Extremity free fillet flap for reconstruction of massive oncologic resection—Surgical technique and outcomes

Abstract

Background and Objectives: The purpose of this study is to present our experience using free fillet flaps to reconstruct massive oncologic defects of the upper and lower extremity.Methods: A retrospective chart review was performed to include patients who underwent oncologic resection followed by reconstruction using free fillet flaps from July 2001 to October 2018. Patient demographics, clinical and surgical characteristics, and postoperative complications were reviewed. Results: In total, 12 patients were identified and included in this study. Mean age was 48.9 years old. Five patients had extended forequarter amputations and seven patients had external hemipelvectomies, all for locally advanced tumors. Mean tumor size was 15 ± SD 6.4 cm, and negative tumor margins were achieved in all the patients. Mean flap size was 1028 ± SD 869 cm 2 . The mean follow-up was 13 months. There were no partial or total flap losses in the postoperative period. Two patients had flap-related postoperative complications, including flap bleeding and wound dehiscence. Median survival was 18 months. Conclusion: The free fillet flap is a safe, reliable, and valuable approach for reconstructing oncological defects. It offers the advantage of avoiding donor site morbidity, while providing extensive soft-tissue coverage as a one-step solution for massive oncologic defects. K E Y W O R D S fillet flap, free flap, sarcoma How to cite this article: Kreutz-Rodrigues L, Mohan AT, Moran SL, et al. Extremity free fillet flap for reconstruction of massive oncologic resection-Surgical technique and outcomes.

Management of Free Fillet Flap Transfers in Large Oncologic Resections

“…In contrast, the free fillet flap reconstruction has shown a 15%-18% complication rate consisting of partial flap necrosis and vascular compromise. [2][3][4][5][6][7][8][9] Kreutz-Rodriguez et al 8 in their two case series of 10 and 12 free fillet flaps report only one flap loss and a 14% complication rate with wound healing and venous thrombosis. 9 In cases with early flap elevation protocols, ischemia time is directly dependent on the final flap elevation after limb amputation and ablation of the tumor.…”

“…In contrast, the free fillet flap reconstruction has shown a 15%–18% complication rate consisting of partial flap necrosis and vascular compromise. 2 – 9 Kreutz-Rodriguez et al 8 in their two case series of 10 and 12 free fillet flaps report only one flap loss and a 14% complication rate with wound healing and venous thrombosis. 9 …”

Forequarter Amputation: Reconstruction With Targeted Muscle Reinnervation to the Filet of Forearm Free Flap

“…The forearm filet flap also has unique anatomic considerations. The flap is created longitudinally from the lateral epicondyle to the distal radioulnar joint 5 . At the wrist, all neurovascular structures, tendons, extensor retinaculum, and volar radiocarpal ligaments are divided.…”

Practical Strategies in Reconstruction of Soft-Tissue Sarcoma

“…The use of "spare parts" using the lower leg as a free filet flap is a very reliable flap and does not incur additional donor-site morbidity. 37,43 For many of these defects requiring a hip disarticulation or an external hemipelvectomy, the use of local or posterior thigh tissue has a higher risk of complications, given the marginal and compromised perfusion, as the external iliac vessels commonly are ligated during the resection. In comparison, a free filet flap based on the popliteal vessels provides the most optimal axial perfusion of the soft tissue from the lower leg in patients with three-vessel runoff.…”