Reconstruction of Foot and Ankle Defects with a Free Anterolateral Thigh Flap in Pediatric Patients

Acar, Mehmet Ali; Güleç, Ali; Aydın, Bahattin Kerem; Erkoçak, Ömer Faruk; Yılmaz, Güney; Şenaran, Hakan

doi:10.1055/s-0034-1395888

Cited by 42 publications

(8 citation statements)

References 18 publications

(31 reference statements)

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“…Complex soft tissue defects of the foot and ankle caused by trauma, infection, tumor cancer or diabetes are common and can be accompanied by exposed tendons, neurovascular bundles and bone. There are multiple options for the reconstruction of complex soft tissue defects in these areas, including the use of both pedicled flaps and free flaps (e.g., a lateral supramalleolar flap [2], a peroneal artery perforator flap [3,4], posterior tibial artery perforator flap [5], a sural neurocutaneous/neurofasciocutaneous flap [6,7,8], a medial pedis flap [9], a dorsal metatarsal flap [10], a dorsalis pedis flap [11], a pedicled or free medial plantar flap [12,13], a free groin flap [14,15], a free anterolateral thigh perforator flap [16,17,18], or a free anteromedial thigh perforator flap [19]). In addition, the successful reconstruction of complex soft tissue defects of the foot and ankle is critical because of the unique standing, weight-bearing and walking functions of the foot.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Cui

Maharjan

et al. 2016

PLoS ONE

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ObjectiveThe purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle.MethodsThis was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model.ResultsThe overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection.ConclusionFlap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.

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Section: Introductionmentioning

confidence: 99%

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Cui

Maharjan

et al. 2016

PLoS ONE

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“…Advances in microsurgical techniques have enabled replantation and soft tissue reconstruction with a high degree of success rate in children. [ 13 , 14 ] Several authors have published a successful series of free tissue transfers in pediatric patients, confirming the safety and reliability of microsurgical reconstruction. However, the properties of pediatric reconstruction differ from those in adults.…”

Section: Discussionmentioning

confidence: 90%

Acute compartment syndrome secondary to anterolateral thigh flap harvesting in a pediatric patient

Pan²,

Jin

et al. 2020

Medicine

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Introduction: The anterolateral thigh (ALT) flap is the most popularly used flap for major soft tissue reconstruction. Although it is widely used, acute compartment syndrome (ACS) in pediatric patients has rarely been reported in the literature. We herein reported a case of ACS in a 6-year-old girl after ALT flap harvest with direct closure of the donor site. Patient concerns: A 6-year-old girl was admitted to the Second Hospital of Jilin University with crush injury on the palmar aspect of the right hand and wrist. Diagnosis: Examination showed soft tissue defect of the hand and wrist, damage on the thenar muscles, lightly crushed flexor tendons, crushed median nerve, and ulnar artery thrombosis. Interventions: The defect was closed with an ipsilateral ALT flap measuring 9 cm in length by 6 cm in width. Outcomes: After debridement was performed 3 times, the majority of the rectus femoris and lateral femoris were removed. Secondary closure by skin grafting was performed 2 weeks later. Three days after the procedure, necrotic tissues were noted on the edges of the wound. The diagnosis of ACS of the right was made. A second exploration was decided, and an extensive anterior compartment fasciotomy was performed. After 6 weeks of vacuum sealing drainage therapy, the defect was closed with a free latissimus dorsi musculocutaneous flap. At 4 months of follow-up, the right thigh wound had healed. At 6 months of follow-up, quadriceps muscle weakness remained. At 1 year of follow-up, the patient's mobility had been significantly improved, but diminished sensation remained on the lateral aspect of the thigh. Conclusion: ACS can occur after ALT flap harvesting in pediatric patients and should be recognized as early as possible to avoid devastating complications.

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“…The most commonly used flap in children are the lattismus dorsi muscle, other options are rectus abdominis muscle and radial forearm [ 9 ], recently with the increase use of perforator free flaps the anterior lateral thigh flap has become more commonly used for reconstruction even in pediatric age group several studies found that ALT to be safe and reliable appealing option for soft tissue coverage and in some centers its becoming the workhorse in even pediatric microvascular reconstruction [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Foot and Ankle Defects with a Free Anterolateral Thigh Flap in Pediatric Patients

Abstract: Level IV.

Cited by 42 publications

References 18 publications

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Acute compartment syndrome secondary to anterolateral thigh flap harvesting in a pediatric patient

Salvage of planned ALT flap with rectus femoris free flap for pediatric lower extremity reconstruction: A demonstrative case report

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