Anterolateral Thigh Flap For Reconstruction Research Articles

Groin and anterolateral thigh flaps for hemiglossectomy reconstruction: A comparison based on Japanese speech intelligibility

ObjectiveThe differences in speech function between groin flap reconstruction and anterolateral thigh (ALT) flap reconstruction after hemiglossectomy have not been clarified to date. This study aimed to compare Japanese speech intelligibility after hemiglossectomy reconstruction using groin and ALT flaps of similar thickness. MethodsData of patients who underwent hemiglossectomy reconstruction with groin or ALT flaps between April 2010 and March 2020 were collected from the medical chart database. The ALT flap was the first choice for hemiglossectomy reconstruction, and a groin flap was used when the ALT flap was >10 mm. Cases in which speech intelligibility assessments based on Hirose's 10-point scoring system, the TKR speech test, and the Japanese speech intelligibility test for 100 monosyllables were performed after 6 months postoperatively were extracted. The per-patient scores for each assessment were initially compared between the two flap groups. Then, the results of the Japanese speech intelligibility test for 100 monosyllables were reanalyzed on a syllable-by-syllable basis. ResultsAmong the 44 hemiglossectomy patients who underwent free-flap reconstruction during the study period, 14 (seven each in the groin flap and ALT flap groups) underwent all three conventional speech intelligibility assessments after 6 months postoperatively. The two groups showed no significant difference in postoperative speech intelligibility in any of the three patient assessment methods. However, in intergroup comparisons based on per-syllable accuracy for each of the 100 monosyllables, the groin flap group showed 19 syllables with a significantly higher accuracy, whereas the ALT flap group showed one such syllable. In particular, five out of the six alveolar consonants (/t/ and /d/) were more accurately articulated in the groin flap group. Per-syllable accuracy was significantly higher in the groin flap group (74.6% vs. 66.7%; 95% confidence interval: 4.6–11.1, p < 0.001). ConclusionIn patients undergoing hemiglossectomy reconstruction, our new analysis method, which compared intelligibility by syllables, showed that the groin flap yielded higher speech intelligibility than the ALT flap. This difference was evident at all four articulation points involving the tongue, whereas there was no significant difference at the two articulation points without tongue involvement.

Efficacy of pedicled anterolateral thigh flap for reconstruction of regional defects - a record analysis.

The anterolateral thigh (ALT) flap was described as the fasciocutaneous flap. It can be harvested as apedicled and/orfree flap. Majority of the free flaps are harvested as afasciocutaneous flap. Their use in head and neck reconstruction and limb trauma is well established. Apart from these advantages, this flap has various applications which are less utilized. ALT flap can be used as amyocutaneous flap along with vastus lateralis muscle. When muscle and fasciocutaneous flaps are required, both can be harvested as achimeric flap which can cover two different regions of the wound. Moreover, harvest of the pedicled flap procedure is less time-consuming than that of afree flap. Since it has along vascular pedicle, when used as pedicled flap, it can reach up to the gluteal region. To evaluate these less applied advantages of pedicled ALT flap, our study was undertaken. This study aimed to evaluate the efficiency of ALT flap in terms of the surface area of coverage, arc of rotation and the advantages of including vastus lateralis muscle as part of the flap. Aretrospective record analysis of all pedicled ALT flap reconstruction of trochanteric, upper thigh, gluteal and flank regions from 2016 to 2018 was undertaken; 7 patients with 8 defects were included. All the flaps healed successfully. There was no major necrosis of the flap and minor complications like wound gapping were found in three patients. The ALT-vastus lateralis flap dimensions can be very large and can be easily harvested in avery short time. Vastus lateralis muscle harvested can be used to fill the defect or can be used as chimera to cover the defect. The use of muscle over long standing infective pressure sores can sterilize the wound bed and help in preventing recurrence. The vascularity of this flap is robust and highly reliable. Even after amaximum arc of rotation (up to 170°) all the flaps survived without any major complications.

Persistent Postsurgical Pain in Oral Cancer Patients Reconstructed with Anterolateral Thigh Free Flap.

Background and Objectives: The anterolateral thigh (ALT) flap is widely used in head and neck reconstruction, but the postoperative thigh sensory function lacks sufficient evaluation. The present study reports the postsurgical pain and cancer-related quality of life (QoL) in different stages of oral cancer patients receiving anterolateral thigh (ALT) flap reconstruction. Materials and Methods: Patients were subgrouped into postoperative early-, mid-, and late-recovery stages (postoperative 0.5–1 years, 1–2 years, and above 2 years) according to the time point of assessment. The QoL was examined using the EORTC C-30. Postsurgical donor and receipt site pain was evaluated through subjective reports and sensory tests. Results: Ninety-four patients were included in the final analysis. The functional and global health-related QoL significantly improved with time after surgery. However, spontaneous pain was reported in 57.7%, 72.3%, and 42% of patients in early-, mid-, and late-recovery stages, mainly in donor sites rather than in receipt sites. The highest incidence of donor site pain after ALT flap reconstruction in oral cancer surgery was in the mid-recovery stage but remained high in the late-recovery stage (56.8% and 36.7%, respectively). Conclusions: The postsurgical pain in the donor site might persist to or exhibit delayed onset one to two years postoperatively but is much improved after postoperatively two years later. A longer postsurgical follow-up for over two years for pain and sensory dysfunction is indicated.

Establishment of a patient-derived mucoepidermoid carcinoma cell line with the CRTC1-MAML2 fusion gene.

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the major and minor salivary glands. Surgical resection is the only curative treatment and there is no effective post-operative therapy for MEC. The present study reports an Institutional Review Board-approved case of a 45-year-old Japanese female diagnosed with low-grade MEC in the hard palate. Radical resection, supraomohyoid neck dissection and antero-lateral thigh flap reconstruction was performed. A MEC cell line was then established from the resected tumor tissue. Short tandem repeat profiling confirmed the origin and authenticity of the cell line, that harbors a CRTC1-MAML2 translocation, which is frequently observed in MEC. Amphiregulin (AREG), identified as one of the targets of the CRTC1-MAML2 fusion gene, was expressed in the cell line. The AREG receptor, epidermal growth factor receptor (EGFR) was also highly phosphorylated. The results predicted that AREG-EGFR signaling, which is required for tumor growth and survival, might be activated in the cell line in a cell-autonomous manner. As AREG expression is associated with EGFR-targeted drug resistance, this cell line might assist with the identification of novel strategies for MEC treatment.

Application of an L-shaped anterolateral thigh flap in reconstruction after hemiglossectomy

ObjectiveTongue defect reconstruction is one of the key components of tongue cancer surgery. In this study, we used an L-shaped flap design adopted as a simple and efficient method to repair tongue defects after hemiglossectomy. Furthermore, we evaluated and contrasted the clinical effects of two methods, the L-shaped and traditional methods.Study designFifteen patients in the L-shaped group and 20 patients in the traditional group were evaluated and compared in terms of postoperative complications, dysphagia, language function and appearance satisfaction.ResultsThe results (Table 1) showed that there were 2 cases of donor area invalid traumas, and 2 patients had scar hyperplasia in the traditional group. The degree of global and functional dysphagia of the L-shaped group (2.60 ± 0.29 and 11.47 ± 1.38) was lower than that of the traditional group (3.55 ± 0.29 and 15.75 ± 1.22) (P < 0.05). In the language evaluation, the traditional group (3.20 ± 0.26) had lower scores than the L-shaped group (4.13 ± 0.30) (P < 0.05).ConclusionThe L-shaped ALTP flap is a simple and efficient modification of ALTP, that can be used for half-tongue repair after radical operations for tongue cancer. It has better performance in the recovery of dysphagia and language function than the traditional ALTP flap.

Application of “chimeric” double anterolateral thigh flaps for reconstruction of massive postburn defect in head and face (Case report).

Head and neck tissue defects are frequently, especially deep and wide defects caused by burning. Choosing sufficient material is a big challenge for surgeons. Using double anterolateral thigh perforator flaps in chimeric type is a new method, a new idea with many advantages for providing large tissue volume to reconstruct extensive defects in face and head area.We were a success in treating a case of extensive facial burn with complicated lesions by using two anterolateral thighs free flap in chimeric type with single anastomosis. Postoperation, both flaps are survived completely and got good outcomes in both function and aesthetics.

Preoperative Computed Tomography Angiography for ALT Flaps Optimizes Design and Reduces Operative Time.

Computed tomography angiography (CTA) has been widely used for perforator mapping in abdominal-based reconstruction, but it is less widespread in the anterolateral thigh (ALT) flap. However, CTA may be quite useful for ALT planning, as this flap has demonstrated substantial variability in intrapatient bilateral vascular anatomy. This study investigated whether standard use of preoperative CTA resulted in selection of the donor extremity with preferential perforator anatomy, and whether this affected operative time and postoperative outcomes. A retrospective review of 105 patients who underwent proposed ALT flap reconstruction was performed. Seventy-nine patients received bilateral lower extremity CTAs, which were evaluated for dominant perforator anatomy (septocutaneous, musculoseptocutaneous, or musculocutaneous). Donor extremity selection was noted, and predicted perforator anatomy was compared with that encountered intraoperatively. Among the 73 patients who received bilateral imaging and ultimately received an ALT, congruent findings between imaging and surgical exploration were observed in 51 (69.8%) patients. Thirty (37.9%) patients had asymmetric perforator anatomy between their bilateral extremities on imaging. Among these, the leg with optimal perforator anatomy was selected in 70% of cases. There were no significant reductions among postoperative complication rates, but selection of the donor site with preferential anatomy was associated with a decrease in operative time (p = 0.049) among patients undergoing extremity reconstruction. CTA is a useful tool for optimizing donor site selection for ALT flaps and reducing operative time. We believe that standard use of preoperative CTA in ALTs warrants further consideration.

Pedicled Anterolateral Thigh Flap As A Workhourse Flap for Reconstruction of Inguino-Scrotal Defects

Background: Reconstructions around inguinoscrotal region has been a challenging task owing to complex anatomy. There are variety of flap options available for reconstruction of Inguinoscrotal region. Our study was done to evaluate the use of pedicled anterolateral thigh flap for reconstruction of defects around inguinoscrotal regions. Methodology: In this study a total of 18 patients with various types of defects around inguinoscrotal region were evaluated. The etiology of defects included trauma (𝑛=6), infection (𝑛=8), malignancy (𝑛=2) and burn (𝑛=2). Patients were evaluated in terms of viability of the flap, number of perforators included, pedicled length and flap dimensions and donor site morbidity. Results: All flaps were survived well except 1 flap develop venous congestion in immediate post operative period due to tension over vascular pedicle which was managed by increasing pedicle length. 2 patients had developed partial loss of the skin graft at the donor site which got healed secondarily in due course. All patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion: Pedicled ALT flap is a versatile, reliable flap, with wide arc of rotation which makes it as an ideal flap for the coverage of defects around inguinoscrotal region.

How to Map All Your Flap Perforators in 2 Minutes

INTRODUCTION: Imaging modalities are changing clinical practice in plastic surgery and becoming more compact, more affordable, and easier to use. Over the last two decades, 3D imaging, ICG angiography, and virtual surgical planning have become commonplace for operative decision-making. Recently, mobile thermal imaging has demonstrated accuracy and consistency in determining perforator locations and visualizing the functional angiosomes.1 A study by Khouri et al in 1992 showed that the sensitivity of surface-temperature recording is 98%, and its predictive value is 75%.2 We sought to investigate whether recovery-enhanced mobile thermal imaging can be used to rapidly and reliably design perforator flaps. METHODS: Thermal imaging was compared with Doppler perforator mapping in five volunteers. Volunteers underwent traditional flap markings on one thigh and mobile thermal imaging (FLIR One Pro, FLIR Systems, Inc., Willsonville, Oreg.) on their contralateral thigh. In the traditional group, a line was drawn from the ASIS to the superolateral border of the patella with a 3-cm-radius circle at the midpoint, followed by perforator identification with a Doppler.3 On the contralateral thigh, ice cooling was performed for 10 seconds followed by inspection with the thermal camera. Time to identify at least three perforators, determination of perforator dominance, and perforator concordance were recorded. Additionally, in two consecutive patients undergoing anterolateral thigh flap reconstruction, flap design was examined based on traditional markings versus thermal imaging. RESULTS: Perforator identification was more rapid (136 seconds versus 232 seconds) and more likely to demonstrate perforator dominance (five versus one) using thermal imaging compared with traditional markings (P < 0.05). In both patients undergoing ALT flap reconstruction, three perforators were located with traditional and thermal imaging markings. In patient one, the middle perforator demonstrated dominance and true anastomoses to the surrounding perforators. In patient two, the transverse branch perforator demonstrated maximal intensity and poor connections to the distal perforators. After this, proximal perforator was divided and the thermal imaging worsened, resulting in resection of the proximal flap and change in flap design. Perforator location matched computed tomography angiographic findings in both patients. No postoperative flap compromise was encountered. CONCLUSIONS: Thermal imaging with ice cooling appears highly effective at rapid perforator and angiosome identification-based flap design. Recovery-enhanced thermography by ice cooling allows for dynamic visualization of angiosome perfusion area. Given improvement in technology and decreasing costs, mobile thermal imaging may become a reliable tool in flap design and flap monitoring. REFERENCES: 1. Pereira N, Valenzuela D, Mangelsdorff G, et al. Detection of perforators for free flap planning using smartphone thermal imaging. Plast Reconstr Surg. 2018;141(3):787–792. 2. Khouri RK, Shaw WW. Monitoring of free flaps with surface-temperature recordings: is it reliable? Plast Reconstr Surg. 1992;89(3):495–499; discussion 500–502. 3. Saint-Cyr M, Oni G, Lee M, et al. Simple approach to harvest of the anterolateral thigh flap. Plast Reconstr Surg. 2012;129(1):207–211.

S2062 Sudden Dysphagia After Total Laryngopharyngectomy

Introduction: Total laryngopharyngectomy is done for extensive laryngeal and hypopharyngeal cancers, including squamous cell carcinoma and advanced thyroid cancer. The surgery’s aim is to remove cancer, and restore continuity of the oral cavity and esophagus. Most commonly a skin flap is used to recreate a neopharynx connecting the mouth to the esophagus. A favored method is to use the anterior thigh flap. Common sequelae of this surgery include fistula formations and strictures. We present a case of food impaction in the post surgical period of an anterolateral thigh flap reconstruction after squamous cell carcinoma of the larynx. Case Description/Methods: A 58 y male with a history of squamous cell carcinoma of the larynx complicated by tumor invasion of the cervical esophagus and epiglottis status post total laryngopharyngectomy, tracheostomy, G tube, and cricothyroidotomy presented to the ED with discomfort after eating lasagna. His post surgical course had been complicated by recurrent fistula formation and was therefore recommended NPO status and a salivary bypass tube was placed. Following his meal he felt a foreign body sensation, dysphagia, and vomited. On physical exam he was noted to be uncomfortable but was able to tolerate his oral secretions. An esophagram revealed occlusion of the proximal salivary bypass tubing and an EGD was subsequently performed. Using a pediatric scope the salivary bypass tubing was entered and retained food was seen. Using gentle suctioning, water, and forceps, the food was pushed into the native esophagus. The patient's symptoms resolved following the procedure and he was discharged on tube feeds. Discussion: Pharyngoesophageal reconstruction with an anterolateral thigh flap reconstruction is a favored surgical technique after total laryngectomy. To prevent or treat a post surgical fistula or stricture, a salivary bypass tube may be placed. While studies show that the majority of patients are eventually able to tolerate nutrition by mouth, gastroenterologists should be aware of the risk of food bolus given the narrow diameter and lack of distensibility and motility of the bypass tubing.Figure 1.: Endoscopy image showing. Red arrow: Inlet patch Blue arrow: melanocytosis.

Recurrent Giant Mucoepidermoid Carcinoma of the Parotid: A Case Report and Review of Literature.

Mucoepidermoid carcinoma is the most common salivary gland malignancy and about one third occurs in the parotid gland. The peak incidence is commonly seen between the third and fifth decades of life. It routinely presents as a fixed, painless mass below the ear. However, its presentation as a giant mass is exceedingly rare. Here, we report a case of a recurrent giant exophytic mucoepidermoid carcinoma in a young male. He underwent Revision Total Parotidectomy with Modified Radical neck dissection with Sural nerve grafting and an Anterolateral thigh flap reconstruction followed by Adjuvant radiotherapy. The rarity of the clinical presentation and the management challenges faced in a young male are being discussed in this case report.

Anterolateral Thigh Flap for Reconstruction of an Oropharyngectomy Defect.

Anterolateral Thigh Flap for Reconstruction of an Oropharyngectomy Defect.

Pedicled sural flaps versus free anterolateral thigh flaps in reconstruction of dorsal foot and ankle defects in children: a systematic review.

BackgroundThis systematic review compared free anterolateral thigh (ALT) flaps versus pedicled distally based sural artery (DBSA) flaps for reconstruction of soft tissue defects of dorsal foot and ankle in children.MethodsA systematic literature search was performed to identify cases where an ALT or DBSA was used to reconstruct the dorsal foot in children. A total of 19 articles were included in the systematic review.ResultsEighty-three patients underwent an ALT reconstruction and 138 patients underwent a DBSA reconstruction. Patients who had a DBSA were more likely to require grafting of the donor site (P<0.001). The size of ALT flaps was significantly larger than DBSA flaps (P=0.002). Subsequent flap thinning was required in 30% of patients after ALT and 12% of patients after DBSA reconstruction (P<0.001). Complications occurred in 11.6% of DBSA and 8.4% of ALT flaps (8.4%).ConclusionsBoth flaps are valid options in reconstructing pediatric foot and ankle defects. Each flap has advantages and disadvantages as discussed in this review article. In general for larger defects, an ALT flap was used. Flap choice should be based on the size of the defect.

Aesthetic and functional outcomes of thinned anterolateral thigh flap in reconstruction of complex wounds of the upper limb.

We studied outcomes of reconstruction of complex upper limb wounds using thinned anterolateral thigh flaps. There were 18 patients with a mean age of 27.5 years. The mean thickness of the flap before and after thinning was 23 mm and 5 mm, respectively. Two patients had partial tip necrosis that was treated conservatively. Aesthetic and functional evaluations were performed using a 5-point Likert scale, QuickDASH score, passive range of motion and power grip at 12 months after surgery. The study showed good results in the aesthetic evaluation by a panel of plastic surgeons (mean score: 19.7) and patient self-assessment (mean score: 18.1). There was a significant correlation between the total scores of the panel and the patients. The mean QuickDASH score was 21, with a high percentage in the middle category 'had a problem but working'. The thinned anterolateral thigh flap is versatile and safe in upper limb reconstruction with good aesthetic and functional results.Level of evidence: IV.

Resuming Oral Feeding in Patients With Oral Squamous Cell Carcinoma With Free Anterolateral Thigh Flap Reconstruction.

Quality of life and functional improvement have emerged as important goals for patients with oncologic disease. For patients with head and neck cancer, free anterolateral thigh (ALT) flaps serve as reliable reconstruction and provide functional restoration. Nevertheless, factors affecting the resumption of oral feeding are rarely described. This study aimed to evaluate and compare the functional outcomes of oral feeding for patients with different oncologic defect patterns and reconstructive ALT flap designs. We retrospectively reviewed patients with head and neck cancer undergoing oncologic ablation and free ALT reconstruction between January 2016 and April 2018 at National Taiwan University Hospital. Patients were categorized into 2 groups as through-and-through (T&T) and non-through-and-through (non-T&T) according to the defect pattern. We further subgrouped T&T patients into lip resection/lip sparing according to lip involvement. Reconstructive ALT flaps were of 2 designs, folded (F-ALT) and chimeric (C-ALT). Outcomes of oral feeding were analyzed using descriptive statistics, and differences between groups were compared using the Student t test. We identified 233 patients who received oncologic ablation and free ALT flap reconstruction. There was no significant difference in functional recovery between the T&T and non-T&T groups (81.2% vs 73%, P = 0.137). However, among patients who succeeded in resuming oral feeding, lip-sparing patients had better functional recovery in terms of early oral feeding within 6 months and nasogastric tube removal compared with lip-resection patients (100% vs 83.3%, P = 0.001). Moreover, the F-ALT design resulted in a higher success rate in resuming oral feeding compared with the C-ALT design (90.5% vs 54.6%, P = 0.032). Patients with head and neck cancer with T&T defects were associated with higher rates of secondary flap revision and a trend of delayed oral feeding. In the long term, improved oral feeding outcome with the F-ALT design was observed compared with the C-ALT design in the specific group with T&T defect.

Pedicled Anterolateral Thigh Flap

Background: Once it has been first described by Song et al., in 1984, anterolateral thigh (ALT) flap gains wide popularity as a free flap with only a few reports in the literature regarding its application as a pedicled flap in regional soft-tissue reconstruction in pediatric patients. Materials and Methods: The author describes his experience about the role of pedicled ALT flap in reconstruction of different local defects in pediatric patients. Representative cases are presented for illustration. Results: Nine patients with ischial, trochanteric, and groin defects have been reconstructed by pedicled ALT flap between January 2018 and January 2019. The patients were between 7- and 15-year-old. The size of the flaps measured from 4 cm × 6 cm to 19 cm × 17 cm. The type of the flap was myocutaneous flaps in six cases and as perforator flaps in three cases. Primary closure of the donor site has been done in seven cases while split-thickness skin grafts were done in two cases. Eight flaps have been totally survived while partial necrosis has been occurred in the distal end of one case. Conclusion: Pedicled ALT flap provide a reliable and versatile option for plastic surgeons in reconstruction of difficult regional soft-tissue defects in pediatric patients especially when bulkiness and resistance of infection is indicated, with accepted functional and cosmetic results.

Mutilating surgery with free flap in oral and oropharyngeal cancer: A report of case series

Introduction: Globally, oral cancer is the eighth most common malignancy with over 300,000 people are diagnosed in each year. It is also the third most common cancer in South East Asia. The tongue is the most common intraoral site for cancer. The aim of this study is to highlight the relevance of mutilating surgery of head and neck cancer in the current minimally invasive and robotic surgery era.Case description: We present four case series of tongue carcinoma who underwent combined mandibulectomy, neck dissection (COMMANDO), resection of tumours and reconstruction with anterolateral thigh flaps. All cases showed remarkable outcome in which the flap was viable and healthy, with good tongue mobility postoperatively. All patients were discharged from ward two weeks after operation with tracheostomy tube decannulated.Conclusion: COMMANDO operation with anterolateral thigh flap reconstruction is relevant in the current era, especially for the late and advanced stages of oropharyngeal carcinoma. Therefore, multidisciplinary trained surgeons are required to perform these cases, i.e. qualified head and neck surgeon with reconstructive teams.Â

Lower Extremity Marjolin's Ulcer Reconstruction With Free Anterolateral Thigh Flap: A Case Series of 11 Patients.

BackgroundMarjolin’s ulcer (MU) of lower extremities usually presents with scar contracture and functional disability. They often follow an aggressive course and poor outcome, and require early radical removal. Split-thickness skin grafts, local flaps, or amputation are commonly practiced surgical options for MU. Though free flaps are gaining popularity for various oncoplastic reconstruction, they are not frequently used for MU. A free anterolateral thigh (ALT) flap may have a beneficial role as it provides simultaneous coverage for a large defect after radical tumor and scar excision.MethodsBetween January 2015 and December 2018, 11 patients with lower limb MU reconstructed with free ALT flap were reviewed retrospectively for the surgical procedure, recurrences, and functional outcomes.ResultsMean dimensions of the defect and flaps were 8 cm × 6 cm and 18.91 cm × 11 cm, respectively, and total flap coverage was obtained in nine cases. Marginal flap loss was noted in one and residual contracture in two cases. Functional improvement of the limb was achieved in all cases. Recurrence or disease-related mortality was not seen in any patient after a mean follow-up of 35.82 months.ConclusionsFree ALT flap reconstruction of MU of extremity facilitates most radical tumor and scar-contracture removal and thus reduces the chances of re-ulceration. It facilitates local radiotherapy protocol with the provision of immediate durable coverage. Thus, it has a beneficial role other than a secondary reconstructive procedure. Moreover, an added benefit may be obtained with a “flow-through’ flap” to avoid amputation and improve functional outcomes.

Assessment of Quality of Life of Free Anterolateral Thigh Flap for Reconstruction of Tissue Defects of Total or Near-Total Glossectomy.

Background The aim of this study was to evaluate quality of life of free anterolateral thigh flap (ALTFF) for reconstruction of tissue defects of total or near-total glossectomy. Methods Quality of life was assessed by means of the University of Washington Quality of Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14), after 12 months postoperatively. Results 65 of 79 questionnaires were returned (82.27%). In the UW-QOL, the best-scoring domain was “shoulder,” whereas the lowest scores were for “chewing” and “pain.” In the OHIP-14, the lowest-scoring domain was “handicap,” followed by “Social disability” and “Psychological disability.” Conclusion Free anterolateral thigh perforator flaps for reconstruction of total or near-total glossectomy defects after cancer resection would have significantly influenced the patients' oral functions and quality of life.

Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report

BackgroundMajor pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life.Case reportA 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap.ConclusionMPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.