Use of Flow-Through Anterolateral Thigh Perforator Flaps in Reconstruction of Complex Extremity Defects

Qing, Liming; Wu, Panfeng; Liang, Jieyu; Yu, Fang; Wang, Congyang; Tang, Juyu

doi:10.1055/s-0035-1555138

Cited by 37 publications

(29 citation statements)

References 30 publications

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“…Our previous experience showed that a flow-through technique is required to revascularize the additional flap (Qing et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…A segment of vastus lateralis muscle was included as the muscle flap to obliterate the dead space. The surgical technique used to harvest the additional perforator flap was similar to our previous study (Qing et al, ).…”

Section: Introductionmentioning

confidence: 91%

“…The surgical technique used to harvest the additional perforator flap was similar to our previous study (Qing et al, 2015).…”

Section: Surgical Techniquementioning

confidence: 96%

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

Qing

et al. 2019

Microsurgery

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Background One‐stage reconstruction of complex soft tissue defects of the extremities is a challenging problem. Repair of complex soft tissue defects requires adequate skin tissues to cover the large surface wound and special tissues for obliterating the dead space. The chimeric flap is one of the most popular approaches for reconstruction of complex soft tissue defects. However, the problems of donor‐site morbidity and inability to repair very large defects at one‐stage remain. The purpose of this study was to present our clinical experience using sequential chimeric perforator flaps for reconstruction of complex extremity defects with primary closure of the donor site. Methods From August 2013 to March 2017, 12 patients with complex soft tissue defects underwent extremity reconstruction using sequential chimeric perforator flaps, which were composed of a chimeric anterolateral thigh perforator (ALTP) flap and an additional free perforator flap. The skin paddles were placed side‐by‐side to cover the large surface soft tissue defects, and the muscle component was used to obliterate the dead space. Of these patients, one was injured by a crushing accident, while the other 11 patients were injured in traffic accidents. Results The size of the skin paddles ranged from 26 cm × 8 cm–10 cm × 6 cm to 30 cm × 8.5 cm–29 cm × 9 cm. The muscle paddle size ranged from 2 cm × 3 cm × 4 cm to 22 cm × 4 cm × 2 cm. All‐components of the sequential chimeric flaps survived in all‐patients. Vascular compromise was observed in one case. One case suffered minor wound‐edge necrosis and was treated conservatively. Primary closure of donor‐site was successfully achieved in all‐patients, and all‐donor‐site wounds healed uneventfully. The mean follow‐up time was 15.25 months. Most of the cases showed a satisfactory contour, and only two patients presented with mildly bulky appearance that treated with a debulking procedure. Conclusions The sequential chimeric perforator flap is an alternative procedure for reconstruct complex soft tissue defects of the extremities. This approach allows for flexible design, a larger cutaneous area, and low donor site morbidity.

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“…Our previous experience showed that a flow-through technique is required to revascularize the additional flap (Qing et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

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

Qing

et al. 2019

Microsurgery

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“…12,13 Moreover, flow-through flaps allow future microsurgical intervention and multistage flap procedures without increased risk of vascular compromise of the extremity in case of recurring disease. 14 Even though the latissimus dorsi muscle flap and the anterolateral thigh flap are mostly described for the flow-through procedure, this technique is applicable in many other flaps 7,8,[15][16][17][18][19][20][21][22][23][24][25][26] with the only requirement being the presence of a side branch with an acceptable diameter for the anastomosis to the distal stump of the recipient artery.…”

Section: Discussionmentioning

confidence: 99%

Flow-Through Flaps in the Absence of an Arterial Gap for Extremity Defect Reconstruction: Minimizing the Donor-Site Morbidity

Garrido

Qiu

2018

J reconstr Microsurg

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Background The use of flow-through flaps was popularized in the early 1990s by Costa, Soutar and Lamberty in cases where an arterial gap was present or a major artery of the limb was damaged. We hypothesized that flow-through flaps can be used in all extremity reconstruction cases, where there is an indication for a free-flap, irrespective of the existence of arterial defect due to its many advantages while not increasing the flap loss significantly. Methods A retrospective study was performed by examining patient status and surgery reports of all patients who underwent extremity reconstruction with a flow-through flap from January 2011 to January 2016. This procedure was applied to all the patients, irrespective of the presence of an arterial gap. Results Forty-seven patients were included. The most frequently used flaps were the anterolateral thigh flap and the latissimus dorsi flap. Reconstructions were either posttraumatic or after oncological resection. Two cases of flap loss were encountered. The mean total operating time was 480 ± 153 minutes. The mean follow-up was 10 ± 3 months. There were no donor-site wound complications. Conclusion Based on our results, the flow-through flap technique can be considered a safe alternative to the end-to-side technique for complex extremity defect reconstruction irrespective of the vascular status. The additional arterial anastomosis, even in the absence of an arterial gap or a vascular compromised extremity, did not increase the complication rate in the hands of experienced microsurgeons.

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“…2,3 In some selected cases, an arterial and venous defect can be reconstructed by means of a "flow-through" microsurgical flap, or by the use of a venous loop for the creation of a temporary arteriovenous fistula. 4,5 The purpose of this study was to retrospectively evaluate the need for venous and arterial reconstruction and its results in a clinical series of free microsurgical transfers for lower limb reconstruction, operated at two reconstructive surgery centers: the University of Palermo (Italy) and the University of Gent (Belgium).…”

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confidence: 99%

Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction

Toia

Zabbia

Roggio

et al. 2017

J reconstr Microsurg

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Background The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (six flow-through flaps, one arterial graft), combined arterial and venous reconstruction in four cases (three vein grafts, one combined venous/arterial graft), and venous reconstruction in one case (one venous graft). The rate of complications and donor-site morbidity related to vascular graft harvest were evaluated. Results Reconstruction was successful in all cases, despite an overall complication rate of 17 and 8% of surgical revision. Donor-site morbidity, subjectively evaluated, was minimal with respect to functional deficits and aesthetic outcome. Indications for the different types of grafts are discussed. Conclusion The use of vascular grafts is needed in a relevant percentage of microsurgical reconstruction cases. Venous and arterial vascular grafts, transient arteriovenous fistulas, and “flow-through” microsurgical flaps showed a safe reconstruction comparable to microsurgical reconstructions without the use of grafts. Donor-site morbidity secondary to vascular graft harvest is minimal, and in almost 70% of cases no additional scars are needed.

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Use of Flow-Through Anterolateral Thigh Perforator Flaps in Reconstruction of Complex Extremity Defects

Abstract: Our experience showed that the flow-through ALTP flap is reliable and suitable for reconstruction of complex defects of the extremities, as well as for various other clinical purposes.

Cited by 37 publications

References 30 publications

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

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

Flow-Through Flaps in the Absence of an Arterial Gap for Extremity Defect Reconstruction: Minimizing the Donor-Site Morbidity

Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction

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