Flow-through Anterolateral Thigh Flap Research Articles

Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns: A Retrospective Case Series

ObjectiveThe objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns. MethodsWe collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018. The clinical and pathological data were extracted from electronic hospital medical records. We obtained follow-up information through clinic visits. ResultsThe injury sites for all 8 patients were the wrists, specifically 5 right and 3 left wrists, all of which were on the flexor side. Five patients had ulnar artery embolism necrosis and patency, with injury to the radial artery. Two patients had ulnar and radial arterial embolization and necrosis. The last patient had ulnar arterial embolization and necrosis with a normal radial artery. After debridement, the wound area ranged from 12 cm × 9 cm to 25 cm × 16 cm. The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns. Free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) were used to repair the wounds. The prognosis for all patients was good after six months to one year of follow-up. ConclusionTreating wrist types II and III high-tension electrical burns is still challenging in clinical practice. The use of free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Survival and Versatility of the Flow-Through Lateral-Thigh Free Flap in Severe Electrical Injuries to the Wrist.

The hand and wrist are most often in contact with electrical currents and thus most vulnerable to severe electrical burns. The treatment of such severe injury via surgical intervention remains a big challenge because of the vast tissue necrosis and the segmental vascular injury. The flow-through lateral-thigh free flap has been used effectively to resurface these defects and to reconstruct segmental vascular defects. Between January 2014 and June 2017, 11 male patients aged 19 to 53 years were admitted to the burn unit of our institution. Each presented with severe electrical burns to the wrist with long segmental vascular injury, and 2 cases suffered from electrical burn on both wrists. After radical debridement, the soft-tissue and segmental artery defects were rebuilt through the application of flow-through lateral-thigh free flap for 1 of the ulnar or radial artery injury (7/12). Ulnar artery defects were rebuilt through the application of flow-through lateral-thigh free flap, and radial artery revascularization was done using a greater saphenous vein graft for both ulnar and radial artery injuries (5/12). Vascular condition was closely monitored throughout the treatment period. Forearm amputation was performed in 1 case as a result of distal immediate necrosis postinjury. Successful limb salvage was achieved in the other 12 wrists. Infection beneath the flap occurred in 3 cases but resolved after debridement. Over the course of the 3- to 12-month follow-up period, the free flaps maintained good texture and sharpness, distal circulation of affected limb became well established, and the appearances of the donor sites were acceptable. High-voltage electrical burns of the wrist are highly destructive, and sophisticated management of damage requires concomitant vascular reconstruction and soft-tissue coverage. The flow-through anterolateral-thigh flap is an optimal solution for this problem. Emphasis must be placed on the affected blood vessel throughout the treatment period.

Flow-through anterolateral thigh flap transfer combined with bone transport technique for repairing the segamental mutilating injury in lower extremity

Objective To explore the clinical application and effect of Flow-through anterolateral thigh flap transfer combined with bone transport technique for repairing the segamental mutilating injury in lower extremity. Methods From June, 2010 to June, 2016, Flow-through anterolateral thigh flap transfer combined with Ilizarov technique were applied to repair the segamental mutilating injury in lower extremity in 10 cases. Of the 10 cases, there were 8 males and 2 females (their ages ranged from 26 to 55, 36 on average). Four caused by road accident, 4 caused by crush injury, 2 cases caused by squeeze injury. First stage, Flow-through anterolateral thigh flap transfer were applied to revascularize the lower limb and repair the soft tissue defect in emergency. Second stage, bone transfort with external fixator were applied to repair bone defect in second stage. The area of the flap ranged from 12.0 cm×15.5 cm to 20.0 cm×25.0 cm. The repair of bone defect ranged from 4.0 cm to 10.0 cm. Time interval between two stages ranged from 2 to 4 months, 3 months on average. Followed-up method was regular outpatient-care after discharge. The main contents include: the presence of red swollen with pus, the condition of infection in the pin, if the fixed pin was loosening, and adjust the speed of bone transport according to the mineralization of new bone. Results All cases were successfully repaired in 10 cases. Ten cases were followed-up with a mean followed-up time of 42 months. All flaps survived, in with 6 cases were healed in first stage, 4 case were healed in second stage (healing time ranged from 14 to 30 days), and bone transfort time ranged from 6 to 16 months. The docking site union occurred in 6 cases and were healed by use of bone debridement, bone graft and compression. Deformity in foot and ankle occurred during the bone transport in 2 cases and were cured by draft therapy with adding ring fixator. The functions of donor sites were not found malfunctional. Conclusion Flow-through anterolateral thigh flap transfer combined with bone transport have high success rate of limb salvage, good quality of osteogenesis, and satisfactory function recovery. It is an optimal method to repair the segamental mutilating injury of the lower extremity. Key words: Anterolateral thigh flap; Flow-through flap; Bone transport technique; Segamental mutilating injury; Lower extremity

Application of MDCTA in free Flow-through anterolateral thigh flap for reconstructing the combined limb soft tissue with main vascular defect

Objective To evaluate the clinical value of MDCTA (Multi-detector computed tomographic angiography) in reconstruction of the soft tissue defect of the limbs combined with the main vascular defects by using Flow-through anterolateral thigh flap. Methods From September, 2013 to May, 2016, 12 cases of limb soft tissue with main vascular defects were examined by MDCTA. The length of vascular defect was measured. The length of bridging vessel needed to design a Flow-through anterolateral thigh flap was measured. The points of anterolateral thigh flap perforator were positioned. The relationship between the perforation and the trunk vascular pedicle was defined. The outcomes were evaluated based on Berton scores for upper extremities and John-Wruh scores for lower extremities. Results The length of the main vascular defects, the positions of flap perforators and the configuration of vascular pedicles were successfully imaged through MDCTA. The length of the main vascular defects were 5-12 cm, which was consistent with the intraoperative findings. The length of bridging vessel for the defects were 7-14 cm, which was enough for the vascular defects. There were not vessel grafts. Twenty perforators were imaged by MDCTA preoperatively, and 22 perforators were found during the operations, which means 2 perforators were not imaged. All flaps survived completely. All patients were followed-up from 6 to 21 months (average, 11 months) . According to the Berton scores for upper extremities and John-Wruh scores for lower extremities, the excellent/good were 6 in 8 cases and 4 in 4 cases, respectively. Conclusion MDCTA can be used to evaluate the pedicle conditions of the free Flow-through anterolateral thigh flap for the reconstructions. It is worthy to be popularized in clinical application. Key words: Anterolateral thigh flap, Flow-through flap; Extremities; Vascular defect; MDCT angiography; Repair

Various forms of anterolateral thigh flap for lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction

Objective To explore the application of various forms of anterolateral thigh flap in lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction. Methods From September 2011 to December 2015, 26 cases of lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction (included 20 male patients and 6 female patients) were admitted, the age ranged from 22 to 61 years old (38.6±4.5). Among these cases, 10 cases received flow-through anterolateral thigh flap, 16 cases used chimeric anterolateral thigh flap with vastus lateralis thigh muscle flap, 15 flaps were thinned in one-staged, 5 flaps were harvested in double-paddled form. The flap size ranged from 10 cm×6 cm to 28 cm×12 cm. The donor site was closed directly in all cases. Results All flaps and replanted extremities survived uneventfully. All patients were followed up for 8 to 30 months with satisfied esthetic and functional results in reconstructed foot and ankle, the texture of flaps was good, no bulky was noted and no second revision was needed. No local ulcer happened and regained protective sensation. Only linear scar left in the donor sites, no hernia occurred. Conclusions Various forms of anterolateral thigh flap is the effective choice in lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction. Key words: Thigh/SU; Surgical flaps; Ankle injuries/SU; Soft tissue injuries/SU

The clinical application and type of anterolateral thigh flap

Objective To investigate the effect of anterolateral thigh flap for repairing soft tissue defects of extremities and the clinical meaning of blood vessel types. Methods From November, 2011 to December, 2014, 102 cases of limbs soft tissue defects were treated with anterolateral thigh flap, through retrospectively analyzed. Seventy-five cases for leg and ankle, 27 cases for forearm and hand. The wounds sized from 5.0 cm × 14.0 cm-14.0 cm × 36.0 cm. The type of blood vessel include type I, 90 cases (contain 21 flow-through anterolateral perforator thigh flaps) , type II, 8 cases, and type IIIa, 4 cases. All of this cases were applied with turbocharge. The flap area was 7.0 cm × 15.0 cm-7.5 cm × 28.0 cm. Flap combination tissues transplantation were 35 cases (contain latissimus dorsi muscle, second digiti pedis, free wrap-around flap, etc.) , 3 cases included 3 tissues. Simultaneously 9 cases were repairing for reconstruction circulation of extremities. Results Ninety-seven cases were survived completely, 2 flaps survived partially, mortification 3 cases. Finally, free skin grafting to repair wound surface. Sixty-two cases had a primary wound healing (stage I) , 24 cases had a delayed wound healing (stage Ⅱ). Three cases had infected, which had not be healed until 2-15 months after operation. Conclusion The method is definite effective for treatment of soft tissue defects of extremities. Anterolateral thigh flap can be incised in Ⅲ types, according to blood vessel. It is most clinical significant that the method of flap circulation establishment can alter the type of flap blood-supply. Key words: Anterolateral thigh perforator flap; Transplantation; Soft tissue defects; Extremity; Microsurgical operation

Emergent free flow-through anterolateral thigh flaps for Gustilo-Anderson III fracture of the upper extremity

Emergent free flow-through anterolateral thigh flaps for Gustilo-Anderson III fracture of the upper extremity

Flow-through anterolateral thigh flap for reconstruction of Gustilo type III C open fractures in upper and lower extremities

Objective To analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in the Gustilo type Ⅲ C traumatized extremities.Methods From June 2008 to June 2011,sixteen flow-through anterolateral thigh flaps were used for limb salvage.All in this series suffered from Gustilo type Ⅲ C open fractures in upper (4 cases) or lower extremities (12 cases).All patients had the presence of wide segmental soft tissue defects and segmental artery defects with compromised circulation.Four patients received primary operations and 12 patients received debridement combined with vacuum sealing drainage and secondary operations.Results All patients were followed up from 12 months to 40 months (average of 22 months).The mean age was 37.5 years old (from 18 to 62 years).The mean timing of free flap transfer was 6.7 days after injury (from 5 hours to 16 days).The mean artery defect was 12 cm in length (from 6 to 16 cm).All the flaps survived completely with a soft tissue texture.After operation,infection occurred in one patient,venous thrombosis occurred 1 day post-operatively in one patient,local flap necrosis occurred in two patients.No donor site morbidity was noted.In the last follow-up,according to Johner-Wruhs and Berton scores,the overall excellent/good rate for lower and upper extremities were 83.3％ and 75.0％ respectively.Conclusion Flow-through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously.Because of avoiding sacrificing one of the major vessels,it particularly indicates for only one major artery survival in the extremity.The clinical results show that the above reconstruction technique is useful for upper and lower extremities salvage. Key words: Gustilo type; Extremities; Flow-through anterolateral thigh flap; Revascularized free skin flap grafting

Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity

BackgroundMany surgeons have to face the challenge of the sophisticated management of catastrophic high-voltage injuries to upper extremities. These patients present with both vast soft tissue defects and varied segmental main artery defects with compromised circulation of the distal limb. This study is a first attempt to analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in acute electrical burns of the severely traumatized upper extremity. Method and patientFrom March 2001 to February 2012, five men were enrolled in the study. All in this series suffered from high voltage current (higher than 1000V) electrical burn and had the presence of wide segmental soft tissue defects, exposure of underlying vital structures and segmental artery injury with compromised circulation. Flow-through anterolateral thigh flaps were used for limb salvage. ResultFollow up for all patients was present from 6 months to 7 years. The mean age was 37.8 years old. The mean timing of free flap transfer was 5.8 days after injury. The mean flap sizes were 31.6cm×16.5cm. The mean artery defect was 14.2cm in length. Venous thrombosis occurred 1 day post-operatively in one patient. No donor site morbidity was noted. In the postoperative period, no infection, no hematoma, nor deaths were noted. Successful limb salvage rate was 80% in this series. ConclusionIn electrical injuries of the severely damaged upper extremity, flow through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously. Although the risk of flap failure is higher than with other etiologies of burn, the data shows that the above reconstruction technique is useful for upper extremity salvage.

Short Interposed Pedicle of Flow-Through Anterolateral Thigh Flap for Reliable Reconstruction of Damaged Upper Extremity

In microvascular reconstructive surgery, the recipient vessel in free flap transfer is often sacrificed to provide the vascular pedicle anastomosis. As the recipient vessel is likely to be necessary for distal circulation in the damaged upper extremity, preserving its patency is critical. Flow-through anastomosis is one method that preserves the recipient vessel's patency. We present here eight patients who underwent upper-extremity reconstructions with a free flow-through anterolateral thigh flap. The flap's short vascular pedicle was interposed into a division of the radial artery and anastomosed on both sides of the pedicle's T-shaped arterial segment. The flow-through flap has various advantages, not only making it possible to reconstruct both vessels and soft tissues but also preserving recipient vessels and balancing the blood supply or pressure in the flap. In clinical situations that do not require reconstruction of the artery, the short interposed pedicle of the free anterolateral thigh flow-through flap offers a versatile and reliable option for microsurgical reconstruction of defects in the upper extremities.

Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: Anatomical study and case report

47 dissections of cadaver thigh were studied to investigate pedicle configurations in the lateral descending branch of the lateral circumflex femoral arterial system, which can be used in harvesting a flow-through anterolateral thigh flap. The descending branch arose from the lateral circumflex femoral artery in 38 of the dissections, and the mean diameter at its origin was 3.0mm (range, 2.2-4.0mm). Skin peforators were of the solely musculocutaneous type in 37 dissections and were a combined septo-musculocutaneous type in 10 dissections. Pure septocutaneous perforator was not found in this study. During the descending branch's journey to the distal part of the thigh, several branches went into the vastus lateralis and vastus intermedius muscles. The diameters were tapering and the mean terminal diameter was 1.3mm (range 0.9-1.8mm), which required intraoperative judgment for proper matching of diameter of the flow-through pedicle and the recipient artery. The mean total length of the descending branch from its origin to terminus was 30.3 cm (range 22.5-37.1cm). In four dissections, the descending branch could not be used as a flow-through anterolateral thigh flap because the origin of the perforator arose from the transverse branch. A flow-through anterolateral thigh flap has several advantages, including a large cutaneous area, acceptable donor-site morbidity, adjustable thickness, the ability to combine adjacent muscle or fascia lata and the possibility of simultaneous reconstruction of long arterial gap and soft-tissue defects. Four patients with severe injury and a vascular gap of longer than 10 cm in the extremities were used to confirm the usefulness of this application.

Flow-through anterolateral thigh flap for a free osteocutaneous fibula flap in secondary composite mandible reconstruction

Head and neck reconstruction after tumour ablation and radiotherapy often requires complex surgery. The need for free composite tissue transfer and the poor quality of the recipient site increase the level of difficulty substantially. We report a case in which the mandible, floor of the mouth and skin of the neck needed to be reconstructed in a heavily irradiated field. A single osteocutaneous fibula flap was insufficient to reconstruct the defect, and a free anterolateral thigh (ALT) flap was also used for external neck skin resurfacing. As the recipient vessels in the ipsilateral neck had been heavily irradiated the free ALT flap was used as an interposition conduit for the free osteocutaneous fibula flap enabling it to reach the healthy recipient vessels in the contralateral neck without needing vein grafts.

Flow-through anterolateral thigh flap reconstruction as a salvage procedure

The anterolateral thigh flap is a very suitable flap to serve as a flow-through flap. It has a large, long pedicle and a large size skin island that can provide adequate soft tissue coverage. One-stage coverage and revascularisation can be achieved using the concept of flow-through circulation. The case presented describes a patient who suffered a major crush injury to the lower leg due to an accident with a fork-lift truck that led to an avascular lower leg. The anterolateral thigh flap was used as flow-through flap and amputation was avoided.