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, Seung Ki; Kim, Sang Wha; Kim, Youn Hwan; Hwang, Kyu Tae

doi:10.1002/micr.22490

Cited by 27 publications

(32 citation statements)

References 28 publications

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“…Revascularization techniques, such as bypass surgery and percutaneous transluminal angioplasty (PTA), can increase the distal circulation, which is favorable for flap survival (Kim, Naidu, & Kim, ; Oh et al, ; Randon et al, ), thereby improving the success rate of free tissue transfer. Microsurgical free tissue transfer techniques have been developed for resurfacing areas where the skin is particularly thin, including the foot and ankle area (Jeon et al, ; Kim et al, , Kim, Kim, Sung, Kim, & Kim, ; Kim et al, ; Youn, Kim, Kim, & Hwang, ). Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, ; Kim et al, , ).…”

Section: Introductionmentioning

confidence: 99%

“…Perforator flaps with long vascular pedicles introduce more healthy and reliable vessels with minimal donor site morbidity and without including muscle tissue (Jeon et al, ; Kim et al, , ). Numerous articles describe the used of anterolateral thigh perforator flaps and thoracodorsal artery perforator (TDAP) flaps for successful limb salvage (Jeon et al, ; Kim et al, , ; Youn et al, ). An improved understanding of perforator and vascular anatomy, coupled with advances in microsurgery, has resulted in the recent development of the chimeric flap technique.…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Sung

Jang²,

Kim³

et al. 2018

Microsurgery

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Sung

Jang²,

Kim³

et al. 2018

Microsurgery

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“…Peroneal tendons and talofibular ligaments were reconstructed with fascia strips rolled and interwoven to connect the peroneus musculotendineous junction and the lateral ankle ligaments similarly to previous reports (Kuo et al, ). For Achilles tendon, patellar and tibialis anterior tendon reconstruction, considering higher tension forces (Lee, Yu, Shieh, Liu, & Pai, ; Youn et al, ), fascia was folded from peripheral to central pattern, to form a double/triple layer of neo‐fascia. No muscular components had to be reconstructed (e.g., quadriceps), but FL could be sutured to residual patellar tendon stumps.…”

Section: Methodsmentioning

confidence: 99%

“…The potential harvesting as composed of vastus lateralis (VL) and fascia lata (FL) (di Summa et al, ; Lin, Lin, & Wei, ) allows for reconstruction of different anatomic components. When mobility is needed, the fascio‐cutaneous components provide coverage of soft tissue defects while the FL sheet, vascularized by the subfascial plexus, can replace tendons, ligament segments or an articular capsula, because of its flexibility and strength (Yildirim, Taylan, & Akoz, ; Youn, Kim, Kim, & Hwang, ).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: Long term recovery and functional outcomes

et al. 2019

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Background We evaluated composite anterolateral thigh (ALT) flaps including vascularized fascia lata (FL), for stable soft tissue coverage and tendons restoration at various joint levels in a one‐stage procedure. Methods We performed a retrospective investigation including 21 “functional” ALT flaps between November 2006 and December 2016. In all patients included, FL was shaped to anatomical reproduce a tendon structure. Functional analysis included range of motion and force assessment. Functional scores were established according to Chen classification, DASH, and LEFS score. Defects resulted from tumor excision, trauma, burn, or infection‐debridement and were distributed in four main anatomical districts: knee (seven cases), ankle (six cases), forearm‐elbow (four cases), and hand‐wrist level (three cases). Results Nineteen flaps were raised as free flaps, while two as distally‐based propeller flaps. Average follow‐up was 38 months. Major complication requiring the harvest of a second flap was seen in two patients, whereas three flaps presented superficial necrosis and was treated in an outpatient regimen. We observed 81% of total ROM recovery compared to contralateral sides with 89% recovered articular stability. Best articulation outcomes were present in elbow reconstruction, while ankle reconstructions showed less articularity. Hospital stay was significantly reduced in hand and wrist functional reconstruction when compared with reconstruction at the ankle level (P < 0.05). Conclusion The ALT flap extended to vascularized FL provides a particularly effective and resistant tissue that can be folded to reconstruct and support tendinous structures. This can restore functional and structural integrity after complex defects in a single stage procedure.

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“…These wounds are frequently accompanied by very large surface soft tissue defects and underlying dead space. Thus, reconstruction of these complex soft tissue defects often depends on a flap to obliterate the dead space and cover the very large surface soft‐tissue defect in a single procedure with primary closure of the donor site (Xu et al, ; Youn, Kim, Kim, & Hwang, ). However, conventional perforator flaps usually lack the versatility to offer adequate tissue volume and allow precise tissue positioning to optimally cover the wound (Tang et al, ; Zhang, Hayakawa, Levin, Hallock, & Lazzeri, ).…”

Section: Introductionmentioning

confidence: 99%

Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

Qing

et al. 2019

Microsurgery

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Background One‐stage reconstruction of complex soft tissue defects of the extremities is a challenging problem. Repair of complex soft tissue defects requires adequate skin tissues to cover the large surface wound and special tissues for obliterating the dead space. The chimeric flap is one of the most popular approaches for reconstruction of complex soft tissue defects. However, the problems of donor‐site morbidity and inability to repair very large defects at one‐stage remain. The purpose of this study was to present our clinical experience using sequential chimeric perforator flaps for reconstruction of complex extremity defects with primary closure of the donor site. Methods From August 2013 to March 2017, 12 patients with complex soft tissue defects underwent extremity reconstruction using sequential chimeric perforator flaps, which were composed of a chimeric anterolateral thigh perforator (ALTP) flap and an additional free perforator flap. The skin paddles were placed side‐by‐side to cover the large surface soft tissue defects, and the muscle component was used to obliterate the dead space. Of these patients, one was injured by a crushing accident, while the other 11 patients were injured in traffic accidents. Results The size of the skin paddles ranged from 26 cm × 8 cm–10 cm × 6 cm to 30 cm × 8.5 cm–29 cm × 9 cm. The muscle paddle size ranged from 2 cm × 3 cm × 4 cm to 22 cm × 4 cm × 2 cm. All‐components of the sequential chimeric flaps survived in all‐patients. Vascular compromise was observed in one case. One case suffered minor wound‐edge necrosis and was treated conservatively. Primary closure of donor‐site was successfully achieved in all‐patients, and all‐donor‐site wounds healed uneventfully. The mean follow‐up time was 15.25 months. Most of the cases showed a satisfactory contour, and only two patients presented with mildly bulky appearance that treated with a debulking procedure. Conclusions The sequential chimeric perforator flap is an alternative procedure for reconstruct complex soft tissue defects of the extremities. This approach allows for flexible design, a larger cutaneous area, and low donor site morbidity.

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

Abstract: The double or triple folding technique of the ALT free flap represents simple, economical use of tissue, with minimal donor site morbidity. Thus, this technique may be useful and versatile reconstructive option for combined defects.

Cited by 27 publications

References 28 publications

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps

Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: Long term recovery and functional outcomes

Use of a sequential chimeric perforator flap for one‐stage reconstruction of complex soft tissue defects of the extremities

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