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

Miyamoto, Shimpei; Fujiki, Masahide; Nakatani, Fumihiko; Sakisaka, Masanobu; Sakuraba, Minoru

doi:10.1002/micr.22421

Cited by 14 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This avoids several complications, including scarring, adhesions, and contour defects caused by skin grafting. If the damage involves the trunk vessels in the recipient area, flowthrough flaps are the best choice because they provide simultaneous arterial reconstruction and soft tissue coverage [15]. The latissimus dorsi flap is most suitable for patients who need restoration of elbow function, because this flap provides good dynamic muscles for the flexor and extensor muscle group [11].…”

Section: Discussionmentioning

confidence: 99%

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Kang

Pan

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background: Despite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries. Methods: From July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm 2. The mean time of flap reconstruction was 14 days (range 5-29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed. Results: The overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S 1 in three cases, S 2 in eight cases, S 3 in 15 cases, and S 4 in nine cases. There were no donor site complications other than three cases with scar hyperplasia. Conclusions: The severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.

show abstract

Section: Discussionmentioning

confidence: 99%

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Kang

Pan

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…The flow‐through ALT flap has been previously reported in several papers, and it can be used to reconstruct the defective arteries of severely injured lower limbs. Moreover, the branches and the distal end of the descending branch of the LCFA can be used as chain‐linked vessels to connect other flaps, thereby expanding the repair area of these sequential flaps (He et al, 2016; He et al, 2018; Henn et al, 2017; Hsu et al, 2009; Miyamoto et al, 2015). The flap can also carry cutaneous nerves; Thus, it can be used to repair weight‐bearing areas (Kim et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

Qing

et al. 2021

Microsurgery

View full text Add to dashboard Cite

Background: Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow-through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft-tissue defects is described. Methods: From January 2012 to September 2018, 12 patients (six men and six women) aged 6-37 years, sustained injuries in road traffic accidents with large softtissue defects in the lower extremities. Seven cases were Gustillo Anderson type IIIB open fractures and two cases were Gustillo Anderson type IIIC open fractures. Two wounds were located in the knee joint, four in the calf, and six in the ankle and foot. The skin defect size ranged from 25 Â 20 cm 2 to 36 Â 25 cm 2 . All patients in this series underwent reconstruction using combined transfer of the LD musculocutaneous flap and flow-through ALT perforator flap, wherein the LD was attached through its pedicle to the distal continuation of the ALT flap.Results: The size of the flow-through ALT perforator flaps ranged from 13.5 Â 6.5 cm 2 to 31 Â 8.5 cm 2 . The size of the LD musculocutaneous skin paddle ranged from 25 Â 6 cm 2 to 34 Â 7 cm 2 , and that of the muscle paddle ranged from 13 Â 3.5 cm 2 to 30 Â 11 cm 2 . One patient experienced postoperative thrombosis of the venous pedicle, and the flap was salvaged after emergency re-exploration and thrombectomy.No other complications were observed postoperatively. The mean follow-up period was 26.8 months. All patients were able to ambulate independently at the end of the follow-up period. Conclusions:The combined transfer of the LD musculocutaneous flap and flowthrough ALT perforator flap ensured adequate surface coverage, making it a feasible procedure for large soft-tissue defects. | INTRODUCTIONHigh-energy traumatic injury often causes significant soft-tissue loss.Early reconstruction of extensive soft-tissue defects is essential to salvage an extremity and restore its functionality (Soni et al., 2012;Zeltzer & Van Landuyt, 2012;Zhu et al., 2013). Fabricated chimeric flaps or sequential chimeric flaps based on the flow-through anterolateral thigh (ALT) perforator flap were commonly used to restore complex lower extremity defects. However, several reports have focused on the simultaneous transfer of microsurgically

show abstract

“…12,13 Moreover, flow-through flaps allow future microsurgical intervention and multistage flap procedures without increased risk of vascular compromise of the extremity in case of recurring disease. 14 Even though the latissimus dorsi muscle flap and the anterolateral thigh flap are mostly described for the flow-through procedure, this technique is applicable in many other flaps 7,8,[15][16][17][18][19][20][21][22][23][24][25][26] with the only requirement being the presence of a side branch with an acceptable diameter for the anastomosis to the distal stump of the recipient artery.…”

Section: Discussionmentioning

confidence: 99%

Flow-Through Flaps in the Absence of an Arterial Gap for Extremity Defect Reconstruction: Minimizing the Donor-Site Morbidity

Garrido

Qiu

2018

J reconstr Microsurg

View full text Add to dashboard Cite

Background The use of flow-through flaps was popularized in the early 1990s by Costa, Soutar and Lamberty in cases where an arterial gap was present or a major artery of the limb was damaged. We hypothesized that flow-through flaps can be used in all extremity reconstruction cases, where there is an indication for a free-flap, irrespective of the existence of arterial defect due to its many advantages while not increasing the flap loss significantly. Methods A retrospective study was performed by examining patient status and surgery reports of all patients who underwent extremity reconstruction with a flow-through flap from January 2011 to January 2016. This procedure was applied to all the patients, irrespective of the presence of an arterial gap. Results Forty-seven patients were included. The most frequently used flaps were the anterolateral thigh flap and the latissimus dorsi flap. Reconstructions were either posttraumatic or after oncological resection. Two cases of flap loss were encountered. The mean total operating time was 480 ± 153 minutes. The mean follow-up was 10 ± 3 months. There were no donor-site wound complications. Conclusion Based on our results, the flow-through flap technique can be considered a safe alternative to the end-to-side technique for complex extremity defect reconstruction irrespective of the vascular status. The additional arterial anastomosis, even in the absence of an arterial gap or a vascular compromised extremity, did not increase the complication rate in the hands of experienced microsurgeons.

show abstract

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

Cited by 14 publications

References 14 publications

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

Flow-Through Flaps in the Absence of an Arterial Gap for Extremity Defect Reconstruction: Minimizing the Donor-Site Morbidity

Contact Info

Product

Resources

About