Anterolateral Thigh Flap For Reconstruction Research Articles

Identification of cutaneous perforators for microvascular surgery using hyperspectral technique – A feasibility study on the antero-lateral thigh

Aim of the study was to compare perforator vessel location using color-coded Doppler ultrasound and hyperspectral imaging in the area of the antero-lateral thigh. In a cross-sectional case-control study, the bilateral antero-lateral thigh region was examined for perforator vessel location via color-coded Doppler ultrasound (control) and hyperspectral imaging (test). For hyperspectral imaging, all measurements were conducted without cooling (T0) and after 1 (T1), 2 (T2) and 3 min (T3) of cooling. Additionally, in the reperfusion period after cooling, hyperspectral imaging was conducted at 1, 2 and 3 min (T4/T5/T6). Results from color-coded Doppler ultrasound and hyperspectral imaging were matched at all time points (T0–T6). In total, 71/73 perforator vessel locations could be matched (sensitivity: 97%). Matching of color-coded Doppler ultrasound and hyperspectral imaging was significantly influenced by the cooling protocol and the highest matching values were seen at T3 (3 min cooling; 60 perforator vessels) and T4 (3 min cooling & 1 min reperfusion; 62 perforator vessels) without significant differences (sensitivity 98%; p = 0.9). There were significant differences between T4 and T0, T1 (both p < 0.001), T5 (p = 0.045) and T6 (p = 0.012). For clinical proof of concept, a patient case using a free antero-lateral thigh flap for reconstruction of a facial defect after perforator vessel identification via color-coded Doppler ultrasound and hyperspectral imaging (3 min cooling & 1 min reperfusion) was carried out successfully. In conclusion, hyperspectral imaging potentially offers an additional opportunity for non-invasive, user-independent perforator-site assessment if prior cooling of the site is conducted.

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

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 hand-made 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. 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. 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%. 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.

Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity-score-matched patient cohorts.

The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction. A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications. Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well-balanced pairs of propensity-score-matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026). This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity-score-matched cohorts.

Use of Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in Orthopedic Oncology: What are the Outcomes?

Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes. Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation. The average flap dimension was 14cm × 12cm. The mean follow-up was 11months (4-28months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above‑knee amputation. The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.

Successful use of a pedicled anterolateral thigh flap for reconstruction of an abdominal wound and peristomal dehiscence.

Successful use of a pedicled anterolateral thigh flap for reconstruction of an abdominal wound and peristomal dehiscence.

Reconstruction of Intrapelvic Defects Using the Free Anterolateral Thigh Flap: Expanding the Traditional Algorithm.

Reconstruction of intrapelvic soft tissue defects traditionally relies on regional pedicled myocutaneous flaps. However, there remain situations in which local options are unavailable. We review our experience treating intrapelvic defects with the anterolateral thigh (ALT) microvascular free flap. A retrospective, institutional review was conducted from 2014 to 2018 of patients undergoing microvascular ALT flap reconstruction of intrapelvic defects. Four patients were identified in this cohort out of 92 total pelvic reconstruction cases. All patients underwent abdominoperineal resection (APR) for rectal cancer treatment. In the two male patients, pelvic abscesses and bladder leak necessitated soft tissue reconstruction after radiation and APR. In both, regional tissue options were unavailable, and a buried ALT free flap was used for soft tissue reconstruction. Both female patients developed rectovaginal fistulas secondary to their tumor burden, necessitating posterior vaginal wall resections. Prior surgical scars and ostomies made abdominal wall tissue unavailable; thus, free ALTs were used to eliminate intrapelvic dead space and reconstruct the posterior vaginal wall. In all cases, recipient vessels were the deep inferior epigastric artery and vein. Flap survival was 100%. Pelvic reconstruction has traditionally been addressed with local/regional pedicled flaps. In cases where these are unavailable, the free ALT flap is a versatile option when buried for intrapelvic reconstruction or posterior vaginal wall lining. We also propose updating Cordeiro et al.'s classic vaginal defect reconstruction algorithm to include the free ALT flap for type IB cases in which the rectus abdominis is unavailable.

Flow-Through Free Anterolateral Thigh Flap in Reconstruction of Severe Limb Injury.

This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury. Four patients (2 male and 2 female subjects), with an average age of 26 (9-39) years, were included. These injuries referred to upper and lower limbs, including bone, soft tissue, nerve, and arterial segments. Two patients experienced large soft tissue defects in the lower limb and were repaired by double flow-through ALT flaps. The sizes of damaged soft tissues in the remaining 2 patients were 14 × 10 cm and 21 × 13 cm, respectively. Three patients had bone fractures, in which one of them experienced bone shortening during operation. The arterial injury was observed in 2 patients and the lengths of defects were 5 and 12 cm, respectively. Flow-through free ALT flap was applied for all 4 patients. Patients were followed up for 18 months. All the flaps have survived successfully without any vascular crisis or infection. All incision wounds were under primary healing stage, without any severe complications. The flaps showed better appearance, color, texture, and satisfactory sensation. All patients had satisfactory functional recovery of their injured limbs. The flow-through free ALT flap assists in overcoming complex traumatic injuries with severe soft tissue and arterial defects in the limbs. This flow-through ALT flap can be an effective alternative for reconstruction of severe limb injury.

Risk factors associated with postoperative complications of free anterolateral thigh flap placement in patients with head and neck cancer: Analysis of propensity score-matched cohorts.

From the perspective of a surgeon, knowledge of the operative risk factors that may affect postoperative outcomes is important in free anterolateral thigh (ALT) flap reconstruction for head and neck defects after tumor ablation. Therefore, this study was designed to examine the surgical intervention factors related to postoperative complications in a propensity score matched patient population. A total of 1,284 head and neck cancer patients who received free ALT flap repair over a 9-year period from March 1, 2008, to February 28, 2017, at a single medical center were selected and divided into two groups (without complications, n = 845 and with complications, n = 439) according to the presence or absence of complications at the recipient site. Complications were defined as the detection of hematoma, surgical site infection, partial flap loss, oral fistula formation, flap partial necrosis, and flap loss. Well-balanced propensity score-matched cohorts with 292 patients each were created using the 1:1 Greedy algorithm, with adjustment for significant baseline patient characteristics. The patients with postoperative complications had a higher proportion of individuals with betel nut chewing (91.8% vs. 86.6%, p = .008), diabetes mellitus (23.0% vs. 17.8%, p = .029), and preoperative chemotherapy (31.7% vs. 25.3%, p = .019), and higher serum creatinine levels (median [Q1-Q3]: 0.92 [0.80-1.07] vs. 0.89 [0.77-1.06], p = .008) and lower serum albumin levels (4.2 [3.9-4.5] vs. 4.3 [4.1-4.5], p < .001) than those without postoperative complications. Individual operator (p < .001), the length of flap (20 [15-23] cm vs. 20 [15-25] cm, p < .001), operative time (6.9 hr [5.7-8.3 hr] vs. 7.3 hr [5.9-8.7 hr], p = .001), operation start time (p = .003), and units of transfused packed red blood cells (0.0 [0.0-0.0] units vs. 0.0 [0.0-2.0] units, p < .001) were the factors significantly associated with the occurrence of postoperative complications. However, in the matched patient cohorts, individual operator (p = .003), flap length (18 [15-22] cm vs. 20 [15-25] cm, p < .001) and length-to-width ratio (2.6 [2.0-3.3] vs. 3.0 [2.5-3.6], p < .001), and operative time (6.9 hr [5.7-8.3 hr] vs. 7.2 hr [5.9-8.7 hr], p = .019) were associated with the occurrence of postoperative complications, but the operation start time (p = .285) and units of transfused packed red blood cells (p = .917) were not. This study demonstrated in matched patient cohorts that individual operator, flap size, and operative time were associated with postoperative complications of free ALT flap reconstruction in patients with head and neck cancer. To reduce the postoperative complication rate, this study implies the importance of length and length-to-width ratio in harvesting the flap, and meanwhile the surgeon experience in free-flap reconstruction.

Application of anteromedial thigh flap as a alternative flap in maxillofacial soft tissue defects

Objective:To explore the application value of anteromedial thigh flap（AMT） as alternative flap in repairing maxillofacial soft tissue defects. Method:Sixty patients were scheduled to underwent anterolateral thigh flap（ALT） reconstruction. Preoperative CT angiography were conducted. Imaging workstations were used to locate perforator vessels in the anterolateral and anteromedial areas respectively. Four patients had no suitable perforator during the preparation of AMT flaps. In the same operation area, ALT flaps were prepared to reconstruct the defect according to the location of the perforator vessels in the anteromedial areas. Result:All four AMT flaps survived uneventfully. Flap sizes ranged from 9 cm×6 cm to 7 cm×4 cm. The follow-up period ranged from 6 to 12 months, the functions of recipient and donor sites recovered well. Conclusion:Preoperative CT angiography can improve the accuracy of the preparation of skin flap effectively. When no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap.

The Anterolateral Thigh Flap for Reconstruction of the Defect After Maxillectomy.

This study aimed to investigate the efficacy and success rate of the anterolateral thigh flap (ALT) in reconstructing total maxillectomy defects. This retrospective study involved patients with total maxillectomy defects, who underwent free ALT reconstruction from June 2005 to October 2014. The study included 72 patients (43 males and 29 females; age range, 7-77 years; mean age, 43 years). Four patients experienced major complications related to surgery: total flap loss in one patient, partial flap necrosis requiring reoperation in one patient, hematoma requiring operative evacuation in 1 patient, and diplopia requiring reoperation in 1 patient. Two patients experienced minor complications: partial flap loss healed by secondary intention with local wound care, and donor site suture rupture in 1 patient healed by secondary intention. Six patients died because of cancer-related death (after local recurrence or metastatic disease). The defects in 5 patients involved the facial skin for which the ALT was segmented into three parts to reconstruct the facial skin, nasal lining, and oral lining. The defects in 4 patients involved the orbital floor for which a segment of tensor fascia lata was included with the flap on the same pedicle and used to repair the orbital floor. In the remaining patients, the free ALT flap, including a segment of vastus lateralis, was used to repair the maxillary defect and fill the dead space. All but one of the surviving patients were satisfied with their final appearance postoperatively. The free ALT flap with or without fascia lata to repair the orbital floor is safe, reliable, and acceptable for reconstructing total maxillectomy defects.

Dermato-fibrosarcome de Darrier-Ferrand de la région inguinale

The study involved a 32-year old man in good general condition presenting with slow growth mass progressing over 5 years. Clinical examination showed reddish nodule mass covered of hard consistency crusts measuring 74x52x68 mm in diameter at the level of the right inguinal region and adhering to the deep planes, without superficial lymphadenopathy (A). Magnetic Resonance Imaging showed burgeoning process infiltrating the subcutaneous fat. This was in contact with the muscular plane without involving the external genitalia (B, C). Local biopsy and histological examination with immunostaining confirmed the diagnosis of Darier Ferrand´s dermatofibrosarcoma. In this case, 3-cm surgical excision margin, pedicled anterolateral fasciocutaneous thigh flap reconstruction and thin thickness skin grafting from the donor area (D) were performed. Dermatofibrosarcoma is a mesenchymal tumor arising in the dermis with intermediary malignancy and a high risk of recurrence. This study highlights that 5-cm surgical excision margin is recommended to improve local control after surgery but it is difficult in patients with Darier Ferrand´s dermatofibrosarcoma affecting such an important anatomical region.

Lymphoedema rates in pedicled anterolateral thigh flaps for coverage of irradiated groin defects.

Limb salvage surgery in conjunction with adjuvant radiotherapy is the preferred treatment for soft tissue sarcoma. This study aims to determine if ipsilateral pedicled anterolateral thigh (ALT) flap reconstruction of groin defects post soft tissue sarcoma resection results in acceptable rates of lymphoedema, while also providing good soft tissue cover and minimal donor site morbidity. A retrospective chart audit was conducted with ethics approval, obtaining a case series of 16 patients operated on at a single institution by the senior surgeon. Patients who underwent ipsilateral pedicled ALT flap coverage of irradiated groin defects following soft tissue sarcoma resection were included. Comparative six-point limb circumference measurements were utilized to diagnose lymphoedema, with a difference of 10% when compared to the non-operative side being deemed significant. Lymphoedema was noted in three patients (18.8%) with an average follow-up period of 40.9 (range 8-59) months. Previously published lymphoedema rates in sarcoma limb salvage surgery of 15.5-30% are comparable to the rates obtained in this cohort. Lymphoedema rates do not appear to be higher in patients undergoing ipsilateral pedicled ALT flap reconstruction, thus making it a useful soft tissue coverage technique in this cohort.

Distal perforator-only propeller (D-POP) anterolateral thigh flap for reconstructions around the knee: 4-year experience

Soft tissue reconstruction around the knee is challenging from a functional and aesthetic perspective. While locoregional options remain limited, free flaps produce additional scarring and longer hospitalization. We describe the most distal "D-perforator" of ALT-axis and present our 4-year experience with a distal perforator-only propeller anterolateral thigh (D-POP ALT) flap for reconstruction around the knee. Seventeen patients (7 males, 10 females, mean age 57 years), had distal perforator-only propeller (D-POP) ALT flap reconstruction of defects following the wide local excision of melanoma around the knee joint between May 2014 and December 2018. The most distal perforator in the line between spina illiaca anterior superior (SIAS) and the upper lateral border of patella was identified and marked with audible-Doppler and perforator-only propeller ALT (POP-ALT) flap, which was designed around it. Perforators were dissected intramuscularly or intraseptally to allow adequate flap mobilization, but no division of main pedicle was ever performed to ensure anterograde blood supply. Flaps were rotated into defects while all donor-sites were closed directly. The largest flap measured 25×6cm. The perforator was found between 4 and 9cm proximal to the upper lateral border of patella in all cases. It was found to be septal in 10 cases and intramuscular in 7 cases. Healing was uneventful in all cases, and patients were ambulatory immediately postoperatively. All patients were discharged on postoperative day 1. Excellent long-term outcomes were observed on follow-up by the senior author. In our experience, this technique is simple, reliable, and versatile. Thin and pliable flaps can be safely raised based on the most distal (D-POP) ALT perforator. In addition, sizeable flaps can be performed while still preserving the main ALT pedicle, if free flap is required for the same patient in the future.

Predictors affecting anterolateral thigh flap in reconstruction of upper extremity.

Our study is aim to explore predictors for failure of anterolateral thigh (ALT) flap in the reconstruction of upper extremity.We performed a retrospective study for 509 patients who underwent ALT flap in the reconstruction of upper extremity. Among them, 27 patients suffered from necrosis of ALT flap (necrosis group, NG) and 482 gained survival of this flap (survival group, SG). We collected possible factors including 3 aspects: demographic variables – age, sex, body mass index (BMI), history of hypertension, diabetes, heart disease, smoking and alcohol, trauma mechanism, and postmenopausal; surgical-related variables – surgical duration, blood loss, number of reconstructed veins, flap size, perforator type, diameter of perforator, and vein graft; blooding variables – hemoglobin, D-dimer, white blood cell, red blood cell, and platelet count (PLT). We compared the above data between NG and SG by univariate, multivariate, and Kaplan–Meier method coupled with a log-rank test linear regression analysis.The survival incidence of ALT flap repairing upper extremity was 94.7% (482 of 509). The outcome of univariate analysis showed that age (53.5 ± 9.2), BMI (26.7 ± 4.5), larger flap size (24.3∗9.2), D-dimer (0.58 ± 0.10), and PLT (278.1 ± 34.4) in NG were significantly higher than these (44.2 ± 7.9, 22.3 ± 4.2, 19.1∗7.9, 0.48 ± 0.08, 236.6 ± 30.5) in SG. However, diameter of perforator (1.07 ± 0.02) in NG was markedly smaller than that (1.12 ± 0.02) in SG. Additionally, female patients, postmenopausal, patients with using venous stapler or 1 reconstructed vein had a higher failure rate. Multivariate and Kaplan–Meier method implied the same results.In summary, many factors were related with failure of ALT in the reconstruction of upper extremity. Postmenopausal, D-dimer, and PLT were the first considered as risk factors for ALT flap repairing upper extremity.

Reconstructing ‘dual-defect’ pressure sores in spinal patients

Background: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.Methods: Eleven consecutive patients with concurrent pressure sores (&gt; grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded. Results: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (ischial). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded. Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

PurposeEvaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution.MethodsAn analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap.ResultsTumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications.ConclusionsThe ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

Transnasal frontal intersinus septum takedown for frontal sinus pyocele

IntroductionThe open frontal intersinus septum takedown (FISST) technique was first described in 1976. We describe our experience with an endoscopic transnasal approach to manage a frontal sinus pyocele arising from an obstructed frontal sinus outflow tract due to anterolateral thigh flap reconstruction of a maxillectomy defect. Case reportA 40-year-old lady experienced upper eyelid swelling and purulent nasal discharge 3 weeks after undergoing a left extended medial maxillectomy with free anterolateral thigh flap reconstruction. A computed tomography (CT) scan revealed total opacification of the left frontal sinus. There was no improvement with intravenous antibiotics and she underwent a surgery, whenshe was found intraoperatively to have a frontal sinus pyocele, which was then drained. She then underwent an endoscopic transnasal FISST to ventilate the left frontal sinus via the contralateral frontal recess with good results. A CT scan performed 3 months postoperatively showed a widely patent interfrontal sinus septal window and right frontal outflow tract with no disease recurrence. DiscussionThe FISST is a useful technique to manage unilateral frontal sinus disease by taking advantage of the contralateral outflow tract when the ipsilateral frontal recess is obstructed.

The Versatility of the Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in the Extremities

The Versatility of the Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in the Extremities