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

Abstract

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.

Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction

“…6 Additionally, STSG in the pediatric population carries an increased risk of hypertrophic scarring and potential growth limitation; thus, STSG should be avoided whenever possible. 2,7 However, attempting to close the donor site primarily under excessive tension can cause compartment syndrome and should also be avoided. 8 …”

Tissue Expander – A Review

“…Allergic responses due to the use of injected fluids or sutures, which may be incompatible to the patients 4. Infections may exist within the expander and this should be overcome by removing the implant. [20] 5. Lack of tissues generated resulting in post surgical graft exposition and loss of grafted bone.…”

“…Lack of tissues generated resulting in post surgical graft exposition and loss of grafted bone. [24] Indications and contraindications:-Indications:-Tissue expansion is used in various surgical procedures that include: 1. augmentation of resorbed edentulous ridges [25] 2. bone regeneration and onlay grafting procedures [20] 3. intraoperative procedures in cleft lip repair surgery [26] 4. treatment of decubitus ulcers with local flaps [27] 5. 5)development of post-auricular skin for external ear reconstruction surgery [28] 6. extension of forehead skin for forehead flap total nasal reconstruction Contraindications [29] :-Tissue expansion is contraindicated in patients with: 1. psychological disturbances 2. active infections in the body 3. poor vascularization of tissue in the implantation area 4. systemic diseases such as diabetes mellitus, bacterial pneumonia, chronic liver disease, renal failure and hypertension [30] Types of tissue expander:-Tissue expanders mainly exist in two forms; cylinder and cupola.…”

“…The cylinder-shaped tissue expander is normally used for straight edentulous regions while the cupola form of tissue expander is usually utilized for curved frontal edentulous region with one or more missing teeth. [20] Commercially available forms of tissue expander [31] :-…”

“…[20] :- Surgical procedure:-Implantation:-Under local anesthesia,a scalpel and scissors are initially used to make a small incision to createa submucosal patch without elevating the periosteumfor easy insertion and removal of the tissue expander. [24] Incision is normally made at a proper depth of 3 cm and wide enough to allow the expander to be placed bilaterally on either side of the defect area.…”