The turbocharged wide anterolateral thigh perforator flap to reconstruct massive soft tissue defects in traumatized lower extremities: A case series

Abstract

BackgroundExtensive traumatic soft tissue defects in the lower extremities typically require complete coverage of exposed bone because inadequate coverage, such as partial flap loss, may result in bony infection and ultimately lead to limb salvage failure. To achieve complete coverage of these defects, we used the wide anterolateral thigh perforator flap in which the turbocharging procedure augments the blood flow. Herein, we describe our turbocharging technique and discuss its effectiveness.MethodsFrom January 2014 to December 2020, the turbocharged wide ALTP free flaps were used to treat 13 patients with massive traumatic soft tissue defects in the lower extremities, ranging in size from 22 × 10 cm2 (220 cm2) to 21 × 17 cm2 (357 cm2) (mean, 270 cm2). All ALTP flaps were supplied by perforators from both the transverse branch of the lateral circumflex artery (TB-LCFA) and descending branch of the lateral circumflex artery (DB-LCFA) simultaneously. The turbocharging procedure by connecting the TB-LCFA to a side branch of the DB-LCFA was carried out in all these flaps. A retrospective review of medical records for each patient was performed.ResultsThe size of the transferred ALTP flap ranged from 23 × 12 cm2 (276 cm2) to 23 × 19 (437 cm2) (mean, 331 cm2). The total number of perforators included in the flaps was three on average. All ALTP flaps survived completely without partial necrosis. The postoperative course was uneventful except for two cases with minor complications, including hematoma and partial necrosis of the recipient's skin.ConclusionFree transfer of the turbocharged wide ALTP flap can be a reliable and effective reconstructive method to obtain complete coverage of extensive traumatic soft tissue defects in the lower extremities and achieve successful limb salvage.

Turbocharging as a strategy to boost extended perforator flap vascularity in head and neck reconstruction—A report of two cases

“…Turbocharging technique was explored and applied to maximize flap coverage with adequate perfusion (Civelek et al, 1998;Fernández Garrido et al, 2018;Jeong et al, 2017Jeong et al, , 2022. Our report adopted the We acknowledged the importance of perfusion test during operation.…”

“…Turbocharging was first clearly defined by Şensöz et al in 1998 as vascular augmentation by manipulating vessels within the flap territory. Turbocharging technique was explored and applied to maximize flap coverage with adequate perfusion (Civelek et al, 1998; Fernández Garrido et al, 2018; Jeong et al, 2017, 2022). Our report adopted the concept of turbocharging as a perforator‐to‐perforator augmentation technique for flap rescue in cases involving recurrent head and neck cancer reconstruction.…”

“…Supercharging refers to vascular augmentation from a distant source of vessels, whereas turbocharging is vascular augmentation by manipulating vessels within flap territory (Civelek et al, 1998). Previous studies applied turbocharging to large defect reconstruction for boost vascularity (Fernández Garrido et al, 2018; Jeong et al, 2022). However, rare perforator to perforator for enhancing vascularity was reported.…”

A Comprehensive Flap Classification

“…Similarly, in flap terms, a turbocharged flap utilizes vascular sources within the flap to augment the flap's angiosomal capture. 25,26 For example, in an ALT flap, one could anastomose the transverse branch of the lateral circumflex artery to a side branch of the descending branch of the lateral circumflex artery 27 (Fig. 1).…”

Reliability of Single Perforator Based Free Anterolateral Thigh Flap Reconstruction among Children with Post Traumatic Limb Defects

“…Once high-energy traumatic injuries occur in the lower limbs, the injuries typically result in heavily contaminated open tibia fractures, which require repeated radical debridement. However, multiple debridements may create extensive soft tissue defects with exposed bone in some patients, and reconstructing these defects can be technically challenging, even for experienced surgeons 1 .…”