Reconstruction of lower lip defects with free super‐thin anterolateral thigh flap

Bali, Zülfükar Ulaş; Özkan, Burak; Parspancı, Aziz; Keçeci, Yavuz; Yoleri, Levent

doi:10.1002/micr.30681

Cited by 19 publications

(30 citation statements)

References 25 publications

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“…However, the conventional ALT flap is often too bulky for resurfacing face defects, so it often needs to be performed a secondary debulking procedure. Moreover, the disadvantages of the free ALT are that skin color and texture are not similar to facial skin, and there is a high incidence of hair presence, especially in male patients [10] , [11] , [12] , [13] .…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a massive facial defect with the pre-expanded free anterolateral thigh flap: A case report

Sơn

Dung

Huy

2022

International Journal of Surgery Case Reports

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Introduction and importance Massive facial defects remain a reconstructive challenge because of the region's unique character and the limitation of a well-matched donor site. Pre-expanded free anterolateral thigh (ALT) flap provides a good alternative for reconstructing massive skin and soft tissue defects. Case presentation A 21-year-old male patient presented to our department with a massive right facial degloving wound caused by a sharp edged-weapon attack. The patient left the hospital after 3 weeks of wound care, and only came back to us after 2 months with large defects at the nasal, cheek, and upper and lower right lip regions. The procedure of ALT flap expansion surgery was performed for 2 months. The pre-expanded ALT flap was used for reconstruction of the patient's facial defects. Two-year follow-up showed that the flap at the reconstructed area resembled the contour of the nasal tip, facial skin color similarities in the cheeks and lips, and the patient's mouth had normal function. Clinical discussion The combined pre-expanded and composite ALT free flap techniques allow simultaneous reconstruction of many different anatomic units. Flap debulking helps to improve the nasal contour from the original defect. The lip separation technique and flap debulking procedure help enhance aesthetic reconstructive outcomes of the skin flap. Conclusion The surgical reconstruction using a pre-expanded ALT free flap for the patient with a massive facial defect was safe. In particular, sufficient skin and soft tissue ensured facial aesthetics and oral function for the patient when using this method.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of a massive facial defect with the pre-expanded free anterolateral thigh flap: A case report

Sơn

Dung

Huy

2022

International Journal of Surgery Case Reports

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“…In this study, we used the PAP free flap from the posteromedial thigh as a secondary donor site instead others free flaps, due to sev- Some of these traditional flaps, as the ALT or the SCIP, offer the advantage of excessive bulkiness avoidance, as they can be easily thinned intraoperatively with no need for secondary revisions, eventually (Bali et al, 2021;Hassan et al, 2020;Lee et al, 2017). Nevertheless, when compared to the ALT flap, the skin at the posteromedial thigh in the PAP flap has more laxity and this allows for primary donor site closure in most instances (Ciudad et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

The profunda artery perforator free flap for lower extremity reconstruction

et al. 2021

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Background: The profunda artery perforator (PAP) flap has been reported in several types of reconstructions. This report aims to evaluate the usefulness and the clinical outcome of patients who underwent the PAP free flap for lower limb reconstruction.Methods: Between February 2018 and February 2020, nine patients with injury at lower third of the leg, foot dorsum or foot plant (eight acute injuries and one chronic ulcer) were selected. Mean wound size was 12.5 × 6.3 cm (9 × 5-14.5 × 6.5). Inclusion criteria consisted in patient's request to hide the donor site scar and the absence of previous traumas or surgery in the donor site. Patients considered unable to bear prolonged surgery were excluded. Patients underwent preoperative CT angiography and peri-operative Doopler, for perforator selection. All flaps were designed with pinch test, in elliptical shape. Microvascular anastomosis was performed to the tibialis anterior/posterior or medial plantar vessels. Outcomes were evaluated in terms of wound coverage success and patient's quality of life through Lower Extremity Functional Scale (LEFS) questionnaire. Results:The mean size of the harvested skin paddle was 13.5 × 7.4 cm (9 × 6-15 × 8) and mean pedicle length was 8.5 cm. Mean flap harvest time was 43.5 min . Flap survival rate was 100%, with one re-exploration with minimal partial flap loss. Mean follow-up was 13.5 months . Reconstructive results were successful in wound coverage and function. All patients reported satisfaction with their result by LEFS questionnaire (score:64.7). Conclusion:With proper patient selection, there was 100% flap survival rate with no major complication. According to our data, the PAP free flap could be a valuable option for lower extremity reconstruction. | INTRODUCTIONInjury to the lower limb poses a challenge to reconstructive surgeons because they require early intervention often involving a multidisciplinary approach. Initial management of the affected extremity will be determined by the cause of injury, as it is necessary to stabilize the patient and determine suitable reconstructive options. These injuries include trauma (crushing, car accidents, high altitude falls) and high voltage burns among others (Patterson et al., 2019). Every patient should receive individualized treatment tailored to the injury and it will

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“…This flap is very versatile and can be trimmed and defatted to suit any type of defect. 5,[10][11][12] The FL can be used as an anchoring structure, similar to the PL tendon previously described. If this flap is not available, the second option is the PAP flap.…”

Section: Table 5 Algorithm For Extensive Lower Lip Defect Reconstructionmentioning

confidence: 99%

“…Composite anterolateral thigh (ALT) free flap and FL offer a good alternative, significantly reducing donor site morbidity. [10][11][12] Various authors have reported successful functional outcomes using free functioning muscle transfers. [13][14][15] In cases of combined lower lip-mandible defects, some authors advocate the use of a double free flap transfer, 16,17 whereas others use free fibula 18 or scapular flaps 19 with extended skin paddles.…”

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confidence: 99%

Microsurgical Reconstruction of Extensive Lower Lip Defects

Ribeiro

Peng²,

Cheong

et al. 2023

Ann Plast Surg

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Background: Large defects of the lower lip pose a difficult challenge for any reconstructive surgeon. When there is limited local tissue available to resurface the defects, free flaps are the preferred option. Aim and Objectives: We reported our experience in the reconstruction of extensive lower lip defects. The authors propose a new algorithm for microsurgical technique selection and assessment of the functional outcomes obtained. Materials and Methods: A retrospective review of all microsurgical reconstructions of extensive lower lip defects by the senior author for 10 years was performed. The functional outcomes assessed included speech, feeding, and oral continence. Patients were stratified according to their status of simultaneous mandible resection (none, marginal, segmental).Results: Fifty-one patients were included in this study. Almost all patients (96.1%) achieved intelligible speech. Only 1 patient experienced severe drooling. Most patients could eat a solid or soft diet (72.5%). Mandible resection was associated with the worst feeding outcomes.Conclusions: Microsurgical reconstruction of extensive lip defects is safe and provides good results. Free flap selection should take into account the location of the defect, the resected structures, and the body mass index of the patient. Feeding status seems to be inversely correlated with the amount of mandibular resection.

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Reconstruction of lower lip defects with free super‐thin anterolateral thigh flap

Cited by 19 publications

References 25 publications

Reconstruction of a massive facial defect with the pre-expanded free anterolateral thigh flap: A case report

Reconstruction of a massive facial defect with the pre-expanded free anterolateral thigh flap: A case report

The profunda artery perforator free flap for lower extremity reconstruction

Microsurgical Reconstruction of Extensive Lower Lip Defects

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