Fascia-Only Anterolateral Thigh Flap for Extremity Reconstruction

Fox, Paige M.; Endress, Ryan; Sen, Subhro K.; Chang, James

doi:10.1097/sap.0000000000000146

Cited by 28 publications

(25 citation statements)

References 13 publications

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“…Also, recent efforts on improving the aesthetic aspects of post-traumatic reconstruction have introduced novel thin variants ofperforatorflaps,asthesuprascarpal(superthin)ALTflap,which haveprovedsafeandbetteradapttothethinlegprofile [35][36][37][38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries

Toia

Zabbia

Scirpo

et al. 2019

Handchir Mikrochir plast Chir

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Background “Orthoplastics” is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. Material and methods Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. Results In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. Conclusion The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction.

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Section: Discussionmentioning

confidence: 99%

Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries

Toia

Zabbia

Scirpo

et al. 2019

Handchir Mikrochir plast Chir

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“…Preoperative view of the extensive soft-tissue defect after debridement panniculus of the thigh is thick even in thin subjects, and especially in women. When we need the fascia lata for tendon repair, massive thinning by removing the deep fascia is not possible (Fox, Endress, Sen, & Chang, 2014;Parrett, Bou-Merhi, Buntic, Safa, Buncke, & Brooks, 2010;Torres-Ortiz Zermeno, & Lopez Mendoza, 2014;Yamamoto, Narushima, Yoshimatsu, Yamamoto, Mihara, & Koshima, 2014).…”

Section: Discussionmentioning

confidence: 99%

Peroneal perforator‐based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft‐tissue defect of the forearm: A case report

2016

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We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43-year-old man had his left arm caught in a conveyor belt resulting in a large soft-tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow-through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow-up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects.

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“…16,17 Flap-related complications in upper extremity reconstruction have been reported in 25 to 27% of cases, including skin necrosis, infection, hematoma, and complete flap loss in one case. [16][17][18][19] The ALT flap provides a large amount of soft tissue and can be used to reconstruct a wide range of upper extremity injuries. Its size and long vascular pedicle makes it well suited for large defects.…”

Section: Anterolateral Thigh Flapmentioning

confidence: 99%

Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction

et al. 2017

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The goals of upper extremity soft tissue reconstruction should go well beyond providing coverage and restoring function. As the field of reconstructive microsurgery has evolved, free cutaneous flaps (FCFs) are gaining wider application. The advantages of FCF include minimizing donor-site morbidity by preserving the muscle and fascia, improving versatility of flap design, and superior aesthetic results. This review highlights the application of anterolateral thigh, superficial circumflex iliac artery, deep inferior epigastric perforator, superficial inferior epigastric artery, and flow-through flaps for reconstruction of upper extremity defects. These flaps share several qualities in common: well-concealed donor sites, preservation of major arteries responsible of providing inflow to distal extremity, and potential for a two-team approach (donor and recipient sites). While the choice of flaps should be decided based on individual patient and defect characteristics, FCF should be considered as excellent options to achieve the goals of upper extremity reconstruction.

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Fascia-Only Anterolateral Thigh Flap for Extremity Reconstruction

Abstract: The fascia-only ALT flap provides reliable, thin, and pliable coverage with improved contour and color over muscle and fasciocutaneous flaps. The fascia-only ALT is another excellent option for reconstructive surgery of the extremities.

Cited by 28 publications

References 13 publications

Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries

Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries

Peroneal perforator‐based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft‐tissue defect of the forearm: A case report

Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction

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