A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery

Abdel‐Rahman, Mohamed S.; McGarry, Kevin; Alsharkawy, Kareem; Wu, Jin‐Hou; Cheong, David

doi:10.1016/j.bjps.2020.10.111

Cited by 4 publications

(5 citation statements)

References 43 publications

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“…Conventionally, those without reliable perforators are often managed with the inclusion of the entire vastus muscle as myocutaneous flaps, which are susceptible to kinking, twisting, or compression of the pedicles that restricts rotation of the skin paddle segments and incapable of providing thin and pliable coverages for defects such as degloving injuries or oral commissures. [35][36][37] Others may suggest conversion to the tensor fasciae latae myocutaneous flaps or the anteromedial thigh flaps instead, 12,35 but these alternatives possess shorter pedicles, smaller perforator calibers, and redundant flap thickness compared with the workhorse anterolateral thigh flaps and extensive dissections on the same leg can result in neurological and functional sequelae. In our prior study, the 7.16% anterolateral thigh flaps harvested with thin-layered capillary nonsizable perforators and further flap splits have been proven feasible without serious complications or flap failures.…”

Section: Discussionmentioning

confidence: 99%

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

Shih,

Chiu,

Jeng

et al. 2024

J Reconstr Microsurg

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Background: Split anterolateral thigh flap is a versatile reconstruction option, yet long underestimated as no practical perforator classification and no optimal strategy were present. Harvesting “capillary non-sizable perforators” could potentially expand flap splits to those with no existing multiple sizable perforators. Concerns over defect characteristics, recipient vessels, pedicle length, and split timing should all be weighted equally in designing the suitable flap. Refinement is thus required to enable precise reconstructions. Methods: All patients undergoing anterolateral thigh flap harvests between 2014 to 2021 performed by a single surgeon were included. The perforator patterns of sizable pedicle, course, origin and further successful flap-split methods were documented. Surgical outcome of flap survival was analyzed. Results: Anatomic variants of 134 (48.4%) dual, 123 (44.4%) single, and 20 (7.2%) no sizable perforators were found in a total of 277 anterolateral thigh flaps. The overall flap survival rate was 97.5%. Flap split was performed in 82 flaps, including 29 single and 5 no sizable perforator cases previously considered “un-splittable”, by utilizing a series of direct skin paddle split, capillary non-sizable perforators harvesting, and flow-through anastomosis technique. Comparable flap survivals were found between split and non-split flaps as well as between split segments supplied by sizable and capillary non-sizable perforators. Primary closure was achieved in 98.9% of the thigh donor sites. Conclusion: A new classification of the common anterolateral thigh flap anatomic variants was proposed and a comprehensive algorithm of split flap strategy was developed along with the innovative “fabricate” concept.

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Section: Discussionmentioning

confidence: 99%

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

Shih,

Chiu,

Jeng

et al. 2024

J Reconstr Microsurg

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Section: Discussionmentioning

confidence: 99%

“…In this study, we reported a cMSAP flap design in reconstructing small to medium‐sized complex defects with deep dead space in extremities. The relatively separated skin paddle and muscle paddle supplied by MSA are harvested through reasonable design 22,23 . The muscle paddle fills the dead space with good blood and oxygen supply and can fight infections, 17 while the skin paddle covers the wound.…”

Section: Discussionmentioning

confidence: 99%

“…The relatively separated skin paddle and muscle paddle supplied by MSA are harvested through reasonable design. 22 , 23 The muscle paddle fills the dead space with good blood and oxygen supply and can fight infections, 17 while the skin paddle covers the wound. Thus, individualised and three‐dimensional reconstruction of the defects was achieved with aesthetic appearance.…”

Section: Discussionmentioning

confidence: 99%

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The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

Sui

Khan

Qing

et al. 2023

International Wound Journal

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Trauma or lesion resection often causes complex wounds with deep soft tissue defects in extremities. Simply covering with a skin flap will leave a deep dead space resulting in infection, non‐healing wounds, and poor long‐term outcomes. Thus, effectively reconstructing complex wounds with dead space leaves a clinical challenge. This manuscript presents our experience using chimeric medial sural artery perforator (cMSAP) flap, to reconstruct complex soft tissue defects of the extremities, thereby exploring broader analysis and indications for future reference. Between March 2016 and May 11, 2022, patients (8 males and 3 females) with a mean age of 41 years (range from 26 to 55 years) underwent reconstructive surgery with the cMSAP flap. The cMSAP flap consists of an MSAP skin paddle and a medial sural muscle paddle. The size of the MSAP skin paddle ranged between 9 × 5 cm and 20 × 6 cm, and the size of the medial sural muscle paddle ranged between 2 × 2 cm and 14 × 4 cm. Primary closure of the donor site was achieved in all cases. Of the 11 patients, the cMSAP flap survived in 10 cases. The vascular compromise occurred in one special case and was treated with surgical procedures. The mean follow‐up duration was 16.5 months (range of 5–25 months). Most patients present satisfactory cosmetic and functional results. The free cMSAP flap is a good option for reconstructing complex soft tissue defects with deep dead space in extremities. The skin flap can cover the skin defect, and the muscle flap can fill the dead space against infection. In addition, three types of cMSAP flaps can be used in a broader range of complex wounds. This procedure can achieve an individualised and three‐dimensional reconstruction of the defects and minimise the donor site morbidities.

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“…Furthermore, prolonged ischemic time can lead to adverse effects on the bone flap and inconsistent outcomes. 31 We therefore proposed DCIA flap harvesting and preparation in two steps, facilitated by cutting and trimming guides, which limits delays/disruptions in surgery procedure and results in high-accuracy final configuration and shorter operation time. Excess bone removal with the trimming guide bypasses the need for repeated adjustments of the flap shape with a surgical burr, thereby simplifying intraoperative workflow and improving surgical efficiency.…”

Section: Discussionmentioning

confidence: 99%

Deep circumflex iliac artery flap reconstruction in Brown’s Class I defect of mandible using a three-component surgical template system

Zheng

Jiang

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Computer-assisted surgery is widely used in mandibular reconstruction, but the process is not well described for cases using the deep circumflex iliac artery flap (DCIA) as the donor site. This study aimed to present a DCIA-based three-component surgical template system (3-STS) in patients with a mandibular Brown class I defect. Methods: This retrospective cohort study compared clinical outcomes of mandibular reconstruction with DCIA flap using 3-STS or conventional surgical templates. The primary outcome of the study was the accuracy of reconstruction, and the secondary outcomes included surgical time and bone flap ischemia time. Surgery-related parameters and functional outcomes were also recorded and compared. Results: Forty-four patients (23 in the 3-STS group and 21 in the control group) between 2015 and 2021 were included. Compared with the control group, the 3-STS group had higher accuracy of reconstruction, indicated by lower deviation in absolute distance (1.45 ± 0.76 mm versus 2.02 ± 0.89 mm; P = 0.034), and less deviation in coronal and sagittal angles (0.86 ± 0.53 degree versus 1.27 ± 0.59 degrees, P = 0.039; and 2.52 ± 1.00 degrees versus 3.25 ± 1.25 versus, P = 0.047) between preoperative and postoperative computed tomographic imaging. Surgical time and bone flap ischemia time were significantly reduced in the 3-STS group compared with the control group (median time, 385 minutes versus 445 minutes and 32 minutes versus 53 minutes, respectively; P < 0.001). In addition, masseter attachment was preserved in the 3-STS group but not in the control group. No differences were found in adverse events or other clinical variables. Conclusion: The 3-STS can improve accuracy, simplify intraoperative procedures to increase surgical efficiency, and preserve functionality in mandibular reconstruction for Brown class I defects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery

Cited by 4 publications

References 43 publications

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

The free chimeric medial sural artery perforator flap for individualised and three‐dimensional reconstruction of complex soft‐tissue defects in extremities

Deep circumflex iliac artery flap reconstruction in Brown’s Class I defect of mandible using a three-component surgical template system

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