Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction

Kim, Sang Woo; Kim, Kyu Nam; Hong, Michael; Park, Sung Woo; Park, Chae Ri; Yoon, Chi Sun

doi:10.1002/micr.22494

Cited by 21 publications

(15 citation statements)

References 31 publications

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“…Alternatively, in situations requiring more bulk and/or obliteration of undulating surfaces and dead space and in chimeric functional reconstructions (ALT plus muscle), the presence of musculocutaneous perforators is necessary for simultaneous skin and vastus lateralis harvest. 29,30 Preoperative CTA can also aid in the identification of multiple perforators supplying an ALT flap, which may be clinically useful in several instances. Our study is in line with Yu's "ABC" description of multiple ALT perforators, which characterizes ALT as having up to three perforators; each separated by • Recipient needs determine donor thigh selection (e.g., thigh with musculocutaneous perforators selected if chimeric flap is required) approximately 5 cm.…”

Section: Discussionmentioning

confidence: 99%

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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Abstract Background The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof. Patients and Methods Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected. Results A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m2. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection. Conclusion ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.

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Section: Discussionmentioning

confidence: 99%

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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“…Reconstruction is an essential goal to obtain a functional extremity. With development of reconstructive microsurgery, the strategy of one‐stage reconstruction with chimeric flaps has become the mainstream treating such complicated defects (Hallock, ; Kim et al, ). The chimeric flap is a subtype of compound flaps, consisting of multiple independent flaps such as vascularized bone grafts, skin flaps, muscle flaps and so on.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of complex tissue defect of forearm with a chimeric flap composed of a sural neurocutaneous flap and a vascularized fibular graft: A case report

Wang

Wen

et al. 2018

Microsurgery

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One-stage reconstruction of composite bone and soft-tissue defects in the forearm remains a tough challenge. Here, we present a case of reconstruction of complex tissue defect at forearm with a chimeric flap consisting of a sural neurocutaneous flap and a fibular graft. A 61-year-old man suffered from a machine crush injury in his left forearm, resulting in a complex tissue defect including extensive dorsomedial soft-tissue, digit extensor muscles of 2-4 fingers, the muscle flexor carpi ulnaris, the ulna bone with 5.5 cm in length, segmental injuries of ulna nerve and vessels, and the radius fracture. The defects were reconstructed by a modified chimeric flap, in which the sural neurocutaneous flap supplied by a peroneal perforator was used to repair the soft-tissue defect and the vascularized fibular graft was used to repair the ulna defect. The two components were supplied by the peroneal vessels. The ulnar nerve defect was bridged by a sural nerve graft. The venous congestion caused by thrombosis was observed at 24 hours postoperatively. After the venous anastomosis was reperformed, the flap survived completely without other complications. Bone healing was achieved at the 7-month follow-up. The index and middle fingers reached nearly full range of motion, while the ranges of motion of metacarpophalangeal joint of the ring and little fingers were less than 60 degrees. The results showed that the modified chimeric flap may be an option for reconstruction of complex tissue defect in the forearm.

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“…The following algorithm illustrates the decision‐making process which was utilized in the presented series (Figure ) (Bibbo et al, ; Demirtas et al, ; Kim et al, ; Knobloch, Herold, & Vogt, ; Nosrati, Chao, Chang, & Yu, ; Sia et al, ; Tachi et al, ). In general, when faced with small‐ to medium sized defects of <150 cm 2 , a standard gracilis muscle flap or fasciocutaneous flap can be employed.…”

Section: Discussionmentioning

confidence: 99%

“…The following algorithm illustrates the decision-making process which was utilized in the presented series ( Figure 6) (Bibbo et al, 2015;Demirtas et al, 2010;Kim et al, 2015;Knobloch, Herold, & Vogt, 2012;Nosrati, Chao, Chang, & Yu, 2012;Sia et al, 2015;Tachi et al, 2010 (Demirtas et al, 2010, Dayan, Lin, & Wei, 2009Park et al, 2007). When deep defects of greater than 150 cm 2 or defects >350 cm 2 need to be reconstructed or if the recipient vessels are compromised, a standard free latissiums dorsi flap or variation thereof usually provide the best option, even though the donor site morbidity is higher compared to the gracilis flap.…”

Section: Several Authors Point Out Size-related Limitations and Consementioning

confidence: 99%

The spreaded gracilis flap revisited: Comparing outcomes in lower limb reconstruction

et al. 2017

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Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction

Abstract: The vastus lateralis muscle-chimeric ALT free flap is a useful option for reconstructing three-dimensional lower extremity defects.

Cited by 21 publications

References 31 publications

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Reconstruction of complex tissue defect of forearm with a chimeric flap composed of a sural neurocutaneous flap and a vascularized fibular graft: A case report

The spreaded gracilis flap revisited: Comparing outcomes in lower limb reconstruction

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