Single stage reconstruction of complex head and neck defects involving the skin with a single ALT flap: A ten year review

Caliceti, Umberto; Sgarzani, Rossella; Cipriani, Riccardo; Cantore, Stefano; Contedini, Federico; Gelati, Chiara; Piccin, Ottavio

doi:10.1016/j.jpra.2019.09.003

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…The use of an ALT free flap has gained popularity over other options such as a latissimus dorsi flap in providing coverage of a scalp defect, as demonstrated in several investigative reports. [33][34][35][36][37] Chou et al have also revealed that the ALT flap is more frequently used for scalp reconstructions, particularly after an angiosarcoma excision, due to the above-mentioned advantages. 13 When the free flap option was considered, superficial temporal vessels were the preferred recipient option, followed by facial vessels when the lesion involved the lateral aspect of the scalp with the potential need for vein grafting.…”

Section: Discussionmentioning

confidence: 99%

Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma

Alharbi‎

Kim

Alshomer

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Cutaneous angiosarcomas are rare, aggressive tumors with high recurrence and poor prognosis. We share our experiences with the challenging surgical management of these lesions, focusing on both ablative and reconstructive outcomes. Methods: Retrospective cross-sectional chart review was conducted of patients diagnosed with scalp cutaneous angiosarcoma between 2005 and 2021. Resectability, defect reconstruction, and survival outcomes were analyzed. Results: Thirty patients were included, 27 (90%) men and three (10%) women, with a mean age at diagnosis of 71.77 ± 7.3 years, and mean follow-up of 429.43 ± 305.6 days. Only 12 patients completed their regular follow-up, while the remaining patients died. There was a median survival of 443.50 days (range, 42-1283) and median time to recurrence of 21 days (range, 30-1690). Multimodal therapy compared with surgery alone had a significantly better overall median survival (468 days versus 71 days; P = 0.021). Defect coverage was obtained in 24 cases (75%) through an anterolateral thigh flap, two patients (6%) with a local transposition flap, and one patient (3%) with a transverse rectus abdominis myocutaneous flap. The remaining three patients received a skin graft. All of the flaps survived, with one requiring a vein graft for venous congestion. Conclusions: Timely multimodal therapy with a histologically safe margin, combined with adjuvant therapy, improves survival and delays recurrence and metastasis, in cutaneous angiosarcoma patients. An anterolateral thigh flap facilitates the coverage of wide defects. Further investigations of advanced treatment modalities such as immunotherapy and/or gene therapy are required to deal with this highly aggressive tumor.

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Section: Discussionmentioning

confidence: 99%

Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma

Alharbi‎

Kim

Alshomer

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Hence, not only the skin and fascia defects but also the muscular defects were repaired using TFL. Caliceti et al [ 9 ] believed that the harvest of an ALT flap with skin or muscle in a large size made the ALT flap an ideal flap for three-dimensional reconstruction. A combined ALT and TFL flap had an abundant blood supply and a strong anti-infective function, thus avoiding foreign body retention or severe infections related to mesh repair.…”

Section: Discussionmentioning

confidence: 99%

Reconstructing abdominal wall defects with a free composite tissue flap: A case report

Wang

2021

WJCC

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BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task. An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps, restoration of the abdominal wall integrity, and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia. When treating huge full-thickness defects, composite autologous tissue flaps are a good option for the repair. CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from full-thickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen. After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels, reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure. The remaining 18 cm × 15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap. The proposed method achieved the functional reconstruction of the abdominal wall. CONCLUSION This approach restored the abdominal wall integrity, maintained certain muscle tension, avoided abdominal hernia, reached satisfactory aesthetic effect, and resulted in no complications in the grafting regions.

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“…The gold standard of reconstruction should be a one-stage procedure with the lowest morbidity, a short hospital stay, early recovery of swallowing, and the restoration of a socially acceptable appearance [2]. Given the aim of getting the patient to adjuvant therapy, achieving the seal of the pharynx to allow for the restoration of enteral feeding and avoidance of neck sepsis is crucial [21].…”

Section: Pre-operative Considerations: Goals and Planningmentioning

confidence: 99%

“…The physiologic cost of surgery needs to be balanced against the well known long term effects of nonsurgical therapies. The role of the reconstructive surgeon is to manage short term perioperative problems and long term functional outcomes to achieve the optimal quality of life result for the patient [2].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Pharyngeal Defects

Yabe¹,

Ashford²

2021

Surgical Management of Head and Neck Pathologies

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The management of pharyngeal defects is one of the most challenging tasks for reconstructive surgeons. The reconstructive method is driven by the amount of tissue loss as well as patient-related factors. Since the advent of organ preservation strategies in the 1990s as described by the Department of Veterans Affairs Laryngeal Cancer Study, salvage surgery has become a common pharyngeal procedure to obtain local control when nonsurgical treatment fails. This chapter is divided into preoperative, intraoperative, and postoperative phases of patient management. Each section will focus on particular aspects of management that are essential to achieve the best therapeutic outcome for patients who need pharyngeal reconstruction.

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Single stage reconstruction of complex head and neck defects involving the skin with a single ALT flap: A ten year review

Cited by 6 publications

References 20 publications

Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma

Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma

Reconstructing abdominal wall defects with a free composite tissue flap: A case report

Reconstruction of Pharyngeal Defects

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