A Simple Method of Intraoperative Identification of a Reliable Perforator while Dissecting an Anterolateral Thigh Flap

Lamba, Shashank; Reddy, Komala Abhishek; Gohil, Amish Jayantilal; Gupta, Ashish Kumar

doi:10.1055/s-0041-1733921

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Where the gracilis myocutaneous flap remains the optimal option for markedly obese patients, additional measures can then be taken to facilitate perforator identification and postoperative monitoring. Some of these additional measures, historically, have included preoperative CTA, magnetic resonance angiography, and digital subtraction angiography, as well as intraoperative color Doppler sonography 21 and indocyanine green fluorescence imaging to confirm the position of the perforator 22 . Postoperatively, clinical examination in addition to portable and implantable Doppler and even certain chemical biomarkers have been used to more closely follow a patient's progress and identify early failure 23 …”

Section: Discussionmentioning

confidence: 99%

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest

Donnelly,

Noh,

Silverman

et al. 2024

Ann Plast Surg

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Introduction The purpose of this study was to evaluate the role of body mass index (BMI) in predicting postoperative complications following myocutaneous free flap transfer. In addition, we sought to identify certain body composition variables that may be used to stratify patients into low- versus high-risk for gracilis myocutaneous free flap with skin paddle failure. Methods Using the National Surgical Quality Improvement Program database, we collected data for all patients who underwent myocutaneous free flap transfer from 2015 to 2021. Demographic data, medical history, surgical characteristics, and postoperative outcomes, including complications, reoperations, and readmissions, were collected. Body mass index was correlated with outcome measures to determine its role in predicting myocutaneous free flap reliability. Subsequently, we retrospectively obtained measurements of perigracilis anatomy in patients who underwent computed tomography angiography bilateral lower extremity scans with intravenous contrast at our institution. We compared body composition data with mathematical equations calculating the potential area along the skin of the thigh within which the gracilis perforator may be found. Results Across the United States, 1549 patients underwent myocutaneous free flap transfer over the 7-year study period. Being in obesity class III (BMI ≥40 kg/m2) was associated with a 4-times greater risk of flap complications necessitating a return to the operating room compared with being within the normal BMI range. In our computed tomography angiography analysis, average perigracilis adipose thickness was 18.3 ± 8.0 mm. Adipose thickness had a strong, positive exponential relationship with the area of skin within which the perforator may be found. Conclusions In our study, higher BMI was associated with decreased myocutaneous free flap reliability. Specifically, inner thigh adipose thickness can be used to estimate the area along the skin within which the gracilis perforator may be found. This variable, along with BMI, can be used to identify patients who are considered high-risk for flap failure and who may benefit from additional postoperative monitoring, such as the use of a color flow Doppler probe and more frequent and prolonged skin paddle monitoring.

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Section: Discussionmentioning

confidence: 99%

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest

Donnelly,

Noh,

Silverman

et al. 2024

Ann Plast Surg

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“…Perforator exploration was performed along the lateral incision about 75% length of the line between the anterior superior iliac spine and the superolateral border of the patella in a subfascial approach. In our practice, “sizable” perforators were defined as vessels with calibers larger than 0.5 mm or comparable to a 24-gauze needle in size 15 where they entered the deep fascia 16 ; whereas “capillary nonsizable” perforators as smaller than 0.5 mm in diameters ( Fig. 1 ).…”

Section: Operative Techniquesmentioning

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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A Simple Method of Intraoperative Identification of a Reliable Perforator while Dissecting an Anterolateral Thigh Flap

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Cited by 2 publications

References 4 publications

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest

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

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