Anterior Lateral Thigh Research Articles

Effect of different degrees of wound eversion sutures on scar formation at donor site of anterolateral thigh flaps: A prospective randomized controlled study

To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. According to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them ( n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m 2 (mean, 23.09 kg/m 2). There was no significant difference in the age and body mass index between groups ( P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant ( P<0.05). There was no significant difference between the groups in the VSS scores and scar widths ( P>0.05). Moderate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.

Pedicled ALT-flap for soft tissue reconstruction in the trochanteric area.

Coverage of soft tissue defects following surgery at the trochanteric area is challenging. Revision surgery in case of compromised wound healing may lead to soft tissue defects requiring reconstruction with pedicled or free flaps. Previous access to the hip joint may jeopardize neurovascular structures relevant to the flap. In this study, we evaluated if the use of a pedicled anterior lateral thigh (ALT) flap is a valuable option for soft tissue reconstruction. In this retrospective study, seven patients were included. Defect etiology was tumor resection in one case, screw osteosynthesis in another case and total hip arthroplasty in three cases. All patients underwent reconstruction by proximal pedicled anterior lateral thigh (ALT) flap. Pedicled ALT flap was a safe procedure in all cases. One patient showed delayed wound healing with need for additional surgery. No further complications were observed. Pedicled ALT flap transfer represents a reliable option for soft tissue coverage in the trochanteric area after primary surgery such as hip arthroplasty, osteosynthesis or tumor resection.

Is It Possible to Monitor the Safest Time to Perform Secondary Surgery on Free Flaps? A Clinical Evaluation of the Tewameter®.

Background and Objectives: Postoperative monitoring, following free flap surgery, plays a crucial role in ensuring the survival of the flap. However, in microsurgery, not only the immediate postoperative monitoring period but also the choice of the right time for secondary surgeries is crucial for the free flap survival. There is no clear consensus concerning the right choice of timing for secondary surgery. Our aim was to evaluate transepidermal water loss (TEWL), with the objective evaluation tool Tewameter® in free flap surgery to monitor flap autonomization. Materials and Methods: Transepidermal water loss was assessed in 20 patients with microsurgically transplanted free anterior lateral thigh (ALTP) flaps. The transplantation of the ALTP-flap and the postoperative care were administered in accordance with the standard of care of the department. Measures were taken on the free flap and normal skin at follow-ups of 1, 3, and 6 months after initial free flap transplantation. Results: Transepidermal water loss gradually increased to the values found in normal skin, after 6 months. The differences between the two areas demonstrated the smallest variance after 6 months, specifically in the ALTP-flap region. The largest disparities were observed between month 1 and month 6, followed by month 3 and month 6, and month 1 and month 3. Conclusions: Free flap autonomization and physiology are complex processes. TEWL might be a valuable parameter to monitor flap autonomization. Our results indicate that TEWL in the free flap is nearly "normal" after six months. For a clear consensus of when to perform individual secondary surgery, further studies are needed.

Reconstruction methods for large cranial-nasal communications: surgeons’ concerns about proper anterior skull base reconstruction

Purpose: Skull base reconstruction is one of the most difficult reconstructive surgical procedures. Due to its complexity, most surgeons have modified the reconstruction methods to minimize the postoperative complications and mortality rate. In the past, flap surgery was not usually performed, but it has recently become more common due to advances in medicine. In this study, we analyzed successful flap surgery methods in skull base reconstruction for large cranial-nasal communications.Methods: Patients who underwent skull base reconstruction from April 2015 to January 2024 were eligible for this study. Of these patients, we included those who underwent reconstruction using a volumetric flap. Reconstructions that only used the conventional galeal flap, allograft skin, or bone substitute were excluded. The reconstruction methods used local flaps and free flaps.Results: In total, 22 patients underwent skull base reconstruction. The most frequently used local flap was the bilateral reverse temporalis muscle flap (seven of 11 cases), and the most frequent free flap was the anterior lateral thigh flap (10 of 11 cases). Other local flap operations used the modified temporalis muscle flap and scalp flap. A rectus myocutaneous flap was also used. There were no cases of flap necrosis.Conclusion: Flap surgery is needed for skull base reconstruction in patients with large cranial-nasal communications. As long as the flap volume is large enough to block and fill the defect, either a local flap or a free flap can be used for reconstruction.

Choice of flaps for phalloplasty: what is the contemporary standard? Consensus Statement of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels

The ever-expanding number of transmen as well as their surgeons share an increasing interest in the construction of a neophallus. While the indication for surgery and the positive effect of a phalloplasty on the quality of life, mental health and sexual function has already been thoroughly analysed, there is a lack of data comparing and evaluating the surgical steps. During the consensus conference on the "choice of flaps for phalloplasty" at the annual meeting of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels, the current literature was discussed and a consensus on the surgical technique of a phalloplasty was reached. This manuscript publishes jointly developed recommendations on the following topics: choice of flaps for phalloplasty, preoperative diagnostic tests before phalloplasty, urethral construction in the radial forearm flap and anterior lateral thigh flap, preformation of the urethra at the forearm or thigh, venous drainage of the radial forearm flap, innervation of the phallus, staged phalloplasty, coronaplasty and managing the donor site of a radial forearm flap.

TREATMENT OF VERY LARGE TRAUMATIC BONE DEFECTS WITH A BIODEGRADABLE POLYCAPROLACTONE-TRICALCIUM PHOSPHATE 3D-PRINTED SCAFFOLD: A REVIEW OF THREE CLINICAL CASES

The need for an artificial scaffold in very large bone defects is clear, not only to limit the risk of graft harvesting, but also to improve clinical success. The use of custom osteoconductive scaffolds made from biodegradable polyester and ceramics can be a valuable patient friendly option, especially in case of a concomitant infection.Multiple types of scaffolds for the Masquelet procedure (MP) are available, however these frequently demonstrate central graft involution when defects exceed a certain size and the complication rates remains high. This paper describes three infected tibial defect nonunions with a segmental defect over ten centimeters long treated with a customized 3D printed polycaprolactone-tricalcium phosphate (PCL-TCP) cage in combination with biological adjuncts.Three male patients, between the age of 37 and 47, were treated for an infected tibial defect nonunion after sustaining Gustilo grade 3 open fractures. All had a segmental midshaft bone defect of more than ten centimeters (range 11–15cm). First stage MPs consisted of extensive debridement, external fixation and placement of anterior lateral thigh flaps (ALT). Positive cultures were obtained from all patients during this first stage, that were treated with specific systemic antibiotics during 12 weeks. The second stage MP was carried out at least two months after the first stage. CT scans were obtained after the first stage to manufacture defect-specific cages. In the final procedure a custom 3D printed PCL-TCP cage (Osteopore, Singapore) was placed in the defect in combination with biological adjuncts (BMAC, RIA derived autograft, iFactor and BioActive Glass). Bridging of the defect, assessed at six months by CT, was achieved in all cases. SPECT-scans 6 months post-operatively demonstrated active bone regeneration, also involving the central part of the scaffold. All three patients regained function and reported less pain with full weight-bearing.This case report shows that 3D printed PCL-TCP cages in combination with biological adjuncts is a novel addition to the surgical treatment of very large bone defects in (infected) posttraumatic nonunion of the tibia. This combination could overcome some of the current drawbacks in this challenging indication.

Evaluation of the predictive value of the body-mass-index choosing perforator flaps from different donor sites

BackgroundFree flap design must fulfill different criteria to ensure functional and aesthetic reconstruction of different types of defects in different body areas. A four-dimensional planning concept was used including flap length, width, thickness and tissue composition. This study evaluates if body-mass-index (BMI) has a predictive value for flap design.MethodsA prospective study including hospitalized patients in the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery was conducted. Not taking into account the reason for admission, the patients were examined based on age, weight, height, BMI and sex. The areas of a potential harvest of free fasciocutaneous and perforator flaps were measured using ultrasound examination to determine the thickness of the subcutaneous layers and prove blood perfusion.ResultsOver the period of four months, a total of 101 patients (36 females and 65 males) were included in this study and gave written consent. No statistical significance regarding the demographic data such as age, sex and BMI could be identified. An average to high correlation between free flap thickness and BMI was shown for the thoracodorsal artery perforator (TDAP), anterior lateral thigh (ALT) and deep inferior epigastric perforator (DIEP) flap in both, male and female patients.Free flaps of distal body parts such as the interosseous posterior flap, showed a lower correlation. No correlation using the Pearson coefficient could be found for age and volume.ConclusionOur study demonstrated that the BMI is a predictive indicator that can be used in the preoperative planning of reconstructions using free flaps. Depending on the defect location, the BMI can be considered to predict the thickness of the free flap and may influence the surgeon’s choice.On the other hand, a lower correlation between BMI and flap thickness encourages the use of standard flaps if more volume is desired, as the DIEP flap might be sufficient even in normal-weight women. Flaps of distal body parts, such as the forearm or lower leg, are not prone to such predictions and require other selection criteria.

Free Flaps for Skin and Soft Tissue Reconstruction in the Elderly Patient: Indication or Contraindication

Increased lifespan and the improvement of medical treatment have given rise to research in reconstructive procedures in elderly patients. Higher postoperative complication rates, longer rehabilitation, and surgical difficulties remain a problem in the elderly. We asked whether a free flap in elderly patients is an indication or a contraindication and performed a retrospective, monocentric study. Patients were divided into two groups (YOUNG 0-59 years; OLD > 60 years). The endpoint was the survival of flaps and their dependence on patient- and surgery-specific parameters using multivariate analysis. A total of 110 patients (OLD n = 59) underwent 129 flaps. The chance of flap loss increased as soon as two flaps were performed in one surgery. Anterior lateral thigh flaps had the highest chance for flap survival. Compared with the lower extremity, the head/neck/trunk group had a significantly increased chance of flap loss. There was a significant increase in the odds of flap loss in linear relation to the administration of erythrocyte concentrates. The results confirm that free flap surgery can be indicated as a safe method for the elderly. Perioperative parameters such as two flaps in one surgery and transfusion regimens must be considered as risk factors for flap loss.

Standardized Quantitative Sensory Testing to Assess Insufficient Recovery of Touch Discrimination in Free Flap Surgery.

With major advances in microsurgical techniques, free tissue transfer has become a widely adopted approach to treat complex soft-tissue defects. However, sensory recovery is poor, leaving the anesthetic skin prone to injuries. Twenty-eight patients with 22 anterior lateral thigh flaps and six latissimus dorsi flaps on their extremities participated in the study. Quantitative sensory testing and two-point discrimination was performed in three test areas and one control on the contralateral unaffected extremity. Physical disability, mental health, quality of life, and characteristics of pain were assessed by the painDetect, Disabilities of the Arm, Shoulder, and Hand, Lower Extremity Functional Scale, and 12-Item Short Form questionnaires, respectively. Somatosensory profiles of all flaps were characterized by an overall loss of nerve function. Small-fiber function was mostly recovered, whereas large-fiber function, and thus touch discrimination, was severely impaired. Mechanical detection thresholds improved over time and from center to the periphery. Reported pain was mild to moderate and correlated with decreased physical function. Standardized quantitative sensory testing provides a useful tool kit to assess the sensory regeneration after surgical treatment of soft-tissue defects. After free tissue transfer, small-fiber function recovers with nerve ingrowth in a centripetal direction from the flap margins to the center, likely by way of collateral axonal sprouting from the undamaged nerves surrounding the flap. Myelinated fibers recover slowly and inefficiently. Therapeutic, IV.

Comparison of the Surgical Outcomes of Free Flap Reconstruction in Head and Neck Cancer Patients

Objective: The goals of this research were to (1) assess the efficacy of free flap reconstruction in patients with early and recurrent head and neck cancers, and (2) investigate the variables associated with these surgeries that increase the risk of problems. Study Design: Retrospective Study Place and Duration: Frontier Medical College, Abbottabad, from March, 2022 to August, 2022. Methods: Total 200 patients of head and neck cancer were included in this study. Patients were both males and females with primary and recurrent cancer types were underwent for free flap reconstruction. After receiving informed written consent, in-depth demographic information about the cases that were enrolled was recorded. Patients were divided in two groups. Hundred patients of recurrent cancers were included in group I and 100 patients of primary cancers were included in group II. Surgical outcomes among both groups were assessed and compared. SPSS 24.0 was used to analyze all data. Results: We found that 87 (87%) patients in group I and 81 (81%) patients in group II were males. Mean age of the patients in group I was 49.8±11.37 years and in group II mean age was 51.4±7.42 years. Majority of the patients had tumor stage 5. Smoking, betel nut and alcohol were the most common causes found in all cases. Anterior lateral thigh (ALT) and anterior medial thigh (AMT) were the most common flap types among both groups. We found that free flap reconstruction had higher success rate in primary cancers found in 96 (96%) as compared to recurrent cancers group in 92 (92%). There was no any significant difference found among both groups in terms of post-surgery complications. Conclusion: This study's findings suggest a greater failure rate for free flap reconstruction in the recurrent group compared to the primary group, however this finding may be attributable to the varied patient characteristics between the two groups.

Postoperative Complications in Patients Undergoing Nonabdominal Wall Flap Reconstruction after Laparoscopic or Robotic Abdominoperineal Resection

INTRODUCTION: Abdominoperineal resection (APR) is the treatment of choice for patients with rectal cancer. Typically, reconstruction after APR is done with a rectus abdominus myocutaneous (RAM) flap. Given the increased management with laparoscopic APRs, abdominally based flap reconstruction is inappropriate because of its invasiveness and significant abdominal wall morbidity. Therefore, a nonabdominal wall based free flap alternative, such as an anterior lateral thigh flap, gluteal flap, or gracilis flap, may be a superior approach looking forward. The aim of this study is to evaluate postoperative short- and long-term complication rates in patients undergoing nonabdominal wall flap reconstruction after laparoscopic or robotic APR. METHODS: We conducted a review of the literature to include adults with rectal cancer and looked at short-term complications such as increased healing time, seroma, hematoma, surgical site infection, dehiscence rates, reoperation rates, as well as long term complications such as perineal hernia rates. RESULTS: Our study included 64 articles and 306 flaps. The overall wound complication rate was 15.0%. In the short-term, 23 patients experienced hematomas, 16 patients experienced surgical site infection, 3 patients dehisced, and 4 required reoperations. The ALT flap offered the lowest rate of complications at 9.3%. CONCLUSION: In conclusion, the wound complication rate of 15.2% was comparable with literature findings of 14.3% in patients with RAM flap reconstruction. Nonabdominal wall-based flap reconstruction is effective after APR. Owing to its low complication rate, the ALT flap may serve as a superior treatment option for laparoscopic or robotic APR in patients with rectal cancer.

Algorithm of reconstruction combined midface defects after resection malignant tumors

Introduction. Surgical treatment of malignant tumors of maxilla and midface results to a combined defects of the soft tissues of the face (upper lip, buccal, zygomatic regions), upper jaw, hard and soft palate, retromolar region, orbit, nasoethmoidal complex. This is one of the most difficult localizations in terms of both the possibility of performing radical surgery and reconstruction. The purpose of reconstruction is not only the elimination of cosmetic deformity, but also the restoration of such vital functions as breathing, swallowing, speech and binocular vision. Till that time, no algorithm has been developed for choosing a method for the reconstruction and there is no comparative analysis of the available methods.The study objective is to improve the functional and aesthetic results of treatment patients with malignant tumors of the upper jaw and midface.Materials and methods. For the period from 2014 to 2020 in the Department of Head and Neck Tumors of the N.N. Blokhin National Medical Research Center of Oncology, ministry of Health of Russia microsurgical reconstruction after resections of the upper jaw and midface was performed in 80 patients. most often (25 (31 %) patients) the primary tumor was localized in the maxillary sinus, then hard palate (16 (20 %) patients), soft palate (11 (14 %) patients), retromolar trigone (13 (16 %) patients). primary location at alveolar process of the upper jaw was in 3 (3 %) cases, nasal cavity and cells of the ethmoid labyrinth - in 4 (5 %), frontal sinus - in 5 (6 %), the skin of the cheek and lower eyelid - in 3 (3 %) patients. we defined 4 main types of resection. Type I - combined lower resections of the maxilla and mucosa of the retromolar region, soft palate, lateral wall of the oropharynx (47 (60 %) patients). Type II - total radical maxillectomy (resection of all walls of the upper jaw, including orbital wall) (12 (15 %) patients). In 5 (42 %) cases, the resection was combined and included, in addition to the upper jaw, the skin of the buccal and zygomatic regions. Type III - combined partial resections of the upper jaw (13 (17 %) cases). In 9 (69 %) cases, the block of tissues to be removed included a fragment of the skin of the buccal region, part of the external nose, and lower eyelid. Type Iv - orbitomaxillary resection with orbital exenteration (6 (8 %) patients), including exenteration of the orbit, cells of the ethmoid labyrinth, resection of the frontal bone, medial wall of the orbit, a fragment of the dura mater (4 (67 %) cases), skin of frontal, buccal, zygomatic areas, upper and lower eyelids. for reconstruction of defects in 80 patients we used 82 free flaps. In 76 (93 %) cases, simultaneous resections of the primary lesion and reconstructions were performed, in 6 (7 %) cases, delayed reconstruction after previously performed combined or complex treatment were performed.Results. In type I resection with limited defects excellent functional and aesthetic results were obtained in all cases of using a radialis fasciocutaneous free flap. In case of subtotal and total defects of the hard palate and the alveolar margin of the upper jaw, the best aesthetic (excellent in 5-46 % of patients, satisfactory in 3-27 %) and functional (excellent speech quality in 8 patients) results were obtained with use free scapula tip flap. In type II resections excellent aesthetic results were obtained in 6 (55 %) patients. In all cases, a chimeric free flap consists of tip of the scapula, fragment of serratus muscle and skin of parascapular region was used. In type III resections in patients with limited defects, 5 (71 %) had excellent aesthetic results, and 2 (29 %) had satisfactory aesthetic results. In all cases a radial free flap was used. In case of half defects of the upper jaw anterior-lateral thigh flap and thoracodorsal free flap was used. In all cases satisfactory aesthetic result was obtained. In type IV resections satisfactory aesthetic results were obtained in all patients.Conclusion. Preoperative computer 3D modeling is necessary in planning of reconstruction. This allows to determining the type and volume of the defect, plan optimal method of reconstruction, model the required flap geometry, making a template for harvesting flap, calculating the position and number of titanium plates for fixation, and, if necessary, print an individual mesh of the infraorbital wall.

V04-10 GENDER-AFFIRMING PHALLOPLASTY WITH ANTEROLATERAL THIGH FLAP

You have accessJournal of UrologyCME1 May 2022V04-10 GENDER-AFFIRMING PHALLOPLASTY WITH ANTEROLATERAL THIGH FLAP Ömer Acar, Alexi Millman, Luca Morgantini, Loren Schechter, and Ervin Kocjancic Ömer AcarÖmer Acar More articles by this author , Alexi MillmanAlexi Millman More articles by this author , Luca MorgantiniLuca Morgantini More articles by this author , Loren SchechterLoren Schechter More articles by this author , and Ervin KocjancicErvin Kocjancic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the options that can be employed within the context of gender-affirming masculinizing genital reconstruction is the anterior lateral thigh (ALT) flap. Our objective is to demonstrate our technique with ALT flap phalloplasty. METHODS: This is a 25-year-old trans male who desired to void in a standing position. Given the subcutaneous thickness of less than 1 cm in his thigh and concerns related to donor-site scarring, the shared decision was to proceed with phalloplasty with an ALT flap constructed in a “tube within a tube” technique. RESULTS: Acoustic Doppler followed by fluoro angiography to confirm perforator location helped outline the ALT flap. A suprapubic tube (SPT) was inserted under direct cystoscopic guidance. Anterior vaginal wall flap was mobilized and tubularized around the catheter. Clitoris was de-epithelialized. A semilunar suprapubic skin incision was made. Clitoris was sutured to the pubic periosteum. The remaining vaginal mucosa was ablated with electrocautery. Colpocleisis was completed using concentric stitches. The patient was then taken out of lithotomy position and the ALT flap was elevated. Dissection was performed to the intermuscular septum between the rectus femoris and the vastus lateralis. Descending branch of the lateral femoral circumflex artery was identified. The lateral femoral cutaneous nerve was dissected proximally. The flap was elevated on a single perforator and repeat fluorescence angiography confirmed intact perfusion. The urethra was reconstructed over an 18 Fr. council tip catheter and closed in a layered fashion. Methylene blue confirmed urethral integrity. Shaft skin was wrapped around the phallic portion of the urethra and closed in a layered fashion. The left ilioinguinal nerve was clipped for later coaptation with the lateral femoral cutaneous nerve. The flap was passed beneath the rectus femoris, sartorius, and then subcutaneously into the recipient site over the pubic symphysis. The anastomosis between the phallic urethra and elongated native urethra was performed over an 18 Fr. council tip catheter using interrupted stitches. Scrotoplasty was performed using labia majora flaps. The flap was then inset in a layered fashion. The donor site was closed by reapproximation and advancing the skin edges. A split-thickness skin graft was harvested from the thigh and applied over the donor site. The donor site was dressed with wound VAC. The procedure lasted 12 hours with an estimated blood loss of 550 ml. The patient was discharged on day 18. The urethral catheter was removed after a 30 days retrograde urethrogram (RUG). SPT was removed a month later. The patient initially voided without issues but then started to notice urine leakage through a phallic skin defect. RUG demonstrated distal phallic urethral stricture and a small urethrocutaneous fistula just proximal to it. The stricture was dilated with sounds. The patient was instructed to do intermittent self-calibration. Voiding improved, stricture did not recur and fistula healed spontaneously. No other urinary complications were encountered. CONCLUSIONS: ALT flap is a valid option for gender-affirming phalloplasty. It can be considered in patients with favorable body habitus who are concerned with donor-site scarring. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e369 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ömer Acar More articles by this author Alexi Millman More articles by this author Luca Morgantini More articles by this author Loren Schechter More articles by this author Ervin Kocjancic More articles by this author Expand All Advertisement PDF downloadLoading ...

Microvascular free flap for head and neck reconstruction: our experiences with 218 free flaps for head and neck reconstructions

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Defect following radical resection for advance head and neck cancers are complex and without doubt microvascular free flap offer the best reconstructive option. The purpose of this study is to investigate the flap survival rate and review each vascular compromised flaps.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a reviewed of 218 microvascular free flaps done for reconstruction of 204 head and neck patients. There were 112 (51.3%) radial forearm flaps (RFF), 82 (37.6%) fibula flaps (FF) and 24 (11%) anterior lateral thigh (ALT) flaps. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 16 complete flap loss and 3 partial flap loss, giving an overall flap survival rate 91.8% (19/218) and flap survival in turn of complete loss 92.7% (16/218). In RFF, there were 7 complete and 1 partial flap loss, giving an overall flap survival rate 92.9% (8/112) and flap survival in turn of complete loss 93.8% (7/112). In FF, there were 6 complete flap loss, giving a flap survival rate 92.7% (6/82). In ALT flap, there were 3 complete and 2 partial flaps loss, giving an overall flap survival rate 79.2% (5/24) and flap survival in turn of flap complete loss 87.5% (3/24). In our series vascular flaps complications rate was 12.3% (27/218), with a salvageable rate of 29.6% (8/27). The most salvageable flap was RFF 46.6% (7/15).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study re-enforce the learning curve in microvascular free flap and RFF is a good flap for a beginner. &lt;/p&gt;

Free Flap Coverage for Complex Primary and Revision Total Knee Arthroplasty.

Free flap coverage in the setting of a total knee arthroplasty is rare. The purpose of the current study was to evaluate the outcome of patients who underwent a free flap to assist with soft-tissue coverage following a complex total knee arthroplasty. The authors used their institutional total joint registry to retrospectively review patients undergoing a free soft-tissue flap in the setting of complex primary and revision total knee arthroplasty. Among 29,069 primary and 6433 revision total knee arthroplasties from 1994 to 2017, eight (0.02 percent) required a free flap for wound coverage. This included three primary total knee arthroplasties (0.01 percent) for posttraumatic arthritis and five revision total knee arthroplasties (0.07 percent) in the setting of infection. Median follow-up was 4 years. Free flaps included vertical rectus abdominis (n = 3), anterior lateral thigh (n = 2), latissimus (n = 2), and transverse rectus abdominis (n = 1). There were no total flap losses; however, one patient required additional skin grafting. Reoperation occurred in six patients, of which four were revisions of the total knee arthroplasty for infection (n = 2) and tibial component loosening (n = 2). One patient ultimately underwent transfemoral amputation for persistent infection. Following reconstruction, there was improvement in the median Knee Society Score (49 versus 82; p = 0.03) and total range of motion between preoperative and postoperative assessments (70 degrees versus 85 degrees; p = 0.14). Free flap coverage in the setting of total knee arthroplasty was associated with a high rate of reoperation; however, the limb was able to be preserved in the majority of patients, with a reasonable functional outcome. Therapeutic, IV.

Clinical T4b Squamous Cell Carcinoma Resection With Hemimandibulectomy and Temporomandibular Joint Reconstruction With Bridging Plate and Modified Dautrey Procedure

Clinical T4b oral squamous cell carcinoma is traditionally considered nonoperable. We present a case of right mandibular squamous cell carcinoma (PT4bN0M0, stage IVB). The tumor had extended to the right mandibular condylar head and masticatory space. The patient received right modified radical neck dissection and radical operation with hemimandibulectomy to remove the right mandibular condyle. Then, we reconstructed the resected portion with an anterior lateral thigh free flap and bridging plate, which was bent to form an artificial condyle and fixed using the modified Dautrey procedure. The patient had stable postoperative occlusion and normal hinge movement of the temporomandibular joint. After postoperative concurrent chemotherapy and radiotherapy, the patient is under regular out patient department follow-up with satisfactory jaw function and oral intake.

Uyluk ve Baldır Bölgesindeki Deri Altı Yağ Dokusunun Subkutan Enjeksiyona Uygunluğunun Bilgisayarlı Tomografi ile Değerlendirilmesi

The most commonly used areas in the lower extremity in subcutaneous injection applications are anterior and lateral surface of the thigh. The calf region, which is an alternative to these areas, is located in the lateral region of the gastrocnemius muscle. The aim of the study is to retrospectively evaluate of suitability of thigh and calf site subcutaneous adipose tissue thickness for subcutaneous injection through computed tomography sections. The sample of this descriptive study consisted of 140 adult patients over the age of 18 who underwent Contrast-Enhanced Lower Extremite Computed Tomography Angiography between March 2020 and March 2021. Subcutaneous tissue thicknesses of the anterior thigh, lateral thigh, and calf injection site of the subjects were measured by a specialist radiologist using computed tomography sections. As a result of the study, a comparison of subcutaneous tissue thickness in the thigh and calf was achieved according to gender and body mass index. The mean subcutaneous tissue thickness of the patients was 13.64 ± 6.85 mm on the anterior thigh, 8.82 ± 7.21 mm on the lateral side of the thigh, and 6.15 ± 3.12 mm in the calf area. It was found that there was a significant difference between subcutaneous tissue thicknesses according to their gender and body mass index. Subcutaneous tissue thickness on the anterior thigh was thicker than the lateral thigh and the calf injection site. Subcutaneous tissue thickness in females was greater than in males. Subcutaneous tissue thickness in the calf region was thicker than 4 mm in 77.1%, 8 mm in 19.3% and 12 mm in 12.3%.

Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review.

Retrospective case series; systematic review. It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.

The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study

The objective of this study was to investigate whether closed incisional negative pressure therapy (cINPT) is suitable to improve anterior lateral thigh (ALT) flap donor site healing and scarring. We identified 271 ALT free flaps of widths between 7 and 9cm and primary donor site closure performed between January 2012 to December 2019. Patients were divided into cases of cINPT versus controls without cINPT as part of this retrospective case-control review. We compared the incidences of postoperative donor site complications (wound dehiscence, infection, seroma, hematoma) and the degree of scarring severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS). A total of 106 ALT donor sites received cINPT (39%), whereas the remaining 165 donor sites received conventional dressings (61%). The distribution of gender, age, body mass index, comorbidities, and mean flap sizes were comparable between both groups. The occurrence of surgical wound dehiscence was significantly lower in the cINPT group (2.8%), when compared to controls (9.0%) (p=0.04). Furthermore, the mean length of postoperative hospital stay was significantly shorter in the cINPT group (19±8 days versus 21±11 days; p=0.03). CINPT was associated with a more favorable donor site scar quality when assessed by VSS (p=0.03) and POSAS (p=0.002). The use of cINPT was associated with significantly less ALT donor site complications and superior scar quality accelerating patients' postoperative recovery.

Free flap surgery in osteoradionecrosis of the head and neck

: Osteoradionecrosis (ORN) following radiation therapy is a much-feared complication of the treatment of head and neck cancer. Free flap reconstruction in the ORN patient has specific challenges for the surgeon. From 2014 to 2020 the Head and Neck Microvascular unit of the Oral and Maxillofacial Surgery Division at Jackson Health/University of Miami treated 149 ORN patients with free flap reconstruction. The fibula free flap (n=65) and anterior lateral thigh free flap (6n=1) were the workhorse flaps in our series comprising 44% and 41% of the total flap surgeries. A total of 13 cases (8.7%) involved performing 2 flaps in the same operation. Thirty cases had recorded complications with one flap loss (0.7%) and one case of partial necrosis (0.7%) of the flap. The most common complications encountered were flap congestion with 8 cases (5%), 5 cases of flap dehiscence,4 cases of neck hematoma (2.6%) and 3 cases of infection of the flap reconstruction site (3%). The average length of stay was 8.2 days. In this paper we present our approach to reconstruction in these patients and the lessons we have learned. Though this surgery is complex and has greater risks than free flap surgery in the “virgin” neck, our experience demonstrates that good outcomes can be achieved consistently with a structured approach.