Usefulness of a template‐based anterolateral thigh flap for reconstruction of head and neck defects

Abstract

Background: One of the challenges in head and neck reconstruction is to have an adequate understanding of the three-dimensionalities of the defects created after resections due to the high variability of clinical scenarios. Consequently, it is essential to design the flap to match the requirements of the defect in order to facilitate the insetting and to achieve a successful outcome. The anterolateral thigh flap (ALT) is a robust and versatile flap commonly used in head and neck reconstruction. In this study the authors use a handmade template as a tool to customize ALT flaps and its variations to fit more accurately the different shapes, volume, and components of the resulting defects. The aim of this study is to describe in detail this surgical approach and present the clinical experience in 100 consecutive cases using a template-based ALT flaps in head and neck reconstruction. Methods: A retrospective review was performed on all microvascular head and neck reconstruction cases between January 2013 and December 2017 in our institution where a template-based ALT flap design was performed. We describe in detail the surgical technique used and present the clinical outcomes. In addition, we analyzed the use of different designs of the ALT flaps including different flap components in relation to the location of the defect. Results: One hundred reconstructions for head and neck defects were performed in 97 patients. Seven types of ALT free flaps were performed: fasciocutaneous (46%), suprafascial (8%), adipofascial (9%), vastus lateralis muscle (3%), composite fasciocutaneous/adipofascial (9%), chimeric flaps (21%), and vascularized nerve grafts (4%). Oropharyngeal and periauricular defects were mostly reconstructed with fasciocutanoues design. In more complex three-dimensional defects such as skull base or midface defects, a chimeric flap was selected. In all cases the used of template facilitated the insetting of the free flap. The total flap loss was 2%. Conclusions: Customization of ALT flaps using intraoperative templates is a useful method for flap design which facilitates fitting of the flap to a variety of defects in head and neck reconstruction. Caroline Driessen and Naomi van Hout contributed equally to this study.

Challenges in the Management of Kidney Allograft Herniation With a Single-stage Pedicled Anterolateral Thigh Flap

“…The allograft and the debrided wound were irrigated with a mixture of saline solution and hydrogen peroxide. An ALT flap with 2 skin perforators was raised in a standard fashion 10 with the inclusion of the widest and longest iliotibial band as possible. 11,12 The descending branch of the lateral femoral circumflex artery was dissected as proximally as possible such that the inset of the ALT flap would not create tension on the pedicle.…”

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

“…The anterolateral thigh (ALT) ap has been considered as a reliable ap option for various soft tissue defects because of its concealed position, constant vascular pedicle, large area, and low donor site morbidity [1]. And the application of ALT ap have been described in many previous studies [2][3][4].…”

Usefulness of a template‐based free flap planning for reconstruction of sarcoma defects

“…We read with great interest the article by Driessen et al (2020) in which the authors show the usefulness of a template-based ALT flap for head and neck reconstruction. We compliment the authors for the effort produced to show how a standardized approach can improve both flap harvesting and insetting and we would like to present our experience with the template-based free flap planning for reconstruction of sarcoma defects.…”