Free tensor fascia lata flap – a reliable and easy to harvest flap for reconstruction

Sathyamurthy, Renuka; Manjunath, Kalapurmat N; Waiker, Veena; Shivalingappa, Shanthakumar; Kumaraswamy, Mohan Kumar

doi:10.48095/ccachp202157

Cited by 4 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Authors tended to emphasize the stringent selection of suitable candidates given the complex nature of the procedure and the associated prolonged period of mandatory immobilization (Bali et al, 2020; Ciudad et al, 2020; Gencel et al, 2016; Hamdi et al, 2000; Lu et al, 2013; Manrique et al, 2018; Serel et al, 2006; Topalan & Ermis, 2001; Woo et al, 2006; Yu et al, 2012). Despite the selective use of CLFFs, the literature reported successful outcomes in cases as varied as those involving pediatric patients (Topalan & Ermis, 2001; Tvrdek et al, 1995), patients with neuropathic foot ulcers (Hamdi et al, 2000), and patients with prior radiation (Bishop et al, 2018), suggesting this technique is useful in a wide range of settings. Meticulous preoperative counseling helps to foster realistic expectations and ensure patient participation during the recovery period (Zhang et al, 2012a; Bali et al, 2020; Bishop et al, 2018; Ciudad et al, 2020; Gencel et al, 2016; Zhang et al, 2012b; Hamdi et al, 2000; Lu et al, 2013; Manrique et al, 2018; Serel et al, 2006; Topalan & Ermis, 2001; Turgut et al, 2010; Woo et al, 2006; Yu et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

The cross‐leg free flap: A systematic review of the literature

Celie,

Guo,

Raya

et al. 2024

Microsurgery

View full text Add to dashboard Cite

BackgroundFree tissue transfer is a mainstay treatment for lower extremity soft tissue injuries. When the traditional cross‐leg flap cannot provide enough coverage, a cross‐leg free flap (CLFF) is a limb‐saving alternative. The aim of this study is to conduct a systematic review of the literature published on the CLFF.MethodsWe conducted a systematic review of articles describing the CLFF, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Inclusion criteria included articles with primary data on the CLFF. Exclusion criteria included those describing pedicled cross‐leg flaps or lacking complete data. Data analysis was performed using SPSS 29.0.ResultsOur review included 28 articles encompassing 130 patients who underwent free tissue transfer. Most were male (63.8%) with a mean age of 32.4 years. Latissimus dorsi was the most common flap type (30.0%), followed by vertical rectus myocutaneous (20.0%). Average flap size was 301.8 cm2, with trauma in the lower third of the leg being the most common indication (73.1%). The contralateral posterior tibialis was the most common recipient artery (84.1%) followed by the anterior tibialis (9.5%). Complications included amputation (1.4%), partial graft loss, thrombosis, hematoma, prolonged pain, nonunion, and seroma; a forest plot was used to illustrate the low overall adverse events rate. Although bivariate analysis identified age, flap size, type, location, and donor site as variables significantly impacting the incidence of complications (p < .05), this was not sustained in a multivariate logistic regression model.ConclusionThe CLFF remains an excellent option for limb salvage when a suitable recipient vessel is unavailable. Our review demonstrates 1.4% flap failure and an acceptable complication rate. While most cases in our review describe muscle flaps, we report a complex case of limb salvage using an unusually large anterolateral thigh flap.

show abstract

Section: Discussionmentioning

confidence: 99%

The cross‐leg free flap: A systematic review of the literature

Celie,

Guo,

Raya

et al. 2024

Microsurgery

View full text Add to dashboard Cite

show abstract

“…It is critical to monitor the transplanted tissue hourly, particularly in the first 24 hours, as this is the period where most microvascular complications will arise due to arterial and/or venous insufficiency. Capillary refill time, temperature, color, and turgor are monitored [141,142], blood flow is confirmed with a doppler, and oxygenation with a tissue oximeter [143,144]. Short capillary refill time (<2 seconds), purple skin color, marked edema, and increased turgor are indications of venous insufficiency [142].…”

Section: Monitoring For Microvascular Complications Post-operativelymentioning

confidence: 99%

Advances in Ischemia Reperfusion Injury Prevention in Free Flaps and Vascularized Composite Allotransplantation

Hadzimustafic,

D’Elia,

Duru

et al. 2024

Cardiology and Cardiovascular Medicine

View full text Add to dashboard Cite

In Plastic and Reconstructive Surgery, ischemia reperfusion injury (IRI) prevention is of utmost importance in free flaps and vascularized composite allotransplantation (VCA) to continue increasing accessibility to these advanced reconstructive options. At present, free flaps and VCA undergo irreversible ischemic damage at 3 hours due to the highly metabolic nature of skeletal muscle, and static cold storage (SCS) can only extend this to 4–6 hours. It is important to understand that one of the major challenges with transplanting composite tissues is that each tissue has a unique tolerance and mechanism to ischemia-reperfusion. Research targeting attenuation of IRI can be subdivided into 3 time periods: the pre-ischemic, ischemic, and post-ischemic. In the pre-ischemic period, there are conditioning methods, the delay phenomenon, which is already used clinically, pharmacologic, and stem cell strategies. In the ischemic period, SCS is used clinically, whilst other preservation methods including cryopreservation, vitrification, machine perfusion, and pharmacologic strategies are being studied. Lastly, in the post-ischemic period, our greatest clinical tool is close post-operative monitoring, however conditioning methods, and pharmacologic strategies have been studied. This chapter covers IRI in tissues implicated in free flaps and VCA, and several prevention strategies either currently in use or in pre-clinical studies.

show abstract

“…Specifically, omental flaps have been used clinically for wound coverage, lymphedema treatment, reconstruction of the chest wall 24 and protection from anastomotic leaks 25 , 26 . Musculocutaneous flaps are of particular interest due to tensile strength 27 , and their broad applications 28 , 29 . We have selected the TFL flap as a representative musculocutaneous flap model for our study.…”

Section: Introductionmentioning

confidence: 99%

Bioengineering of vascularized porcine flaps using perfusion-recellularization

Xu,

D’Elia,

Hadzimustafic

et al. 2024

Sci Rep

View full text Add to dashboard Cite

Large volume soft tissue defects greatly impact patient quality of life and function while suitable repair options remain a challenge in reconstructive surgery. Engineered flaps could represent a clinically translatable option that may circumvent issues related to donor site morbidity and tissue availability. Herein, we describe the regeneration of vascularized porcine flaps, specifically of the omentum and tensor fascia lata (TFL) flaps, using a tissue engineering perfusion-decellularization and recellularization approach. Flaps were decellularized using a low concentration sodium dodecyl sulfate (SDS) detergent perfusion to generate an acellular scaffold with retained extracellular matrix (ECM) components while removing underlying cellular and nuclear contents. A perfusion-recellularization strategy allowed for seeding of acellular flaps with a co-culture of human umbilical vein endothelial cell (HUVEC) and mesenchymal stromal cells (MSC) onto the decellularized omentum and TFL flaps. Our recellularization technique demonstrated evidence of intravascular cell attachment, as well as markers of endothelial and mesenchymal phenotype. Altogether, our findings support the potential of using bioengineered porcine flaps as a novel, clinically-translatable strategy for future application in reconstructive surgery.

show abstract

Free tensor fascia lata flap – a reliable and easy to harvest flap for reconstruction

Cited by 4 publications

References 0 publications

The cross‐leg free flap: A systematic review of the literature

The cross‐leg free flap: A systematic review of the literature

Advances in Ischemia Reperfusion Injury Prevention in Free Flaps and Vascularized Composite Allotransplantation

Bioengineering of vascularized porcine flaps using perfusion-recellularization

Contact Info

Product

Resources

About