Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography

Heo, Chan Yeong; Eun, Seok Chan; Bae, Ro Na; Minn, Kyung Won

doi:10.1016/j.bjps.2009.08.009

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…Hence, to perform the reverse anterolateral thigh flap, a proper preoperative vascular evaluation such as computed tomography-or magnetic resonance-angiography would be helpful for the benefit of these patients [12,13].…”

Section: Discussionmentioning

confidence: 99%

Distal anastomosis patterns of the descending branch of the lateral circumflex femoral artery

Boonrod

Thammaroj

Jianmongkol

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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Section: Discussionmentioning

confidence: 99%

Distal anastomosis patterns of the descending branch of the lateral circumflex femoral artery

Boonrod

Thammaroj

Jianmongkol

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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“…3D reconstructed images have been used in surgical reconstruction with latissimus dorsi muscular flaps, anterolateral thigh flaps and dorsalis pedis flaps. [7][8][9][10] Complete 3D image of flap blood supply can be built by perfusion specimens and digital technology, which allows clinicians to intuitively understand the relationship between blood vessels, skin and muscle, as well as a complete vascular morphology. This article explored the role of digital 3D reconstruction technique in saphenous artery flap anatomy and visualization.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional digitalized virtual planning for saphenous artery flap: a pilot study

Zhang

Wen

Zhang

et al. 2016

Computer Assisted Surgery

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Objective: Since the 1970s, research and applications on flap and muscle flap had solved many problems in microsurgical reconstruction. However, the traditional flap design is completely dependent on two-dimensional (2D) images. The purpose of this study was to discuss the methods in the visualization of saphenous artery flap by digitalized technique and its applications by digitalized technique. Methods: Two adult fresh cadaver specimens, one male and one female, were subject to radiographic computerized tomography (CT) scanning before and after perfused with lead oxide-gelatine mixture, whose collimation are 0.625 mm (120 kV, 110 mA, 512 Â 512 matrix). Through Amira 5.4.1 software, the 2D images in DICOM format were transformed into the 3D models of the entire region. The structures of saphenous artery were observed and the digitized visible models of saphenous artery flap were established through three-dimensional (3D) computerized reconstructions methods from these data using Amira 5.4.1 software. Next six cases of soft-tissue defects of the tibia region, involving the exposure bones underwent contrast-enhanced CT angiography of lower limbs utilizing a 64-row multi-slice spiral CT after median cubital vein injection with Ultravist (3.5 ml/s). 2D images from these data in DICOM format were transformed into computer. The structures of saphenous artery flap were observed and measured using Amira 5.4.1 software. Then, all cases were treated by saphenous artery flap. Results: The 3D reconstructed visible models established from these datasets perfectly displayed the saphenous artery flap anatomy. In six cases, the main trunk and branched of the blood vessels in the designed flap were consistent with the surgical findings. The starting point of the saphenous artery to the average distance of the knee clearance were 119.2 ± 9.6 mm, the average diameter of the saphenous artery from the starting point were 1.5 ± 0.3 mm. The range of flap was 8.0 Â 5.0 cm to 20.0 Â 8.0 cm. All flaps survived well. After 8-24 months' follow-up the knee flexion was 120-140 , the straight 0-10 . There was no case appeared incision infection. Conclusions: The preoperative use of 3D digitalized virtual planning for the saphenous artery flap improves the surgical accuracy, decreases the operation time and increases the survival rate of the flap.

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“…In those cases, conversion to a free flap is recommended . When there is concern, preoperative imaging studies may identify such cases beforehand …”

Section: Discussionmentioning

confidence: 99%

The distally based, venous supercharged anterolateral thigh flap

et al. 2015

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The distally-based anterolateral thigh flap is an attractive option for proximal leg and knee coverage but venous congestion is common. Restoration of antegrade venous drainage via great saphenous vein supercharge to the proximal flap vein is proposed. The purpose of this study was to evaluate and compare outcomes of 18 large, distally-based anterolateral thigh flaps with and without venous augmentation on the basis of flap size, venous congestion, and clinical course. The average age of 12 men and 6 women was 35.9-year old (range, 16-50 years old). Wounds resulting from trauma, burn sequela, sarcoma, and infection were localized to the knee, proximal leg, knee stump and popliteal fossa. The mean defect was 17.6 × 9.4 cm(2) (range, 6 × 7 cm(2) to 22 × 20 cm(2) ). The mean flap size was 21.4 × 8.8 cm(2) (range, 12 × 6 to 27 × 12 cm(2)). There were 14 cases in the venous supercharged group and 4 cases in the group without supercharge. The mean size of flaps in the venous supercharged group was significantly larger than that in the group without supercharge (22.6 ± 3.8 × 9.1 ± 1.7 cm vs. 17.5 ± 4.4 × 7.8 ± 1.7 cm, P = 0.03). Venous congestion occurred in all four flaps without supercharge that lasted 3-7 days and partial flap loss occurred in two cases. There was no early venous congestion and partial flap loss in supercharged flaps but venous congestion secondary to anastomotic occlusion developed in two cases. Early exploration with vein grafting resolved venous congestion in one case. Late exploration in the other resulted in flap loss. Preventive venous supercharge is suggested for the large, distally-based anterolateral thigh flap.

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Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography

Cited by 19 publications

References 11 publications

Distal anastomosis patterns of the descending branch of the lateral circumflex femoral artery

Distal anastomosis patterns of the descending branch of the lateral circumflex femoral artery

Three-dimensional digitalized virtual planning for saphenous artery flap: a pilot study

The distally based, venous supercharged anterolateral thigh flap

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