Anterolateral Thigh Adipofascial Flap for Correction of Facial Contour Deformities and Micromastia

Abstract

The anterolateral thigh (ALT) flap has gained popularity, yet the donor site remains problematic. With increased knowledge of the vascular anatomy, we anticipated that we would be able to contour the ALT adipofascial flap when reconstructing facial deformities and micromastia without sacrificing skin at the donor site. A total of 24 cases of hemifacial atrophy and 1 case of micromastia underwent anterolateral thigh adipofascial flap transplantation with vascular anastomosis. All surgical reconstructions resulted in satisfactory results with minimal donor-site morbidity. The anterolateral thigh adipofascial perforator flap is an ideal choice for autologous tissue reconstruction with primary defatting.

Decellularized skin/adipose tissue flap matrix for engineering vascularized composite soft tissue flaps

“…Hence, ischemia/hypoxia always leads to necrosis or dysfunction of cells-biomaterials constructs and especially that of the core of large-scale engineered constructs. Unsurprisingly, then, we found in the present study that without reanastomosis to recipient vessels, even with precellularization, adipose tissue regeneration occurred only in the peripheral area of the explants in group B, whereas fibrosis occurred in most areas of the explant in both group B and group C. This finding coincides with previously reported clinical findings indicating that compared with non-vascularized free flap transplantation, vascularized adipose facial free flap transplantation results in better outcomes for patients undergoing facial contour deformity correction [43–44]. Unlike the constructs of groups B and C, the construct of group A was highly vascularized at 3 months, and this vascularization was closely associated with better constructive remodeling and maintenance of mature adipose tissue regeneration.…”

Esthetic Restoration in Progressive Hemifacial Atrophy (Romberg Disease)

“…[1][2][3][4][5][6][7][8] Free Microsurgical Transfer to Volume Restoration Thirty-nine articles were included in this second group and were published from 1974 to 2011. 12,21,25,26,[30][31][32]45 Volume correction was achieved with a single free flap harvested from the trunk in 17 cases, 9,10,12,14,17,19,21,22,27,29,36,37,39,42,44,47 with a single free flap from the limbs in 8 cases, 26,[33][34][35]40,43,45,46 and with a single free flap from the abdomen in 3 cases. The mean age of correction was 24.7 years (range, 5-59 y) 9-11,13-20,22-24,27-29,33.44,46,47 and was not available in 8 articles.…”

“…In the remaining cases, volume restoration was obtained using 2 free flaps in 4 articles (31 patients), 11,20,28,41 3 free flaps in 5 articles (194 patients), 16,23,24,31,32 and 5 free flaps in 1 article (1 patient). 39,44,46 The mean follow-up was 41 months (range, 0.5-228 mo) and was not available in 4 articles. Complications were reported in 21 articles 9,11,[13][14][15][16]20,22,27,28,30,31,34,[38][39][40][41][43][44][45]47 and included hematoma, 11,14,16,27,28,31,41,43 infection, 9,16,30 partial flap loss, 14,20,30,38 bulkiness, 15,16,39,40,45 atrophy, 34,41 d...…”

“…The mean follow-up (41 mo) is close to that of patients who have undergone soft tissue restoration using structural fat grafting (43 mo). They did not report flap atrophy and noticed that, in patients who gained 3 Groin flap 11,12,14,16,17,20,22,24,25,29,31,32 12 Deep inferior epigastric perforators flap 11 1 Scapular and parascapular 17,[23][24][25]27,[30][31][32]36,37,47 11 Latissimus dorsi flap 21,24,25,31,39,41 6 Omental flap 13,15,20,23,38 5 Dorsalis pedis flap 16 1 Circumflex iliac flap 16,42 2 Gracilis flap 23 1 Radial forearm flap 25,26,30 3 Serratus flap 28,44 2 Lateral arm flap 28 1 Anterolateral thigh flap [33][34][35]40,41,43,45,46 8 The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014 Fat Grafting Versus Local/Free Flaps weight, the flap volume increased but the free tissue transfer did not alter the natural history of the disease process. First, the structural fat grafting technique has been introduced to the clinical practice more recently with respect to the microsurgical correction of soft tissue volume deficiency, which in part explains the larger number of patients treated with free tissue transfer.…”

Use of Various Free Flaps in Progressive Hemifacial Atrophy

“…The variation in vascular anatomy, which may make the dissection of perforators hard, is one disadvantage of the ALT flap. 26,27 In our study, adjunctive procedures such as fat injection to fill the edge of the flap and additional bone graft or orthognathic surgery to correct skeletal asymmetry were used if, after first surgical procedure, the flap became partially undercorrected, or better morphologic results were desired with additional contouring of the facial bony structure. The hemifacial atrophy patients with severe maxillary deficits showed asymmetry of zygoma and deviation of the occlusive plane, causing defective occlusive function.…”