Impact of body mass index, gender, and smoking on thickness of free soft tissue flaps used for orofacial reconstruction

Hakim, Samer G.; Jacobsen, Hans-Christian; Trenkle, Thomas; Sieg, Peter; Wieker, Henning

doi:10.1016/j.jcms.2015.06.026

Cited by 14 publications

(7 citation statements)

References 18 publications

(21 reference statements)

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“…Similar to our study, earlier studies have also demonstrated thicker subcutaneous fat in the anterior thigh region in female patients than in male patients [8,11,12,13], and also the ALT flap thickness has been correlated with BMI [8,11,13,14]. In the present study, we have demonstrated for the first time that there exists a correlation between flap thickness and BMI and gender in all thigh flaps studied, including the PAP flap.…”

Section: Discussionsupporting

confidence: 91%

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Heredero¹,

Falguera²,

Sanjuan³

et al. 2019

IMJ

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Soft tissue microsurgical reconstruction in the head and neck regions can be performed with different types of free flaps. For decades, the anterolateral and anteromedial thigh regions have been considered as the ideal donor sites [1,2], especially in Asian countries. Recently, the profunda artery perforator (PAP) flap harvested from the posteromedial region of the thigh has been proposed as a good choice for use in oral cavity reconstruction [3,4,5]. However, in the Western countries, thigh flaps, especially the PAP flaps, are not used as often as in the Asian countries for oral reconstruction because there are concerns regarding the greater thickness of thigh flaps as compared with the radial forearm free flaps (RFFF). There are previous publications on anterolateral thigh (ALT) flap thickness measured with Doppler ultrasound [6,7] and only one study using computed tomographic angiography (CTA) [8]. However, none of these studies compare ALT flap thickness with PAP flap thickness in the same patient. The aim of this study was to compare the PAP flap thickness with the thickness of other thigh flaps that were more commonly used for intraoral reconstruction and to identify the factors influencing its thickness in our population using CTA. This information would be useful to facilitate flap selection based on desired tissue volume in patients with greater thigh thickness, like our population. MATERIAL AND METHODS Study Sample The study sample comprised 72 legs of 36 patients. The inclusion criteria were the patients who underwent head and neck microsurgical reconstruction with a fibula free flap and a preoperative CTA. The exclusion criteria consisted of the antecedent of previous thigh flap harvested. CTA was performed on a 64-slice multiple detector computed tomography scanner (LightSpeed VCT; GE Healthcare, Milwaukee, WI, USA) using a standardized protocol. Data post-processing was done using the open-source software Horos TM v 1.1.7 (GNU Lesser General Public License, version 3). Morphologic analysis of flap thickness and perforator location was done for the ALT flap, the anteromedial (AMT) flap, the distal superficial femoral artery perforator (d-SFAP) flap, and the PAP flap in all 72 legs. The d-SFAP flap is not commonly used for intraoral reconstruction, but it was also included in this study because of the constancy of the location of its perforator. For the ALT flap, the references were the anterior superior iliac spine (ASIS) and the superolateral border of the patella. The best perforator around the midpoint between both references was identified and its location relative to the ASIS was registered. The same references were used for the AMT flap. The cutaneous perforator of the AMT flap was located close to the intersection between the rectus femoris and sartorius muscles. The perforator's location (relative to the ASIS) and its origin-whether arising from the lateral circumflex femoral artery (LCFA), medial circumflex femoral artery (MCFA), or superficial femoral artery (SFA)-were identified. For the P...

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Section: Discussionsupporting

confidence: 91%

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Heredero¹,

Falguera²,

Sanjuan³

et al. 2019

IMJ

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“…In addition, the majority (60%) of the undetected perforators in this study were the perforator Cs, which were the most distally located perforators. The thickness of the adipose layer in the lower limbs is consistently thicker proximally and becomes thinner distally . For perforator Cs, (1) core body heat is more easily transmitted to the overlying skin and interferes with the observation of the perforator‐based rewarming and (2) this scenario was also true for the applied cold challenge, which may have led to vasospasm and hindered the perforator‐based rewarming.…”

Section: Discussionmentioning

confidence: 99%

“…The thickness of the adipose layer in the lower limbs is consistently thicker proximally and becomes thinner distally. 39 For perforator Cs, (1) core body heat is more easily transmitted to the overlying skin and interferes with the observation of the perforator-based rewarming and (2) this scenario was also true for the applied cold challenge, which may have led to vasospasm and hindered the perforator-based rewarming. Therefore, some distal perforators, or the perforators in the lean patients, could have been overlooked and resulted in a false negative.…”

Section: Discussionmentioning

confidence: 99%

Value of a smartphone‐compatible thermal imaging camera in the detection of peroneal artery perforators: Comparative study with computed tomography angiography

Chen

Huang

et al. 2019

Head & Neck

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Background The aim of this study was to investigate the value of a smartphone‐compatible thermal imaging camera in the mapping of the peroneal artery perforators. Methods Twelve consecutive patients scheduled for fibular flap reconstruction were enrolled. The lower limbs were first studied using smartphone‐based dynamic infrared thermography (DIRT). During the rewarming, the hotspots were marked, small rubber markers were taped to the registered sites, and then the patients were sent for a CT scan. The diagnostic performance of smartphone‐based DIRT was evaluated by comparing the DIRT findings with CT angiography and intraoperative findings. Results DIRT detected 42 of the 57 dominant perforators in 24 limbs and resulted in a sensitivity of 73.7% and a positive predictive value of 65.6%. Conclusions The sensitivity and positive predictive value of the smartphone‐based DIRT are low. Currently, it should be used as an adjunctive tool together with the established imaging techniques.

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“…Third, although the ALT flap has been widely applied in the head and neck reconstruction, it is significantly correlated with body mass index. 26 For obese patients or North American Caucasian patients, the ALT flap may be too thick with an excess of subcutaneous fat. Thus, the effect of the transillumination method might be limited.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps

Huang¹,

Huang²,

et al. 2018

Facial plast Surg

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Without well recognizing the vascular territories of the perforator, surgery might damage the pedicle and diminish flap survival. This study described a transillumination method for intraoperative mapping of the subfascial plexus of the perforator in the head and neck reconstruction with an anterolateral thigh (ALT) flap and also compared the perioperative outcomes and complications of the method with those of the conventional two-pedicle ALT flap. Between January 2011 and December 2017, 26 patients who underwent head and neck reconstruction with ALT flaps were evaluated as follows: 13 underwent the transillumination method (case group), and 13 (age- and sex-matched) underwent standard two-pedicle flap procedures (control group). Demographic factors, diagnosis, flap size, recipient site, perioperative data, and postoperative complications were compared between the two groups. There was no significant difference in age, sex, diagnosis, recipient sites, and flap size between the case and control groups. Regarding the perioperative outcomes, the harvesting time was significantly shorter in the case group than in the control group (60 vs. 100 minutes, < 0.001). The operative time was shorter in the case group than in the control group, but this difference was not statistically significant (300 vs. 420 minutes, = 0.058). The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the ALT flap, which facilitates intraoperative flap design in head and neck reconstruction.

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Impact of body mass index, gender, and smoking on thickness of free soft tissue flaps used for orofacial reconstruction

Cited by 14 publications

References 18 publications

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Value of a smartphone‐compatible thermal imaging camera in the detection of peroneal artery perforators: Comparative study with computed tomography angiography

Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps

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