Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel

Sirimahachaiyakul, Pornthep; Orfaniotis, Georgios; Gesakis, Kanellos; Kiranantawat, Kidakorn; Ciudad, Pedro; Nicoli, Fabio; Maruccia, Michele; Saçak, Bülent; Chen, Hung-Chi

doi:10.1002/micr.22377

Cited by 11 publications

(11 citation statements)

References 35 publications

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“…The use of cross‐finger, thenar or distant flaps (ie, from abdomen and chest) have been widely used in the past; they involve a large period of immobilization and always leave unpleasant donor site scars, moreover, these procedures require at least 2 operations (Edgerton & Beasley, ; Edgerton & Beasley, ). Perforators flap, that is, anterolateral thigh flap, have been described just for thumb and metacarpophalangeal area reconstruction (Maruccia et al, ; Sirimahachaiyakul et al, ).…”

Section: Discussionmentioning

confidence: 99%

Modified single pedicle reverse adipofascial flap for fingertip reconstruction

et al. 2018

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Background: Homodigital adipofascial flap is a well-established method for treating a distal fingertip defect; nonetheless, its use has some limitations. Reconstruction of fingertip injuries, with radial or ulnar tissue loss, may lead to some difficulties in providing an adequate bone coverage.The standard bipedicled technique did not allow the flap to cover the bone exposure without excessive tension. In our series, the reverse adipofascial flap had a single pedicle. The modified technique, because of its improved degree of rotation, granted the flap to reach either radial or ulnar tissue losses. Patients and Methods:We treated 15 fingertip amputations distal to the lunula (9 Allen's type II and 6 type III), the mean size of defects was 2.7 cm 2 (range, 1.8-3.2 cm 2 ), the mean age of patients was 44 years (range, 22-63 years). Quick Disabilities of the Arm, Shoulder, and Hand score and Visual Analogue Scale were evaluated along with a 2-point discrimination test; the aesthetic satisfaction of the patients was estimated subjectively using a 5-point Likert scale. Results: Mean flap size was 3.6 cm 2 (range, 2.5-4.2 cm 2 ), primary flap survival was observed in 14 out of 15 cases, partial flap necrosis was observed in 1 case, the nail grew in all fingers in about 6 months. Mean proximal and distal interphalangeal joint motion was 89 (range, 80 -100 ) and 71 (range, 65 -80 ), respectively. No complications were observed at the donor site.The median static 2-point discrimination was 4.5 mm (range, 3-8 mm), the mean quick DASH score was 2.6 (range, 0-9.1). All patients returned to work within a mean of 4.4 weeks (range, 4-5 weeks). The follow-up was 12 months.Conclusions: Single pedicle reverse adipofascial flap is an effective technique. This modified procedure allows a wider degree of flap rotation; it represents the ultimate arrow in our bow to address some particular defect geometry.

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Section: Discussionmentioning

confidence: 99%

Modified single pedicle reverse adipofascial flap for fingertip reconstruction

et al. 2018

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“…ALT flaps are commonly used among various fields of reconstructive surgery, and most reconstructive microsurgeons are familiar with this type of flap . It is well recognized that ALT flaps have the advantage of a long vascular pedicle, large flap territory, durable skin quality, free of design, and a thinness, trimmed to 3–5 mm thickness . Composite‐free ALT flaps with the fascia lata have been used in many procedures for the reconstruction of composite Achilles tendon defects .…”

Section: Discussionmentioning

confidence: 99%

The composite anterolateral thigh flap for achilles tendon and soft tissue defect reconstruction with tendon repair by fascia with double or triple folding technique

Youn

Kim

et al. 2015

Microsurgery

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“…The pedicle ALT perforator flap has been previously adopted for perineoscrotal reconstruction and became a workhorse for this kind of reconstruction: it can provide a large skin paddle with or without the muscle, and it can be transferred to the scrotal defect with its long pedicle. However, extensive perforator dissections through the rectus femoris muscle and tunneling through the medial thigh are necessary. It inevitably leaves a conspicuous scar on the lateral thigh.…”

Section: Discussionmentioning

confidence: 99%

“…Different reconstructive options for perineoscrotal defects, such as skin grafting, local fasciocutaneous flaps, musculocutaneous flaps, and local perforators flaps have been described . In the last few years the anterolateral thigh (ALT) skin as donor site has been largely employed worldwide for perineoscrotal reconstruction and the ALT perforator flap has become a workhorse for such a reconctruction . However, sometimes because of the defect dimension, more flaps need to be applied in order to reach a total coverage.…”

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confidence: 99%

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

et al. 2016

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Fournier's gangrene is an acute and potentially lethal necrotizing fasciitis that can lead to extensive defects of the perineoscrotal area and lower abdominal wall as well. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Local perforator pedicle flaps and muscle flaps can be employed and combined for such a reconstruction. In this report we present a case of reconstruction of a massive perineoscrotal and upper medial thigh defect because of Fournier's gangrene using a bilateral pedicle anterolateral thigh (ALT) flap and sartorius muscle flap. A 61 year-old male who suffered from Fournier's gangrene resulted in a perineal, scrotal, and medial thigh defect of 27 × 30 cm with exposure of the femoral vessels. A bilateral pedicle ALT flap measuring 30 × 9 cm based on two perforators and a bilateral sartorius muscle flap were harvested for soft tissue defect reconstruction and inguinal vessels coverage, respectively. The flaps survived completely, with no recipient or donor site morbidity. The length of follow-up was 6 months and was uneventful. A bilateral pedicle ALT flap combined with bilateral sartorius flap may be considered as a valid and safe option for an extensive inguinal and perineoscrotal reconstruction in selected cases. © 2016 Wiley Periodicals, Inc. Microsurgery 37:669-673, 2017.

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Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel

Abstract: The keyhole design may be a valuable method of partition of the ALT flap for specific reconstructions around protruding organs, cavities, or canals.

Cited by 11 publications

References 35 publications

Modified single pedicle reverse adipofascial flap for fingertip reconstruction

Modified single pedicle reverse adipofascial flap for fingertip reconstruction

The composite anterolateral thigh flap for achilles tendon and soft tissue defect reconstruction with tendon repair by fascia with double or triple folding technique

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

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