Pedicled anterolateral thigh flap transfer for the reconstruction of a large gluteal defect assisted by preoperative computed tomographic angiography and intraoperative indocyanine green angiography: A case report

Abstract

The efficacy of the use of the pedicled ALT flap for buttock defects has not been established in the literature. Here, we present a case of a successful reconstruction of a large gluteal defect after sarcoma resection using a pedicled ALT flap assisted by preoperative computed tomographic angiography (CTA) and intraoperative indocyanine green (ICG) angiography. A 94-year-old man underwent resection of a large soft tissue tumor in the gluteal region resulting in a 19 Â 15 cm defect. Based on three-dimensional reconstructed images of the preoperative CTA, the length of the pedicle of an ALT flap was estimated. Perfusion of the whole flap was confirmed using intraoperative ICG angiography. The flap was inserted through a subcutaneous tunnel and covered the defect completely. The postoperative course was uneventful.The patient resumed ambulation 1 week after the operation. The follow-up at 2 months showed complete flap survival, and the patient was able to walk with a cane. The pedicled ALT flap transfer may be a reliable alternative for gluteal reconstruction when guided by pre-and intraoperative imaging modalities.

Multiple Flap Transfer for Multiple Local Recurrence of Soft Tissue Sarcoma

“…While smaller defects can be addressed with primary closure, larger ones necessitate more advanced plastic and reconstructive surgery techniques, such as local or free flap transfers. These reconstruction techniques have been explored extensively in the academic literature [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. With the current improvements in microsurgical techniques and instruments, some recent studies have shown that free flap transfers have a similar safety profile to the reconstruction using a local flap [ 2 , 3 , 10 ].…”

Perfusion Dynamics during Secondary Flap Debulking with Liposuction

“…1,2 In reconstructive microsurgery, ICG fluorescence angiography is mostly used for its predictive qualities regarding skin and flap survival. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] By distinguishing between well-perfused and poorly perfused tissues, ICG fluorescence angiography is fundamental for intraoperative decisionmaking and allows precise tailoring in view of minimal postoperative complications. [19][20][21][22] Because of real-time flow assessment, ICG fluorescence angiography is an accurate modality which has contributed to our understanding of flap dynamics and which is superior to the trained eye of the reconstructive surgeon.…”