Chimeric anterolateral thigh free flap for head and neck reconstruction

Karonidis, Athanasios; Yao, Sheng Fa

doi:10.1016/j.bjps.2008.08.031

Cited by 15 publications

(8 citation statements)

References 4 publications

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“…Previous studies have reported that an average of four musculocutaneous perforators could be identified per thigh despite the anatomical variations in ALT flaps. Moreover, only 7% of cases presented with only one perforator [9][10][11] . Therefore, the probability of harvesting a perforator-based ALT flap was very high.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification

Yao

Liu

2020

Sci Rep

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Reconstruction of composite oral and maxillofacial defects using free flaps is challenging. The key to such delicate reconstruction lies in the evaluation of the defect. However, few reports have described the clinical classification of these difficult defects. In this study, we proposed a classification method and developed different reconstructive solutions using free flap techniques according to this classification. This classification method was established based on two parameters (the elements and distribution of the missing tissues). Among the 17 patients with composite oral and maxillofacial defects included in this study, 8 patients presented with type A defects, one patient presented with a type B defect, and the other 8 patients presented with type C defects. No type D defects were observed in this study. Three types of free flaps were used to reconstruct the respective types of composite defects. Perforator-based ALT flaps were used to reconstruct Type A defects. Branch-based ALT flaps were used to reconstruct Type B defects. For Type C defects, two reconstructive solutions were used, including a well-designed fibular flap and a perforator-based ALT flap with or without a metal plate for bony reconstruction. All flaps survived after surgery. This classification system may help select and design specific free flaps for reconstructing composite oral and maxillofacial defects.Composite oral and maxillofacial defects after ablative oncological surgery, such as typical through-and-through oral defects, are challenging clinical problems for plastic and reconstructive surgeons. Multiple factors, including different related anatomical sites, multiple types of missing tissues, and sometimes even two separate defects, often cause these composite defects to be variable and complicated to reconstruct. Understanding the features or patterns of these composite defects may provide a framework to describe these defects and help plan the reconstructive algorithm. However, as we know, few studies have reported the classification of composite oral and maxillofacial defects.Surgical reconstruction for these composite defects is quite difficult because multiple types of tissue from different anatomic sites are missing 1,2 . Reconstruction of these complicated defects not only requires restoring the anatomy but also replacing the exact amount and types of missing tissue. The application of free flaps to reconstruct composite oral and maxillofacial defects has been well reported in the literature 3-7 . However, few studies have discussed choosing different reconstructive solutions and designing free flaps based on a classification of composite oral and maxillofacial defects.In the present study, we reviewed a series of patients with composite oral and maxillofacial defects and proposed a new classification method based on the elements and distribution of the missing tissues. Three types of reconstructive solutions using a free flap technique were developed accordingly. The reconstructive results using free flaps based on thi...

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Section: Discussionmentioning

confidence: 99%

Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification

Yao

Liu

2020

Sci Rep

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“…3 Thus, this flap can be inset into many different kinds of defects. The versatility of this flap offers many advantages, but the variability of the pedicle anatomy and the difficult dissection can be a challenge for the surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…The oral cavity is the most common site of this tumor, and wide excision is the most commonly used treatment. 1 To restore the lips, free-tissue transfer is the first choice of reconstruction after cancer resection in the head and neck area, 2 and several kinds of reconstructive options have been proposed, including chimeric anterolateral thigh (ALT) flaps, 3 scalp visor flaps, 4 and free radial forearm (RFA) flaps. [5][6][7][8][9] We chose one free ALT flap in chimeric style for reconstruction with two skin islands, each with its independent perforator.…”

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confidence: 99%

Reconstruction of the complete loss of upper and lower lips with a chimeric anterolateral thigh flap: A case report

et al. 2011

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It is difficult to totally reconstruct the lips and achieve good functional and aesthetic results, such as oral sphincter function, sensation, appearance, color, and movement. There have been few reports of reconstructing complete lip defects. We present a case of completely reconstructing the lip defects of a 55-year-old patient who had verrucous carcinoma of the buccal mucosa and lips. Extensive ablation was performed by wide bilateral excision of the buccal mucosa and marginal resection of the anterior mandible and both lips. The tongue, partial tongue base mucosa, and retromolar trigone were preserved. To reconstruct and resurface the intraoral and lip defects nearly totally, we applied a free anterolateral thigh (ALT) flap in chimeric style with two independent sets of perforators and skin islands. To achieve better oral function and cosmetics, revisions of the ALT flap, full-thickness scrotal skin grafting, autologous fat grafting, and skin tattooing were done in stages. Postoperative oral sphincter function was obtained without drooling; the general appearance of the lips was also acceptable.

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“…4,[23][24][25][26][27] Furthermore, by inclusion of the descending branch of the lateral femoral circumflex artery, a flow through flap or a combination with other free tissue transplants-in terms of a chimeric flap-can be generated. [28][29][30] These attributes turned the ALT flap to one of the most applied free flaps in reconstructive surgery. 31,32 Although most authors confirmed acceptable results concerning donor-site morbidity, weakness of the leg and a sensitivity deficit were often observed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Donor-Site Morbidity and Satisfaction between Anterolateral Thigh and Parascapular Free Flaps in the Same Patient

Fischer

Klinkenberg

Behr

et al. 2013

J reconstr Microsurg

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The purpose of this study was to compare donor-site morbidity after anterolateral thigh (ALT) and parascapular (PS) free flap harvest in the same patient. A total of 13 patients were included in this study. Because of initial flap loss, each patient received ALT as well as PS free flap transplantation. A total of 10 patients were available for follow-up. The average follow-up time was 44.5 months. Besides physical examination, range of motion and scar dimensions were assessed to objectify donor-site deficiencies. The subjective donor-site morbidity was assessed by the patients using a self-report questionnaire. In addition, patients were requested to state their donor-site preference. ALT donor site revealed more sensitivity deficiencies compared with the PS harvest site (8 vs. 4). The latter provoked less functional impairments (1 vs. 2). Scar dimensions were larger at PS harvest site (25.8 × 4.3 cm vs. 23.3 × 3.6 cm). Patients' satisfaction was in favor of the PS donor site (1.9 vs. 2.7). Among the 10 patients, 7 patients preferred the PS and 3 patients preferred the ALT donor site. Comparison of donor-site morbidities in the same patient reveals a valuable tool to diminish individual bias. Despite the low number of cases, we were able to demonstrate the superiority of PS compared with ALT donor sites.The Level of Evidence of the study is III.

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Chimeric anterolateral thigh free flap for head and neck reconstruction

Cited by 15 publications

References 4 publications

Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification

Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification

Reconstruction of the complete loss of upper and lower lips with a chimeric anterolateral thigh flap: A case report

Comparison of Donor-Site Morbidity and Satisfaction between Anterolateral Thigh and Parascapular Free Flaps in the Same Patient

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