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

Huang, Jong Khing; Huang, Chih‐Sheng; Wu, Shang-Lin; Shih, Yu-Chung; Lin, Yi‐Ying; Perng, Cherng-Kang

doi:10.1055/s-0038-1666783

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…Advantages of this technique include shorter operation time, less trauma, and direct closure of donor sites. Combined with the concept of the “economic flap” proposed by Professor Yixin Zhang ( 21 , 22 ) and the anatomical characteristics of the large amount of tissue around the defect on the buttocks, designed two or three local freestyle perforator flaps transferring to the defect, which made it possible to re-embed or tile a new flap with a larger area and volume. Therefore, we applied the jigsaw puzzle flap based on the freestyle perforator to repair decubitus ulcers with large and deep cavities on the buttocks.…”

Section: Introductionmentioning

confidence: 99%

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks

et al. 2022

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BackgroundDecubitus ulcers are common skin injuries in plastic and burn surgery departments, usually occur in patients with a long disease course and poor underlying health. Designing a reconstruction procedure with safety blood supply to a large volume soft tissue and resulting in minimal trauma is a priority for surgeons.MethodsThe free-style perforators on the potential donor sites surrounding the ulcers were detected by Doppler, and the area of the ulcer was divided into several sections based on the location of pre-design perforator flaps. According to the insertion point of the perforators, small V-Y advancement flaps, propeller flaps and rotation flaps pedicled with freestyle perforators were formed and moderately modified during surgery. All of the small flaps were transplanted from donor sites to the defect and reassembled into a new composite flap to repair the ulcer. The donor sites were directly closed. The area of the flaps ranged from 7.0 × 10.5 cm to 8.0 × 22.0 cm and the diameter of the pedicle perforators ranged from 0.5 to 4.0 mm.ResultsIn 30 patients, 65 flaps were constructed, and all of the flaps survived with direct closure of all donor sites. One case with effusion healed 1 month postoperatively through draining and application of a mild pressure dressing. After a 3–24 months follow-up period, all of the patients were satisfied with post-operative function and appearance, and only one case had a local recurrence 6 months postoperatively.ConclusionThe jigsaw puzzle flap based on freestyle perforators can repair the large skin and soft tissue defects caused by decubitus ulcers on the buttocks, with direct donor flap area closure. This method is easy to perform with a safe blood supply and minimal trauma resulting from the avoidance of microvascular anastomosis and the conventional myocutaneous flap.

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Section: Introductionmentioning

confidence: 99%

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks

et al. 2022

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Risk factors associated with postoperative complications of free anterolateral thigh flap placement in patients with head and neck cancer: Analysis of propensity score‐matched cohorts

Lin

Kuo

et al. 2020

Microsurgery

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BackgroundFrom the perspective of a surgeon, knowledge of the operative risk factors that may affect postoperative outcomes is important in free anterolateral thigh (ALT) flap reconstruction for head and neck defects after tumor ablation. Therefore, this study was designed to examine the surgical intervention factors related to postoperative complications in a propensity score matched patient population.Patients and MethodsA total of 1,284 head and neck cancer patients who received free ALT flap repair over a 9‐year period from March 1, 2008, to February 28, 2017, at a single medical center were selected and divided into two groups (without complications, n = 845 and with complications, n = 439) according to the presence or absence of complications at the recipient site. Complications were defined as the detection of hematoma, surgical site infection, partial flap loss, oral fistula formation, flap partial necrosis, and flap loss. Well‐balanced propensity score‐matched cohorts with 292 patients each were created using the 1:1 Greedy algorithm, with adjustment for significant baseline patient characteristics.ResultsThe patients with postoperative complications had a higher proportion of individuals with betel nut chewing (91.8% vs. 86.6%, p = .008), diabetes mellitus (23.0% vs. 17.8%, p = .029), and preoperative chemotherapy (31.7% vs. 25.3%, p = .019), and higher serum creatinine levels (median [Q1–Q3]: 0.92 [0.80–1.07] vs. 0.89 [0.77–1.06], p = .008) and lower serum albumin levels (4.2 [3.9–4.5] vs. 4.3 [4.1–4.5], p < .001) than those without postoperative complications. Individual operator (p < .001), the length of flap (20 [15–23] cm vs. 20 [15–25] cm, p < .001), operative time (6.9 hr [5.7–8.3 hr] vs. 7.3 hr [5.9–8.7 hr], p = .001), operation start time (p = .003), and units of transfused packed red blood cells (0.0 [0.0–0.0] units vs. 0.0 [0.0–2.0] units, p < .001) were the factors significantly associated with the occurrence of postoperative complications. However, in the matched patient cohorts, individual operator (p = .003), flap length (18 [15–22] cm vs. 20 [15–25] cm, p < .001) and length‐to‐width ratio (2.6 [2.0–3.3] vs. 3.0 [2.5–3.6], p < .001), and operative time (6.9 hr [5.7–8.3 hr] vs. 7.2 hr [5.9–8.7 hr], p = .019) were associated with the occurrence of postoperative complications, but the operation start time (p = .285) and units of transfused packed red blood cells (p = .917) were not.ConclusionsThis study demonstrated in matched patient cohorts that individual operator, flap size, and operative time were associated with postoperative complications of free ALT flap reconstruction in patients with head and neck cancer. To reduce the postoperative complication rate, this study implies the importance of length and length‐to‐width ratio in harvesting the flap, and meanwhile the surgeon experience in free‐flap reconstruction.

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

Cited by 2 publications

References 25 publications

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks

Risk factors associated with postoperative complications of free anterolateral thigh flap placement in patients with head and neck cancer: Analysis of propensity score‐matched cohorts

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