Chimeric ALT Plus TFL Perforator Flap for Breast Reconstruction Post Radical Mastectomy with Large Skin Defect

Jaiswal, Dushyant; Mantri, Mayur; Shankhdhar, Vinay Kant; Wagh, Snehjeet Hemant

doi:10.1055/s-0041-1730844

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…This technique can also be employed for other chimeric flaps or when large ALT needing a STSG for closure is required. 9 Here a longer flap with primarily closable donor area can be harvested preserving the nerves. The flap can be divided into separate components or paddles based on separate perforators, which are subsequently rearranged to cover a larger defects.…”

Section: Discussionmentioning

confidence: 99%

In-Situ ‘Divide’ and ‘Deliver’: A Simple Technique to Preserve Nerves in Chimeric Anterolateral Thigh Flap Harvest

Jaiswal

Parekh²,

Mathews

et al. 2023

Indian J Plast Surg

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Anterolateral thigh (ALT) flap is the workhorse for reconstruction in head and neck post cancer excision. Chimeric multi-paddle flaps are useful for composite defects involving skin, mucosa, and soft tissue. The nerve to vastus lateralis (VL) runs along the pedicle, frequently interdigitating with it or the perforators. Sometimes, the nerve may be preserved during harvest but needs to be sacrificed frequently, leading to increased donor site morbidity.We recommend a simple technique to preserve the nerve, wherein the skin paddles or chimeric components are divided in-situ and manipulated around it without causing injury.This technique was used in 27 cases over 5 years. All involved nerves, perforators and pedicles were preserved.The technique can be extended to any flap harvest with multiple perforators with nerves in proximity, when multiple skin islands are desired.

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Section: Discussionmentioning

confidence: 99%

In-Situ ‘Divide’ and ‘Deliver’: A Simple Technique to Preserve Nerves in Chimeric Anterolateral Thigh Flap Harvest

Jaiswal

Parekh²,

Mathews

et al. 2023

Indian J Plast Surg

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“…9 ) flaps or both free ALT and free tensor fascia latae (TFL) flaps as double free flaps are sometimes needed for radical mastectomy for recurrent or large primary invasive ductal carcinoma, malignant phyllodes, or rarer chest wall tumors. 2 Sometimes the large ALT flaps are perfused by multiple perforators arising from two separate pedicles. In case of combined free ALT and TFL flaps, their use as separate free flaps requires extra set of vessels for the other flap.…”

Section: Discussionmentioning

confidence: 99%

Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle

Jaiswal

Mathews

Gupta

et al. 2022

Indian J Plast Surg

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Introduction The aim of this study is to assess the results of retrograde flow of internal mammary artery and vein (IMA/V) as a donor vessel for free flap microvascular anastomosis (MVA). This need arises with bipedicle deep inferior epigastric perforator (DIEP) flaps, when all four zones with extra fat need to be harvested for unilateral breast reconstruction coupled with poor midline crossover of circulation naturally or because of midline scar. Large anterolateral thigh flaps for chest wall cover, with multiple perforators from separate pedicles, also need supercharging. This needs an additional source of donor vessels, antegrade IMA/V being the first one. Materials and Methods Retrospective study of microvascular breast reconstruction using retrograde internal mammary donor vessels. Results Out of 35 cases, 20 cases had distal IMA/V, with retrograde flow, as donor vessel for second set of arterial and venous anastomosis. In two cases, retrograde IMA/V was used for the solitary set of MVA. In remaining 13 cases, either retrograde IMA or V was utilized either as a principal or accessory donor. No flap was lost. Venous and arterial insufficiency happened in one case each, both were salvaged. Two cases developed partial necrosis, needing debridement and suturing. One case developed marginal necrosis. Only one case developed fat necrosis with superadded infection on follow-up. Conclusion Distal end of IMA and IMV on retrograde flow is safe for MVA as an additional or sole pedicle. It is convenient to use being in the same field. It enables preservation of other including thoracodorsal pedicle and latissimus dorsi flap for use in case of a complication or recurrence.

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“…These types of flaps involve harvesting part of the skin, subcutaneous fat and muscle of the calf and transplanting to the affected area 4 . However, the major problem of the myocutaneous flap is the unseparated skin and muscle flaps with limited mobility between the skin and muscle 5 . As a result, the appearance of the recipient site is usually bulky and the donor site is damaged greatly.…”

Section: Introductionmentioning

confidence: 99%

“… 4 However, the major problem of the myocutaneous flap is the unseparated skin and muscle flaps with limited mobility between the skin and muscle. 5 As a result, the appearance of the recipient site is usually bulky and the donor site is damaged greatly. Another available method is combined free skin flaps and muscle flaps transplantation for repairing wounds with deep dead space.…”

Section: Introductionmentioning

confidence: 99%

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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Chimeric ALT Plus TFL Perforator Flap for Breast Reconstruction Post Radical Mastectomy with Large Skin Defect

Cited by 3 publications

References 8 publications

In-Situ ‘Divide’ and ‘Deliver’: A Simple Technique to Preserve Nerves in Chimeric Anterolateral Thigh Flap Harvest

In-Situ ‘Divide’ and ‘Deliver’: A Simple Technique to Preserve Nerves in Chimeric Anterolateral Thigh Flap Harvest

Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle

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

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