Sandwich Fascial Anterolateral Thigh Flap in Head and Neck Reconstruction: Evolution or Revolution?

Cherubino, Mario; Berli, Jens U.; Turri‐Zanoni, Mario; Battaglia, Paolo; Maggiulli, Francesca; Corno, Martina; Tamborini, Federico; Montrasio, Edoardo Francesco; Castelnuovo, Paolo; Valdatta, Luigi

doi:10.1097/gox.0000000000001197

Cited by 20 publications

(16 citation statements)

References 26 publications

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“…Different techniques have been suggested when describing other flaps, for example anterolateral thigh flap, to harvest them in a thinner fashion. [32][33][34] We think that the proximal ulnar skin provides a very good match, in terms of thickness and texture, with the hand. In our case series, in fact, the texture match with the volar aspect of the hand was very satisfactory, and we obtained "acceptable" to "very good" aesthetical outcomes in all cases treated.…”

Section: Discussionmentioning

confidence: 98%

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Cherubino

Bolletta

Baroni

et al. 2020

J Reconstr Microsurg

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Background The purpose of this study is to document the vascular anatomy of the free ulnar artery proximal perforator flap and to highlight the possibility of harvesting it based on the perforators originating from the posterior ulnar recurrent artery (PURA), to spare both the main axis of vascular supply to the hand. In addition, we present a case series of five patients treated for soft tissue defects of the hand with free ulnar artery proximal perforator flaps. Methods Ten specimens of anterior forearm were dissected in this study to register number and characteristics of ulnar perforators. The dissection was focused on the perforators originating from the larger branch of the ulnar artery, the PURA, at the proximal third of anteromedial forearm. The anatomical dissections were evaluated in relationship with clinical dissections performed during flap harvesting in five patients. Results In three of the specimens dissected, the proximal perforator originated from the PURA, and in the other seven specimens, it originated directly from the ulnar artery. Five cases of reconstruction of the hand were performed with success using the free ulnar artery proximal perforator flap, and in two cases, the perforator from the PURA was found and it was possible to raise the flap based on this branch of the ulnar artery. Conclusion The free ulnar artery proximal perforator flap can be harvested in two different manners for the same skin island of the forearm. When possible, harvesting it form the PURA allows lengthening of the pedicle. In our experience, this flap presents many advantages such as thinness and hairlessness; it allows preservation of the ulnar neurovascular bundle with an acceptable donor site morbidity. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 98%

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Cherubino

Bolletta

Baroni

et al. 2020

J Reconstr Microsurg

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“…Despite its description more than 20 years ago, little literature exists on the application of the fasciaonly ALT flap, and mainly concerns its employ in oral or dorsal hand reconstruction. [48][49][50] Recently, the ALT flap as vascularized fascial flap has been proposed also for lower extremity reconstruction. 51,52 We believe that the fasciaonly variation presents three major advantages over other muscle or fasciocutaneous flaps.…”

Section: Fasciocutaneous Flapsmentioning

confidence: 99%

Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

Cherubino

Corno

D’Arpa

et al. 2017

J reconstr Microsurg

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Soft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge in perforator anatomy and their mapping, a new era of lower limb reconstruction has begun. Propeller flap could be raised on any suitable perforator vessel and, without the aid of microsurgical anastomosis, used to restore small- to middle-sized soft tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous free flaps and the applicability of the propeller flaps in lower limb reconstruction

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“…The antero-lateral aspect of the lower leg is rich in septocutaneous perforators and can be utilized in pedicled flaps or free flaps to reconstruct structural defects, such as those arising secondary to chronic diseases or following trauma. [5][6][7] There are numerous flaps used for intraoral reconstructions and to cover lower limb defects. However, they can be associated with significant comorbidity and impair distal arterial supply.…”

Section: Introductionmentioning

confidence: 99%

Superficial peroneal nerve accessory artery (SPNAA) flap for head and neck reconstruction: A cadaveric anatomical study and retrospective case series review

Stocco

Murphy

Gargiulo

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Sandwich Fascial Anterolateral Thigh Flap in Head and Neck Reconstruction: Evolution or Revolution?

Abstract: Supplemental Digital Content is available in the text.

Cited by 20 publications

References 26 publications

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

Superficial peroneal nerve accessory artery (SPNAA) flap for head and neck reconstruction: A cadaveric anatomical study and retrospective case series review

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