Versatility of Adipofascial Anterolateral Thigh Flap for Reconstruction of Maxillary Defects with Infratemporal Fossa Extension

Abstract

Tumors arising from the posterior hard palate or posterolateral maxilla may extend to involve the infratemporal fossa (ITF). Resection of these tumors results in infrastructural maxillectomy with ITF defects. In this study, we describe the use of an adipofascial anterolateral thigh flap (ALT) specifically for such defects. This case series includes four patients who underwent an infrastructure maxillectomy with ITF clearance and the resultant defects were reconstructed using adipofascial anterolateral thigh flaps. The complications as well as the functional outcomes were assessed. This study included patients with lesions involving the hard palate, posterolateral part of maxilla with extension into the ITF. The mean flap dimension was 150 cm2 (range, 120–180 cm2). All flaps were harvested based on a single perforator. The flap was used to obliterate the ITF defect and also to achieve oroantral separation. All flaps mucosalized well within 6 weeks. All patients were on oral diet and had adequate mouth opening. There were no donor-site complications. Adipofascial ALT is an excellent choice for infrastructural maxillectomy defects with ITF extension. The intraoral part got mucosalized well and provided a smooth and taut surface. A large adipofascial tissue flap helps obliterate the ITF, thus minimizing complications.

Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report

“…The fat from the ALT flap at the reconstructed esophageal site mucosalized well, as observed by fibroscopy. It is the same principle as described in previous pharyngeal wall reconstructions and intraoral reconstructions with both ALT adipofascial flaps and fibula osteo-adipofascial flaps (Kekatpure, Hedne, Chavre, Pillai, & Trivedi, 2014;Rodriguez-Lorenzo et al, 2014). The novelty of our case report is the use of an ALT as a vascularized adipofascial flap instead of fasciocutaneous flap for posterior esophagus wall reconstruction to overcome the technical challenges related to difficult insetting and narrow space, and offers low donor site morbidity without the need for a laparotomy.…”

Tumors Involving the Infratemporal Fossa: A Systematic Review of Clinical Characteristics and Treatment Outcomes

“…Of the 112 papers selected for retrieval, 85 articles failed to meet our inclusion criteria and were subsequently excluded. Thus, 27 articles were included in this systematic review based upon the prespecified criteria ( Supplementary Table S2 ) [ 1 , 2 , 3 , 6 , 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle

“…In previous studies about maxillary reconstruction, diverse methods, such as reverse facial-submental artery island flap ( 10 , 11 ), radial forearm free flap( 12 ), free vascularized iliac crest flap ( 13 ) and anterolateral thigh(ALT) flap have been reported ( 14 , 15 ). However, submental island flap is strongly not recommended for patients with clinically cervical lymph node positive due to the possibility of metastatic tissue transfer and recurrence in the flap base ( 16 ).…”