Sequential chimeric medial femoral condyle and anterolateral thigh flow‐through flaps for one‐stage reconstructions of composite bone and soft tissue defects: Report of three cases

Abstract

Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients. Two female and one male patients ages 39-58 years suffered from composite bone and soft tissue defects of the lower extremity and clavicle caused by tumor resection and postoperative radiation resp. infected tibial pilon fracture. The sizes of the soft tissue defects ranged from 15-23 × 4.5-6 cm and the sizes of the bone defects ranged from 1.5-4 × 2-4 cm. Defect reconstructions were performed in all cases with sequential chimeric MFC-ALT flaps with sizes ranging from 2-4 × 1.6-4 cm for the MFC and 21-23 × 7-8 cm for the ALT skin paddles. Functional reconstructions were achieved in all cases resulting in stable unions and soft tissue coverage enabling the patients to bear full weight without assistance on 5-months follow-up. Postoperative course was uneventful and complications were restricted to a small skin necrosis at the suture line in one case. MFC-ALT flaps may be a safe, and effective procedure for one-stage reconstructions of small, irregularly shaped bone defects with concomitant large soft tissue loss or surrounding instable scarring, particularly in cases of recalcitrant non-unions after radiation exposure.

Intra- and Extrathoracic Malignant Tracheoesophageal Fistula—A Differentiated Reconstructive Algorithm

“…The radial forearm flaps were combined with ALT flaps, free jejunum segment flaps or a free osseous fibula [37]. The ALT flap itself has been described as a potential flowthrough flap for sequential connections of multiple flaps [38]. Consequently, we changed our approach in patients with free jejunum segment flaps and insufficient soft tissue of the neck towards chimeric ALT flaps that were anastomosed to internal mammary vessels outside prior operation and radiation fields, and that served as a "vascular bridge" for the jejunum, which was anastomosed to the distal ALT pedicle.…”

Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

“…To reduce the donor site morbidities, sequential chimeric aps were used to repair large soft-tissue defects [16][17][18] . Qing et al reported using the bilateral chain-linked ALT perforator aps for large defects [19] .…”

Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

“…The main drawbacks of those flaps for reconstruction of complex soft tissue defects repair motivated us to research a new method to overcome these limitations. The sequential chimeric flap consists of two or more tissue components joined together by means of a microanastomosis instead of naturally occurring (Henn et al, ; Vanmierlo, Craggs, Van Eeckhout, Zeltzer, & Hamdi, ). However, most of these combined flaps were aim to get special tissue components, such as bone or muscle, to reconstruct deep tissue structures.…”