Primary Closure of Donor Site in Anterolateral Cutaneous Thigh Free Flap

Calderón, Wilfredo; Borel, Claudio; Roco, H.; Piñeros, J.L.; Olguin, Fernando A.

doi:10.1097/01.prs.0000220007.35546.54

Cited by 13 publications

(11 citation statements)

References 5 publications

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“…In this modern era of reconstructive surgery, we should strive to improve outcomes not only at the recipient site but also at the donor site. [35][36][37] In a study previously performed at our institution, we demonstrated that it was possible to directly close the ALT donor-site defects that were less than 16% of the thigh circumference. 19 With this in mind, in five patients for whom a wide skin paddle was required, we adopted the principle of designing the ALT flap based on two sizable perforators.…”

Section: Discussionmentioning

confidence: 87%

Versatility of the Free Anterolateral Thigh Flap in the Reconstruction of Large Defects of the Weight-Bearing Foot: A Single-Center Experience with 20 Consecutive Cases

Pappalardo

Jeng

Sadigh

et al. 2016

J reconstr Microsurg

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Background?Reconstruction of the weight-bearing surface of the foot represents a challenging task. With very little scope to borrow glabrous tissue from adjacent areas means that achieving a ?like for like? reconstruction is rarely possible. In this setting, alternative approaches need to be considered. In this article we present our experience with various differing designs of the anterolateral thigh flap (ALT) in the reconstruction of 20 large defects of the weight-bearing sole. Methods?Twenty patients with complex soft tissue defects of the weight-bearing sole underwent reconstruction over a 5-year period. Five cases were complicated by osteomyelitis resulting in significant calcaneal defects. The follow-up period ranged from 8 to 48 months and outcomes were assessed by two-point discrimination and protective sensation, observation of gait, and the ability of the patient to return to wearing normal footwear. Results?All flaps survived with the exception of two partial skin necrosis. Sensory nerve coaptation was performed in 12/20 cases. One patient underwent second-stage total calcaneal reconstruction with a fibula osteocutaneous flap. Five large defects were reconstructed with the split skin paddle technique to allow for direct donor-site closure. No evidence of postoperative ulceration was noted in any of the patients over the follow-up period and all were satisfied regarding the functional and aesthetic results achieved. Conclusion?Complex defects of the weight-bearing sole can be successfully reconstructed using the free ALT flap resulting in very favorable functional outcomes. Even when calcaneal osteomyelitis has set in, excellent outcomes can be achieved.

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Section: Discussionmentioning

confidence: 87%

Versatility of the Free Anterolateral Thigh Flap in the Reconstruction of Large Defects of the Weight-Bearing Foot: A Single-Center Experience with 20 Consecutive Cases

Pappalardo

Jeng

Sadigh

et al. 2016

J reconstr Microsurg

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“…Despite statements that donor site morbidity usually is minimal, it too justifiably has become a concern. 2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Collins et al, 16 in a systematic and extensive literature search, listed lateral thigh paresthesias, musculoskeletal dysfunction, hypertrophic scarring, wound breakdown, infection, pain, seroma, hematoma, compartment syndrome, and muscle necrosis as possible donor site sequela. Only paresthesias were common because of the sometimes necessary division of the medial branch of lateral femoral cutaneous nerve.…”

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confidence: 99%

Tissue Expansion Techniques to Minimize Morbidity of the Anterolateral Thigh Perforator Flap Donor Site

Hallock

2013

J reconstr Microsurg

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Selection of any free flap donor site must not only meet the requirements of the recipient site but also minimize untoward sequela at the donor site itself. Although the anterolateral thigh (ALT) perforator flap is an ideal soft tissue donor site, a major drawback can be its nonesthetic appearance if a skin graft was needed. This detriment can be ameliorated by using traditional tissue expansion techniques. In a retrospective review over the past decade, 14 patients had ALT free flap donor site tissue expansion. These were subcategorized as pretransfer, concurrent, or posttransfer tissue expansion. In this group, mean ALT flap width was 12.2 ± 4.2 cm, which precluded direct donor site closure. Rectangular expanders were generally recommended. Multiple expanders are suggested for larger defects. The duration of expansion averaged 291.4 ± 163.9 days. The mean instilled volume ratio exceeded 2.43 ± 0.9 times the maximum vendor recommendation. Small skin graft residua were still left in four patients. Tissue expansion proved to be an important modality to consider for minimizing the stigmata of the skin grafted ALT free flap donor site. However, this process is time consuming and requires an additional surgical procedure. As such, this option must be reserved for the most motivated and compliant patients.

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“…flaps for ALT donor-site reconstruction such as VY advancement, transposition, and keystone flaps have been reported. [4][5][6][7][8][9] However, these local flaps have limited mobility with consequent need of large flap size to obtain defect coverage.…”

mentioning

confidence: 99%

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

Pagliara¹,

Mangialardi

Vitagliano

et al. 2020

J Reconstr Microsurg

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Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

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Primary Closure of Donor Site in Anterolateral Cutaneous Thigh Free Flap

Cited by 13 publications

References 5 publications

Versatility of the Free Anterolateral Thigh Flap in the Reconstruction of Large Defects of the Weight-Bearing Foot: A Single-Center Experience with 20 Consecutive Cases

Versatility of the Free Anterolateral Thigh Flap in the Reconstruction of Large Defects of the Weight-Bearing Foot: A Single-Center Experience with 20 Consecutive Cases

Tissue Expansion Techniques to Minimize Morbidity of the Anterolateral Thigh Perforator Flap Donor Site

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

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