Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects

Gong, Zhaojian; Zhang, Sheng; Wang, Kai; H, Tan; Zhu, Zhao-fu; Liu, Jinbing; Ren, Zhenhu; He, Zhijing; Wu, Hanjiang

doi:10.1016/j.bjoms.2014.10.017

Cited by 24 publications

(22 citation statements)

References 19 publications

(29 reference statements)

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“…Torsion or tension on the flap components may result from folding and twisting during flap inset. Perforator kinking or stretching may also cause impaired vascularity (Chang, ; Gong et al, ; Kuo et al, ). With the proposed method, the flap can be inset at a temporary relaxed position while neovascularization is being established.…”

Section: Discussionmentioning

confidence: 99%

“…Such defects require large composite flaps for reconstruction. Multiflap approaches (Huang et al, ; Jeng, Kuo, Wei, Su, & Chien, ; Kuzon, Jejurikar, Wilkins, & Swartz, ) have been reported for this purpose, however, additional donor sites and vascular anastomoses, lead to increased donor site morbidity and operative times (Huang et al, , ; Gong et al, ). Furthermore, the reconstruction may be rendered even more challenging by previous failed attempts at reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

et al. 2018

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Introduction Microsurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions. Methods From February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset. Results Fifty‐one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate re‐exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2% and the average time between 2 stages was 24 days (range, 21–28). Conclusion Staged flap inset can improve free flap survival in complex head and neck reconstructions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

et al. 2018

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“…In 1991, Hallock first described the chimeric flap consisting of two or more different tissues supplied by separate branches of a single vascular source, and refined the nomenclature for compound flaps several times (Hallock, 2000(Hallock, , 2006(Hallock, , 2011(Hallock, , 2017. Since then, several studies verified that the chimeric perforator flap was suitable for repairing complex skin and soft tissue defects (Gong et al, 2015;Kim, Kim, & Ghanem, 2015;Xu, Duan, Tan, & Sun, 2015). The literature to date has generally recommended an ALTP flap configured with a Y-shaped pedicle with separate branches originating from the LCFA to supply the skin and muscle segments, separately.…”

Section: Casementioning

confidence: 99%

Versatile design of compound vastus lateralis muscle and anterolateral thigh musculocutaneous perforator free flaps for customized reconstruction of complex skin and soft tissue defects in the extremities

Zhou

et al. 2020

Microsurgery

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Background: Compound anterolateral thigh flaps are popular for three-dimensional reconstruction of complex soft tissue defects. We present our 10-year experience using compound vastus lateralis (VL) muscle and anterolateral thigh musculocutaneous perforator (ALTP) flaps, and introduce three versatile customizations of this flap for individualized reconstruction of complex threedimensional soft tissue defects. Methods: From May 2008 to June 2017, compound VL muscle and ALTP flaps were performed in 67 consecutive patients aged 14-75 years (62 men and 5 women). The defects were in either the lower (n = 53) or upper extremity (n = 14), and ranged in size from 8 × 4 cm 2 to 25 × 6 cm 2. Dead space volume ranged from 4 × 2 × 1 cm 3 to 20 × 3 × 2 cm 3 , and all flaps were harvested from patients' thighs as one of three types. In type A, a single perforator supplied both the skin and muscle components, with the vascular bundle penetrating the muscle component. In type B, a single perforator supplied both skin and muscle components with separate branches to the skin and muscle. In type C, separate vessels supplied the skin and muscle. Results: In the 67 patients, 65 flaps survived, and the donor site was closed directly. Vascular compromise occurred in four patients on the first postoperative day. Two flaps were salvaged after emergency re-exploration. Flap loss occurred in two patients, and these defects were repaired using other flaps. The follow-up period ranged from 8 to 60 months (mean, 11.9 months). All flaps had satisfactory appearance and texture, and no patients experienced limited hip and knee joint mobility from the donor site operation. Conclusions: Compound VL muscle and ALTP flaps are a reliable option to reconstruct complex defects of the extremities. Identifying three flap types allowed for more precise customization to cover complex defects with limited donor site morbidity.

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“…(Chen et al, ; Gabr et al, ; Jeng et al, ; Said et al, ) However, double or multiple free flaps require additional donor sites and vascular anastomoses which result in increased donor site morbidity and operative time. (Gong et al, ; Huang et al, ; Huang, Chen, Wei, Cheng, & Schnur, )…”

Section: Introductionmentioning

confidence: 99%

Optimizing survival of large fibula osteocutaneous flaps for extensive full‐thickness oromandibular defects: A two‐stage approach with temporary orocutaneous fistula

Ciudad¹,

Huang

Manrique

et al. 2018

Microsurgery

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Introduction: Composite and large head and neck defects requiring extensive skin-mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable twostage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions. Methods: From October 2011 to September 2016, 47 patients with through-and-through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de-epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded.Results: The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm 2 (range 300-504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take-back for evacuation of recipient site hematoma (2.1%) but no flap loss.Conclusion: Two-staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap.

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Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects

Cited by 24 publications

References 19 publications

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

Versatile design of compound vastus lateralis muscle and anterolateral thigh musculocutaneous perforator free flaps for customized reconstruction of complex skin and soft tissue defects in the extremities

Optimizing survival of large fibula osteocutaneous flaps for extensive full‐thickness oromandibular defects: A two‐stage approach with temporary orocutaneous fistula

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