultrasonic Shears Decrease Postoperative Hematomas in Head and Neck Microvascular Reconstruction

“…The overall hematoma rate in the literature for head and neck reconstruction with free flaps ranges from 0.6% to 5.6% 2‐4,20‐23 . In our large series of patients undergoing microvascular reconstruction, overall hematoma rate was 1.3%.…”

“…5.6%. [2][3][4][20][21][22][23] In our large series of patients undergoing microvascular reconstruction, overall hematoma rate was 1.3%. However, after the institution of ultrasonic shears, our hematoma rate significantly decreased to 0.6% (n = 9/1418).…”

Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects

“…A chimeric perforator flap consisting of independent tissue flaps, such as skin flaps and muscle flaps with their own independent vascular supply linked to a common vascular source, has many advantages in covering extensive tissue defects [6,[27][28][29][30][31][32].…”