Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: Anatomical study and case report

Sananpanich, Kanit; Tu, Yuan Kun; Kraisarin, Jirachart; Chalidapong, Preecha

doi:10.1016/j.injury.2008.08.031

Cited by 38 publications

(33 citation statements)

References 14 publications

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“…Sananpanich et al dissected 47 cadavers to investigate pedicle configurations in the lateral descending branch of LCFA system. The mean total length of the descending branch from its origin to terminus was 30.3 cm (range 22.5–37.1 cm) and the mean diameter at its origin was 3.0 mm (range, 2.2–4.0 mm) while the mean terminal diameter was 1.3 mm (range 0.9–1.8 mm) . In our study, the mean diameter of the descending branch of LCFA was 1.2 mm and the mean length was 14.4 mm.…”

Section: Discussionsupporting

confidence: 47%

Descending branch of the lateral circumflex femoral artery as a recipient vessel for vascularized fibular grafts: Clinical case series

et al. 2014

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Vascularized fibular grafts (VFG) are used for the treatment of femoral head avascular necrosis, osteomyelitis, nonunions, and excessive bone defects. Mostly the ascending branch of the lateral circumflex femoral artery (LCFA) or first or second perforating branch of the profound femoral artery is used for the customary recipient vessel. In this report, an alternative technique of using descending branch of LCFA in VFG surgery and its clinical results are reported. Sixteen patients (13 men and 3 women) underwent VFG surgery between the years 2005 and 2012. Predicted etiologies were: ANFH in 10 hips, traumatic femur neck pseudoarthrosis in 4 hips, tumor in 1 hip, and 1 femur shaft defect due to osteomyelitis. Patients' average age at the time of surgery was 29 years (range, 14-43 years). All patients were treated with VFG. All of the grafts survived and none of the patients needed any revision surgery. One had superficial wound infection, one developed peroneal nerve palsy, and one had trochanteric bursitis. The follow-up time was 36 months (range 20-72). It is believed that the descending branch of LCFA is a reliable alternative for anastomosis in VFG surgery.

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Section: Discussionsupporting

confidence: 47%

Descending branch of the lateral circumflex femoral artery as a recipient vessel for vascularized fibular grafts: Clinical case series

et al. 2014

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“…24,25 The anterolateral thigh flap exhibits many advantages, including a large cutaneous area, long vascular pedicle, adjustable sickness and acceptable donor-site morbidity. 13 In this study, of the five patients treated with anterolateral thigh flaps, no severe complications occurred, and only one patient complained of paroxysmal neuralgia and skin numbness of the lower limb postoperatively.…”

Section: Surgical Treatmentsmentioning

confidence: 58%

“…Ideally, the designed flap dimension should be 10% larger than the defect. The anatomical details of the vasculature of this flap have been described by Sananpanich et al 13 Second, the vasculature was anatomized to an appropriate length to ensure that the flap exhibited sufficient movement (Figure 4d). A tunnel was made between the donor area and the defect.…”

mentioning

confidence: 99%

Penoscrotal extramammary Paget's disease: surgical techniques and follow-up experiences with thirty patients

Chen¹,

Chen²,

Wang³

et al. 2013

Asian J Androl

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To report the surgical management, complications and prognosis of patients with penoscrotal extramammary Paget's disease (EMPD) at different clinical stages. Between 2003 and 2008, a total of 30 male patients with penoscrotal EMPD were enrolled and evaluated. All enrolled subjects received frozen biopsy-guided local wide resection and immediate reconstruction. Patients were followed every 3 months postoperatively. Among the 30 patients who accepted and underwent frozen biopsy-guided local wide resection treatment and reconstruction, two (6.7%) cases exhibited positive margins, verified by pathological examination, and underwent re-excision after surgery. The technique of primary closure or an adjacent flap was used in 10 (33.3%) cases, split-thickness skin grafts were used in 15 (50%), and an anterolateral thigh perforator flap was used in five cases (16.7%). The postoperative complications were acceptable. The mean follow-up time was 64.9629.6 months. Of all 30 cases, 22 patients (73.3%) survived with no evidence of recurrence, four patients (13.3%) exhibited local recurrence, two patients (6.7%) exhibited both local recurrence and distant metastasis and the remaining two patients (6.7%) exhibited distant metastasis. Five patients died from metastasis or cachexia. Current surgical techniques, including primary closure, adjacent flaps, split-thickness skin flaps and anterolateral thigh perforator flaps are able to reconstruct all types of defects with acceptable complications. Some patients with negative margins went on to exhibit local recurrence, potentially due to adnexal carcinoma or internal malignancy.

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“…The use of a flow‐through ALT flap for popliteal artery reconstruction is a concern, because of the size discrepancy between the popliteal artery and flap artery. This is not a problem at the proximal anastomosis, because the diameter of the proximal LCFA is comparable to that of the popliteal artery; however, the distal stump of the descending branch of LCFA is usually much smaller (0.9–1.8 mm) and direct anastomosis to the popliteal artery is impossible . There are two possible solutions to this problem.…”

Section: Discussionmentioning

confidence: 99%

Free flow‐through anterolateral thigh flap for complex knee defect including the popliteal artery

et al. 2015

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Reconstruction of complex knee defects including the popliteal artery presents a challenging problem in reconstructive microsurgery. Reconstruction of the popliteal artery and soft-tissue coverage should be performed simultaneously for limb salvage. We present the one-stage reconstruction of a complex knee defect including the popliteal artery using a free flow-through anterolateral thigh (ALT) flap as a bypass flap in two patients with sarcomas. In both patients, the popliteal artery and vein were reconstructed using branches of the lateral circumflex femoral arterial system. The flaps survived without vascular compromise and the limbs were preserved successfully. Free flow-through ALT flap enables simultaneous leg revascularization and soft-tissue coverage with a single free flap. The lateral circumflex femoral arterial system has many branches with large diameters, making it suitable for reconstruction of multiple infrapopliteal arteries.

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Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: Anatomical study and case report

Cited by 38 publications

References 14 publications

Descending branch of the lateral circumflex femoral artery as a recipient vessel for vascularized fibular grafts: Clinical case series

Descending branch of the lateral circumflex femoral artery as a recipient vessel for vascularized fibular grafts: Clinical case series

Penoscrotal extramammary Paget's disease: surgical techniques and follow-up experiences with thirty patients

Free flow‐through anterolateral thigh flap for complex knee defect including the popliteal artery

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