Hand Reconstruction Using the Thin Anterolateral Thigh Flap

Adani, Roberto; Tarallo, Luigi; Marcoccio, Ignazio; Cipriani, Riccardo; Gelati, Chiara; Innocenti, Marco

doi:10.1097/01.prs.0000173059.73982.50

Cited by 96 publications

(75 citation statements)

References 37 publications

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“…If local flaps are not feasible, free tissue transfer often is the treatment of choice because of superior functional and esthetic results. For coverage of defects of the hand, especially the lateral arm flap, the parascapular flap, the anterior lateral thigh flap as well as temporalis and serratus fascial flaps are excellent options [1,6,11,13]. In our practice, the use of the pedicled radial forearm flap is therefore generally limited to Figure 4 Soft tissue defect in a 43-year-old patient exposing a reconstructed extensor tendon in the partially amputated ring finger after loss of the second and fifth digit.…”

Section: Discussionmentioning

confidence: 99%

The Evolution of the Pedicled Radial Forearm Flap

Megerle

Sauerbier²,

Germann

2009

Hand (New York, N,Y.)

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Because of the thin skin envelope of the hand, especially at the dorsum, flaps are frequently required for defect reconstruction in the hand. The pedicled radial forearm flap is a time proven procedure that offers reliable coverage in this area without the need of advanced microsurgical expertise. Despite several alternatives and an increasing acceptance of free tissue transfers, the pedicled radial forearm flap can still be the procedure of choice under special circumstances. Variations of the original technique address the two main disadvantages, the conspicuous donor site and the sacrifice of the radial artery. Indications, anatomy, surgical technique, and limitations of this classic workhorse flap are presented.

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Section: Discussionmentioning

confidence: 99%

The Evolution of the Pedicled Radial Forearm Flap

Megerle

Sauerbier²,

Germann

2009

Hand (New York, N,Y.)

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“…In bulky fasciocutaneous flaps, postoperative staged thinning procedures may become necessary to improve hand function. 29,30 Secondary procedures have the imminent risk of denervation and skin necrosis. 31 Hair growth of fasciocutaneous flaps may not be appreciated aesthetically especially in women.…”

Section: Unit (R) And/or Unit (U) Defects Of the Palmmentioning

confidence: 99%

“…32 In sensory fasciocutaneous flaps, an intact sensory donor nerve, e.g., the palmar branch of the median nerve is required for coaptation. Without any donor nerve, available alternative fasciocutaneous free flaps, e.g., scapular-, parascapular flap, 33 thoracodorsal artery perforator flap, 34 anterolateral thigh flap 29 and more innovative procedures (see unit (c) defects) or local pedicled flaps such as the posterior interosseus artery flap 35 are optional. In noninnervated fasciocutaneous flaps, nerve regeneration by collateral sprouting may also result in inconsistent postoperative sensation of the skin.…”

Section: Unit (R) And/or Unit (U) Defects Of the Palmmentioning

confidence: 99%

Functional resurfacing of the palm: Flap selection based on defect analysis

et al. 2011

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Extensive defect coverage of the palm and anatomical reconstruction of its unique functional capacity remains difficult. In manual laborers, reconstruction of sensation, range of motion, grip strength but also mechanical stability is required. Sensate musculo-/fasciocutaneous flaps bear disadvantages of tissue mobility with shifting/bulkiness under stress. Thin muscle and fascial flaps show adherence but preclude sensory nerve coaptation. The purpose of this review is to present our algorithm for reliable selection of the most appropriate procedure based on defect analysis. Defect analysis focusing on units of tactile gnosis provides information to weigh needs for sensation or soft tissue stability. We distinguish radial unit (r)-thenar, ulnar unit (u)-hypothenar and unit (c)-central plus distal palm. Individual parameters need similar consideration to choose adequate treatment. Unit (r) and unit (u) are regions of secondary touch demanding protective sensation. Restoration of sensation using neurovascular, fasciocutaneous flaps is recommended. In unit (c), tactile gnosis is of less, mechanical resistance of greater value. Reconstruction of soft tissue resistance is suggested first in this unit. In laborers, free fascial- or muscle flaps with plantar instep skin grafts may achieve near to anatomical reconstruction with minimal sensation. Combined defects involving unit (c) require correlation with individual parameters for optimal flap selection. Defect coverage of the palm should not consist of merely providing sensate vascularized tissue. The most appropriate procedure should be derived from careful defect analysis to achieve near to anatomical reconstruction. In laborers, defect related demands need close correlation with sensation and mechanical stability to be expected.

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“…Today, such flaps have a very wide range of indications such as in reconstructions of the head and neck, trunk and limb extremities (14)(15)(16)(17)(18) , especially because of the anatomical and safety characteristics of the flap and because of the minimal morbidity in the donor area.…”

Section: Discussionmentioning

confidence: 99%

Reconstrução após ressecção extensa de tumor das cinturas pélvica e escapular: relato de dois casos

Dall'Agnol¹,

Freitas²,

Crivellaro³

et al. 2012

Rev. bras. ortop.

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The authors declare that there was no conflict of interest in conducting this work ABSTRACTRadical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases -one hemipelvectomy and one interscapulothoracicl amputation -using these two the flaps to close the defect.

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Hand Reconstruction Using the Thin Anterolateral Thigh Flap

Cited by 96 publications

References 37 publications

The Evolution of the Pedicled Radial Forearm Flap

The Evolution of the Pedicled Radial Forearm Flap

Functional resurfacing of the palm: Flap selection based on defect analysis

Reconstrução após ressecção extensa de tumor das cinturas pélvica e escapular: relato de dois casos

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