Virtual planning of the anterolateral thigh free flap for heel reconstruction

Abstract

Purpose: three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction.Patients and methods: a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm 3 . Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery.Results: Six patients received thinned ALT (mean size = 139 cm 3 ) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm 3 ). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69-86). All patients regained their walking capability.Conclusions: 3-D virtual planning of complex heel defects facilitates covering nonelliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility. | INTRODUCTIONHeel defects vary in severity ranging from simple skin defects to complex soft tissue and bony defects. Such defects may result from mechanical, chemical or thermal injuries in addition to tumoural resection, peripheral artery occlusive disease, diabetic neuropathy or prolonged bed recumbency (Struckmann et al., 2014). Hidalgo and Shaw have classified these injuries according to the degree of soft tissue and bony involvement into three types; type I (small soft tissue defects), type II (larger soft tissue defects without bony involvement),

Volumetric Analysis of a Novel Chimeric Gracilis and Profunda Artery Perforator Flap

“…A previous series has reported average ALT volume to be larger at 139 cm 3 for thinned flaps and 199 cm 3 for standard ALT flaps. 20 Our previous studies have found the common perforator to be present in 51 to 59% 1,2 of patients, and we have now demonstrated that it has enough volume to be versatile without being overly bulky. In patients where the chimeric flap would offer satisfactory reconstruction, preoperative imaging for identification of a potential common perforator should be strongly considered.…”

“…A previous series has reported average ALT volume to be larger at 139 cm 3 for thinned flaps and 199 cm 3 for standard ALT flaps. 20…”

Three-dimensional Planning for Lower Extremity Soft-tissue Reconstruction after Sarcoma Resection: Systematic Review and Reflections

“…Elleban et al described how the precision of this workflow helps minimize donor site morbidity for an anterolateral thigh free flap. 3 Similarly, Chae et al applied this process to a radial forearm free flap. In both studies, flap design was guided by 3D-printed mockups, which represented a computer-assisted subtraction of the soft-tissue defect from a model of the intact contralateral extremity.…”

Comparison of instep and non‐instep flap in the reconstruction of the weight‐bearing portion of the forefoot and heel

“…These flaps can be used as proximally based flaps for heel reconstruction and as distally based flaps for forefoot reconstruction (Park et al, 2017). However, in cases of substantial defects or poor vascularity, or when these flaps cannot be used due to injury to the plantar region, reverse sural flaps (RSF) or free anterolateral thigh flaps (ALTF) can be utilized (Acar et al, 2015; Ellabban et al, 2022; Park et al, 2021; Xu et al, 2021). The RSF is a useful option for heel reconstruction, but it may not be suitable for relatively larger forefoot defects, in which case a ALTF can be considered (Krishna et al, 2021).…”