Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery

Gentileschi, Stefano; Servillo, Maria; Garganese, Giorgia; Fragomeni, Simona Maria; Scambia, Giovanni; Salgarello, Marzia

doi:10.1002/micr.30077

Cited by 40 publications

(36 citation statements)

References 20 publications

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“…ALT flap is probably one of the most useful and versatile perforator flaps for vulvoperineal reconstruction; it can reach mons pubis, vulva, perineum, lower abdominal wall, and groin area with strong axial vascularization that allows for thinning and splitting the flap, avoiding sometimes contralateral flaps [18] (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

et al. 2016

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ObjectiveTo create a comprehensive algorithmic approach to reconstruction after vulvar cancer ablative surgery, which includes both traditional and perforator flaps, evaluating anatomical subunits and shape of the defect.MethodsWe retrospectively reviewed 80 cases of reconstruction after vulvar cancer ablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. We registered the possibility to achieve the complete wound closure, even in presence of very complex defects, and the postoperative complications. On the basis of these experience, analyzing the choices made and considering the complications, we developed an algorithm to help with the selection of the flap in vulvoperineal reconstruction after oncologic ablative surgery for vulvar cancer.ResultsWe employed eight types of different flaps, including 54 traditional fasciocutaneous V-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Y gracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, two Limberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and one superficial circumflex iliac artery perforator flap. The structures most frequently involved in resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely, rectum, bladder, and lower abdominal wall.ConclusionThe algorithm we implemented can be a useful tool to help flap selection. The key points in the decision-making process are: anatomical subunits to be covered, overall shape and symmetry of the defect and some patient features such as skin laxity or previous radiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperineal reconstruction, although in some cases traditional flaps remain the best choice.

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Section: Discussionmentioning

confidence: 99%

Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

et al. 2016

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“…Median overall time to perform fusion imaging was 32 (range, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] min. Median duration of Step 1 (acquisition of 3D volumes and target identification on CT and SPECT) was 10 (range, 8-12) min; of Step 2 (coregistration and synchronization of SPECT/CT and ultrasound) was 10 (range, 7-10) min; and of Step 3 (fine tuning and SPECT/CT and ultrasound fusion imaging navigation) was 12 (range, [8][9][10][11][12][13][14][15][16][17][18][19] min. Time spent performing Steps 1 and 2 was similar in all 10 cases, whereas the time spent performing Step 3 reduced significantly from the first to the last examination (19 vs 12 min; Figure 4).…”

Section: Resultsmentioning

confidence: 99%

Fusion of ultrasound and 3D single‐photon‐emission computed tomography/computed tomography to identify sentinel lymph nodes in vulvar cancer: feasibility study

Garganese

Bove

Zagaria

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To evaluate the feasibility of fusion of ultrasound imaging and three‐dimensional (3D) single‐photon‐emission computed tomography/computed tomography (SPECT/CT) in detecting sentinel lymph nodes in women with vulvar cancer. Methods This was a prospective pilot single‐center study. Patients with vulvar cancer who were candidates for sentinel lymph‐node biopsy were enrolled between December 2018 and February 2019. Fusion imaging virtual navigation using 3D SPECT/CT and ultrasound was performed to investigate the tumor‐draining lymph node. All clinical, imaging, surgical and histological information was collected prospectively and entered into a dedicated Excel file. Feasibility and success of fusion imaging virtual navigation and time needed to perform the three steps of fusion imaging were evaluated. Results Ten lymph‐node sites were evaluated in five consecutive women with a histological diagnosis of vulvar cancer. Fusion imaging virtual navigation was feasible and completed successfully for all (10/10) draining sites. Median overall time to perform fusion imaging was 32 (range, 25–40) min and the time decreased from the first to the last examination. Conclusions The present study demonstrated that fusion imaging virtual navigation using 3D SPECT/CT and ultrasound is feasible and able to detect sentinel lymph nodes in women with vulvar carcinoma. Fusion imaging using ultrasound for detection of sentinel lymph nodes opens up multiple diagnostic and therapeutic opportunities in gynecological oncology. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Many authors focussed the utility of pedicled ALT for various soft tissue defects pertaining to specific anatomical regions [4][5][6][7]. To the best of our knowledge, very few articles described the diverse anatomical locations where pedicled ALT flap was used, including the abdomen, groin, trochanteric region, and the knee [8].…”

Section: Discussionmentioning

confidence: 99%

The Versatility of Pedicled Anterolateral Thigh Flap: A Tertiary Re-ferral Center Experience from India

Naalla¹,

Chauhan²,

Bhattacharyya³

et al. 2017

IMJ

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Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery

Abstract: ALT flap should be included in the first line options for reconstructions of complex defects resulting from vulvar cancer surgery because of its reliability and versatility. © 2016 Wiley Periodicals, Inc. Microsurgery 37:516-524, 2017.

Cited by 40 publications

References 20 publications

Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

Fusion of ultrasound and 3D single‐photon‐emission computed tomography/computed tomography to identify sentinel lymph nodes in vulvar cancer: feasibility study

The Versatility of Pedicled Anterolateral Thigh Flap: A Tertiary Re-ferral Center Experience from India

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