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

Fischer, Sebastian; Klinkenberg, Marek; Behr, Bjoern; Hirsch, Tobias; Kremer, Thomas; Hernekamp, Frederick; Kolbenschlag, Jonas; Lehnhardt, Marcus; Kneser, Ulrich; Daigeler, Adrien

doi:10.1055/s-0033-1351394

Cited by 26 publications

(9 citation statements)

References 35 publications

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“…Fisher et al compared patient's satisfaction who received both, ALT and parascapular flap. Herein parascapular flap was also the preferred flap, even though the scar dimensions were greater than with the ALT flap (22). Furthermore, partial flap de-epithelialization can be done (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

et al. 2019

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Reconstructions of complex scalp after ablative resection or by post-traumatic tissue loss, can present difficulties regarding recipient vessel selection, functional, and aesthetic outcome. The harvesting method for many microvascular free flaps requires a need for changing patients position during surgery and makes a simultaneous interdisciplinary two-team approach complicated, which is a major disadvantage regarding safety and operation time. The ideal flap for scalp reconstruction has yet to be described, although the microvascular latissimus dorsi flap is frequently referred to as the first choice in this context, especially after resection of large defects. The purpose of this study is to compare two different microvascular free flaps for a simultaneous scalp reconstruction in an interdisciplinary two-team approach applying a standardized algorithm. All consecutively operated complex scalp defects after ablative surgery from April 2017 until August 2018 were included in this retrospective study. The indications were divided into neoplasm or wound healing disorder. Two microvascular flaps (latissimus dorsi or parascapular flap) were used to cover the soft tissue component of the resulting defects. Seventeen patients met the inclusion criterion and were treated in an interdisciplinary two-team approach. Skull reconstruction with a CAD/CAM implant was performed in 10 cases of which four were in a secondary stage. Nine patients received a parascapular flap and eight patients were treated with latissimus dorsi flap with split thickness skin graft. Anastomosis was performed with no exception to the temporal vessels. One parascapular flap had venous insufficiency after 1 week followed by flap loss. One latissimus dorsi flap had necrosis of the serratus part of the flap. All other flaps healed uneventful and could be further treated with adjuvant therapy or CAD/CAM calvarial implants. Regarding overall complications, flap related complications, flap loss, and inpatient stay no statistical differences were seen between the diagnosis or type of reconstruction. The parascapular flap seems to be a good alternative for reconstruction of complex tumor defects of the scalp besides the latissimus dorsi flap. Stable long-term results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary two-team approach.

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Section: Discussionmentioning

confidence: 99%

A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

et al. 2019

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“…Sensory impairment at the donor site after free flap elevation is one of the most frequently reported morbidities, and abnormal sensation at the donor site is among the most common subjective complaints from patients [ 14 , 24 ]. Elevating ALT free flaps over the superficial fascia was reported to lead to fewer cases of abnormal sensation than in cases of subfascial ALT free flaps due to preservation of the fascial layer [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Thin elevation: A technique for achieving thin perforator flaps

2018

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Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.

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“…The expendable muscle with its reliable pedicle (thoracodorsal artery) can be harvested with or without a skin island from the posterior trunk and is excellently suited for widespread defects. The donor site morbidity of most free flaps is moderate and well tolerated by most of the patients, especially if the donor site can be closed primarily ( 47 – 49 ). Despite the adjuvant radiotherapy applied, the postoperative complications are tolerable and do not limit the use of microvascular tissue transfer.…”

Section: Plastic Surgical Reconstruction Optionsmentioning

confidence: 99%

Reconstruction of Soft-Tissue Defects at the Foot and Ankle after Oncological Resection

et al. 2016

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IntroductionSolid malignancies at the foot and ankle region are rare and include mainly soft-tissue sarcomas, bone sarcomas, and skin malignancies. Complete surgical resection with clear margins still remains the mainstay of therapy in these malignancies. However, attainment of negative surgical margins in patients with locally advanced tumors of the foot and ankle region may require extensive surgery and could result in loss of extremity function. In these circumstances, plastic surgical techniques can frequently reduce functional impairment and cover soft-tissue defects, particularly in cases of large tumor size or localization adjacent to critical anatomic structures, thereby improving the quality of life for these patients. The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with malignant tumors of the foot and ankle region.Materials and methodsThis article is based on the review of the current literature and the evaluation of the author’s own patient database.ResultsThe local treatment of malignant extremity tumors has undergone major changes over the last few decades. Primary amputations have been increasingly replaced by limb-sparing techniques, preserving extremity function as much as possible. Although defect coverage at the foot and ankle region is demanding due to complex anatomical features and functional requirements, several plastic surgical treatment options can be implemented in the curative treatment of patients with malignant solid tumors in this area. Soft-tissue defects after tumor resection can be covered by a variety of local flaps. If local flaps are not applicable, free flap transfers, such as the anterolateral thigh flap, parascapular flap, or latissimus dorsi flap, can be utilized to cover nearly all kinds of defects in the foot and ankle region.ConclusionSoft-tissue reconstruction in the foot and ankle region is a vital component of limb-sparing surgery. It enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. Modern plastic surgical techniques should, therefore, be integrated in the multimodal treatment concept of malignancies in the foot and ankle region.

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

Cited by 26 publications

References 35 publications

A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

Thin elevation: A technique for achieving thin perforator flaps

Reconstruction of Soft-Tissue Defects at the Foot and Ankle after Oncological Resection

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