Medial versus lateral approach to harvesting of anterolateral thigh flap

Xie, Renguo

doi:10.1177/0300060518786912

Cited by 9 publications

(7 citation statements)

References 16 publications

(30 reference statements)

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“…In 2008, Adler et al 32 published a different medial incision starting technique for harvesting complex lateral femoral circumflex chimeric free tissue transfers. However, a study concluded that medial incision is more efficient than starting with a lateral incision 33 .…”

Section: Discussionmentioning

confidence: 99%

“…The classic harvesting technique for the ALT flap is based on anatomic markers. It involves an open surgical procedure in which perforators are identified intra-operatively without a prior systematic investigation 33 . Thinning of the flap was initially described by Kimura et al 34 after a clear understanding of the perforasome concepts 35 .…”

Section: Discussionmentioning

confidence: 99%

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Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Hagiga

Aly²,

Kadhum³

et al. 2022

WJPS

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Background: Soft tissue coverage in the upper limb after trauma, burn injury, or tumour removal is a commonly addressed problem by the plastic surgeon. The anterolateral thigh flap (ALT) is recognized as a popular free flap option for covering various types of soft tissue defects due to its versatility. We aimed to assess the functional and aesthetic outcomes of the ALT flap for reconstruction of upper limb defects. Methods: Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, and Cochrane) from inception to Feb 2021. Two reviewers independently extracted the data and performed risk assessment using the modified Downs and Black (MDB) quality assessment tool and the modified Newcastle Ottawa Scale for case series. Results: This review included seven studies for quantitative assessment. The eligible studies had 67 patients. Included studies had used a varied number of validated upper extremity functional scoring systems; the most commonly used score was QuickDASH with mean of 21.24, DASH score was 15.5. In regard to aesthetic outcome, an overall satisfactory result was reported. A secondary debulking procedure was performed in 7 patients. Conclusion: Further studies are recommended to ascertain the functional and aesthetic outcomes of the ALT free flap for upper limb defects, especially using standardized outcome scoring systems. This may be supplemented with a questionnaire that addresses common patient concerns (such as colour, contour, textile and hair growth) for the aesthetic outcome. Nevertheless, based on our review, the ALT flap may be a good reliable reconstructive option for upper limb defects with good functional outcome and satisfactory aesthetic results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Hagiga

Aly²,

Kadhum³

et al. 2022

WJPS

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“…In this study, the operative time in this study was 138.1 (120–175) min, which was significantly shorter than the time required for free anterolateral thigh flap grafting (usually > 3 h) [ 14 , 15 ]. In thoracodorsal artery polyfoliate perforator flaps, perforators travel superficially in the intermuscular space and are easier to separate than those in the anterolateral thigh flap.…”

Section: Discussionmentioning

confidence: 99%

Free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand

et al. 2021

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Background Hand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.The feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand needs to be confirmed in clinical practice. Methods Fifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated. Results The flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12–26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Mean score of scars at the donor site were assessed using the modified Vancouver scar scale (VSS) was 2.7. A puffed appearance in the recipient area was noted in four patients. To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs. Conclusion Free thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

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“…The ALT flap is mainly harvested as fasciocutaneous free flap incorporating fascia lata (FL), overlying adipose tissue and skin, or as myocutaneous flap with additional muscular component to increase bulk [5][6][7]. The FL as fascial component of the ALT flap is preferred particularly for tendon reconstruction of lower and upper limbs [8,9]. In addition, the FL is routinely used as non-vascularized graft in anterior skull base surgery or rhinology to cover small skull base defects.…”

Section: Introductionmentioning

confidence: 99%

The vascularized fascia lata free flap: an anatomical study and clinical considerations

Janik

Hirtler

Traxler

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap. Methods We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined. Results Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo-or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6-60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm 2. In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL. Conclusion We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.

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Medial versus lateral approach to harvesting of anterolateral thigh flap

Cited by 9 publications

References 16 publications

Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand

The vascularized fascia lata free flap: an anatomical study and clinical considerations

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