Comparisons of fascio‐cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction

Cherubino, Mario; Stocco, Chiara; Ronga, Mario; Tamborini, Federico; Maggiulli, Francesca; Giovanna, Danilo Di; Campisi, C.; Summa, Pietro di; Valdatta, Luigi

doi:10.1002/micr.30515

Cited by 18 publications

(21 citation statements)

References 20 publications

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“…Different techniques have been suggested when describing other flaps, for example anterolateral thigh flap, to harvest them in a thinner fashion. [32][33][34] We think that the proximal ulnar skin provides a very good match, in terms of thickness and texture, with the hand. In our case series, in fact, the texture match with the volar aspect of the hand was very satisfactory, and we obtained "acceptable" to "very good" aesthetical outcomes in all cases treated.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Cherubino

Bolletta

Baroni

et al. 2020

J Reconstr Microsurg

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Background The purpose of this study is to document the vascular anatomy of the free ulnar artery proximal perforator flap and to highlight the possibility of harvesting it based on the perforators originating from the posterior ulnar recurrent artery (PURA), to spare both the main axis of vascular supply to the hand. In addition, we present a case series of five patients treated for soft tissue defects of the hand with free ulnar artery proximal perforator flaps. Methods Ten specimens of anterior forearm were dissected in this study to register number and characteristics of ulnar perforators. The dissection was focused on the perforators originating from the larger branch of the ulnar artery, the PURA, at the proximal third of anteromedial forearm. The anatomical dissections were evaluated in relationship with clinical dissections performed during flap harvesting in five patients. Results In three of the specimens dissected, the proximal perforator originated from the PURA, and in the other seven specimens, it originated directly from the ulnar artery. Five cases of reconstruction of the hand were performed with success using the free ulnar artery proximal perforator flap, and in two cases, the perforator from the PURA was found and it was possible to raise the flap based on this branch of the ulnar artery. Conclusion The free ulnar artery proximal perforator flap can be harvested in two different manners for the same skin island of the forearm. When possible, harvesting it form the PURA allows lengthening of the pedicle. In our experience, this flap presents many advantages such as thinness and hairlessness; it allows preservation of the ulnar neurovascular bundle with an acceptable donor site morbidity. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 99%

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Cherubino

Bolletta

Baroni

et al. 2020

J Reconstr Microsurg

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“…However, LEFS used in our study, which is a very established and sensitive tool to measure lower extremities functional impairment, 11,29 showed similar results if compared with data obtained from literature. 30,31 In particular, Fischer et al 30 reported a mean LEFS of 55.4 (n ¼ 20) and 59.0 (n ¼ 20) in a cohort of 40 patients who underwent soft tissue reconstruction with an adipocutaneous ALT and a fasciocutaneous ALT, respectively. Although it remains to be proven, these results suggest how the harvesting of a muscular flap could not affect the long-term donor site morbidity in terms of lower extremities function.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap

et al. 2021

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The aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75–69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5–33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0–72.5). The median PSS-HN score was 80.0 (IQR: 45.0–95.0), 75.0 (IQR: 62.5–100.0), 75.0 (IQR: 62.5–100.0) for “Normalcy of Diet,” “Public Eating,” and “Understandability of Speech,” respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5–74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

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“…Very few comparisons have been made in the literature between ALT and SALT flaps, as the latter has only recently been described. 17 Undoubtedly, a thinner flap has the added benefit of a better adaptability to previously excised structures and of a more anatomical reconstruction of the orbital pocket. Compared with the standard or with the suprafascial ALT flap, the SALT flap generally does not need secondary surgical thinning, allowing for a one-step procedure before the socket positioning.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, its versatility has allowed us to experience different variations in recent years. Among all, the chimeric ALT free flap 14 , 15 is used for complex orbital defects, and the “sandwich” fascial ALT flap (SALT) 16 , 17 (Fig. 2 ) and a multilayer fascia ALT free flap were designed to ameliorate the postoperative aesthetic appearance.…”

Section: Introductionmentioning

confidence: 99%

Social Perception of Reconstruction following Orbital Exenteration

Cherubino

Baroni

Santoro

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Orbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered. Facial disfigurement following reconstructive surgery often leads to great discomfort and social retirement, which can limit social interaction. The aim of this study was to explore how the society perceives the aspect of patients who underwent orbital exenteration and subsequent reconstruction, comparing two different types of reconstruction: standard anterolateral thigh (ALT) or “sandwich” fascial ALT (SALT) free flap. Methods: An online survey was created based on four questions regarding the perception of reconstruction (discomfort at looking at that patient, perception of unhealthiness, hypothesis of social life impairment, etc); five possible answers were provided, ranging from “completely” to “not at all.” The survey was administered to the general population and to medical students. Results: In total, 255 people participated to the survey (130 medical students and 125 people of the general population); a total of 245 surveys were considered eligible (10 were incomplete and then discharged). Statistical significance was found ( P < 0.001) regarding the better overall appearance of the SALT group over the ALT one. Conclusions: After analysis, the surgical outcome after SALT reconstruction has been found to be less disruptive in both groups, due to a reduced scar burden and a more pleasant orbital pocket. Our results encourage more research in the field of postexenteration reconstruction to achieve more aesthetic and social acceptability.

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Comparisons of fascio‐cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction

Cited by 18 publications

References 20 publications

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap

Social Perception of Reconstruction following Orbital Exenteration

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