Free Anterolateral Thigh Research Articles

Fusarium infection-induced partial failure of free anterolateral thigh musculocutaneous flap: Case report.

Fusarium species, a soil-borne fungi, causes disease in animals and humans, particularly in immunocompromized patients. A 62-year-old male presented with type II diabetes mellitus, diagnosed 4 years ago. He had a motorcycle accident-caused open tibiofibular fracture of the left lower extremity (Gustilo grade IIIb). With open reduction and internal fixation, an anterolateral thigh musculocutaneous flap was harvested for coverage of exposed bone and defect reconstruction. Partial failure of the flap occurred 9 days following reconstruction, and histological examination revealed Fusarium spp. After treatment with antifungal drugs and debridement, we performed a split-thickness skin graft. At 2-year follow-up, the flap was viable with adequate bone union. This is the first reported case of partial flap failure due to a Fusarium spp. infection. Possibility of fungal infections in patients with late-onset flap failure should be noted. Prompt diagnosis and treatment are needed to prevent repeated free-tissue transfer and/or devastating outcomes.

A giant trichoblastic carcinoma.

Trichoblastic carcinoma usually occurs as a malignant transformation of the trichoblastoma, but is very rare. A 25-year-old man was admitted with trichoblastoma in the nuchal area with frequent recurrences since birth. The preoperative neck magnetic resonance image revealed lobulated soft tissue lesions involving superficial fascia and infiltrating into both proximal trapezius muscles. In our department, wide excision and reconstruction with a free anterolateral thigh flap were performed. Histological examination revealed skin adnexal carcinoma, originating from the hair follicles, consistent with trichoblastic carcinoma. There was no palpable mass 5 years postoperatively, and there was no recurrence on follow-up positron emission tomography-computed tomography. Trichoblastic carcinomas are rare and difficult to diagnose, but histopathological findings include atypical basaloid keratinocytes with crowded, hyperchromatic nuclei, and increased mitotic activity. The presence of hypercellular stroma is a criterion for distinguishing trichoblastic carcinoma from basal cell carcinoma. A rare giant trichoblastic carcinoma was reported, which was the biggest one in the literature.

Simultaneous flap thinning with ultrasound-assisted liposuction during free flap surgery: Preliminary results.

Ultrasound-assisted liposuction (UAL) has been previously used for postoperative flap thinning. Although it had been reported that UAL causes less damage to the vessels, the simultaneous use of UAL with free flap reconstruction has not been reported. The aim of this report was to determine the results and the complication rates of simultaneous use of UAL with free flap reconstruction. Twelve patients who underwent simultaneous flap thinning with UAL during free anterolateral thigh flap surgery between 2014 and 2016 were included in this prospective study. The mean age of the patients was 46.7 (ranging 10-76) years. The mean body mass index of the patients was 26.81 (ranging 25.2-29.8). Flaps were thinned with UAL before harvesting. The mean flap thicknesses were measured using a metal ruler before and after the UAL procedure. Biopsies were performed lateral to the center of the flaps, after completion of the UAL procedure. Vascular and collagen structures were histopathologically examined. The Likert scale, which evaluates the general appearance, shape, color, and texture, was used to assess the aesthetic results of the UAL procedure. The average flap size was 13 × 9 cm. The mean pedicle length was 8.3 (ranging 7-10) cm. The mean flap thickness was 23 (ranging 19-27) mm and decreased to a mean of 8.1 (ranging 5-11) mm. Wound dehiscence and partial skin necrosis was observed in 2 patients (2/12, 16.66%). None of the patients had total flap necrosis. Vascular and collagen structures of the biopsied samples were normal. Patients were followed for an average of 13 months post UAL. The mean Likert score was 17.1 (ranging 15-19). Flap thinning with UAL can be safely performed during the initial free flap reconstruction operation.

Clinical study of free anterolateral thigh perforator flap in repairing maxillary complex tissue defects

Objective To explore the effect of free anterolateral thigh (ALT) perforator flap in the repairment of complex maxillary defects. Methods The clinical data of 51 patients undergoing the reconstruction of maxillary defects in ALT perforator flap between January 2013 and October 2016 in the Peking University Hospital of Stomatology were retrospectively analyzed. All the patients received ALT reconstruction during the maxillary tumor resection. Results Four patients had blood vessel crisis after surgery in 51 cases. Two cases were removed due to flap necrosis, and 49 cases survived with a satisfactory appearance and function, and the overall flap survival rate of 49 cases was 96.08% (49/51). Conclusion ALT perforator flap provides an ideal reconstruction for complex maxillary defects with a well-restored function in the surgical ares which could avoid the facial asymmetry and contribute to the following treatment. Key words: Maxillary neoplasms; Reconstructive surgical procedures; Anterolateral thigh flap; Maxillary defects; Reconstruction

Functional and Aesthetic Outcomes of Reconstruction of Soft-Tissue Defects of the Heel with Free Flap

ObjectiveTo evaluate functional and aesthetic outcomes of the reconstruction of soft-tissue defects of the heel with microsurgical techniques using a free radial forearm flap and an anterolateral thigh flap. Patients and methodsThe study included 25 patients, 15 males and 10 females, with a mean age of 34.3 ± 10.4 years, with soft-tissue defects of the heel. Of them, 11 patients whose defects were of size between 5 and 10 cm in their largest dimension were treated using a free radial forearm flap, and 14 patients whose defects were of size larger than 10 cm in their largest dimension were treated using a free anterolateral thigh flap.Post-operatively, avoidance of weight-bearing and walking was required for 8 to 10 weeks. At the end of the follow-up, all patients underwent functional, aesthetic and sensation evaluation in addition to assessment of patient satisfaction. ResultsThe median follow-up period was 24 months. The causes of the defect were trauma (14 patients), neuropathic ulcer (8 patients) and neoplasia (3 patients). The size of the defect ranged from 5 × 6 cm to 14 × 24 cm. Four patients had calcaneal fracture. By the end of the follow-up period, 21 cases showed complete success, whereas 2 flaps failed, one in each flap type, and the remaining two flaps showed partial loss of the edges (anterolateral thigh flaps). Failure was due to venous congestion (one patient) and ischaemia (one patient). Eighteen patients were satisfied with their aesthetic appearance, functional outcome and flap sensation. ConclusionReconstruction of large heel defects, using radial forearm and anterolateral thigh free flaps, provides acceptable functional and aesthetic outcomes.

Free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap for repairing the complex tissue defect of dorsum wrist

Objective To explore the clinical outcome of free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap for repairing the complex tissue defect of dorsum wrist. Methods From June, 2005 to March, 2014, free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap was used for repairing the complex tissue defect of dorsum wrist in 15 cases, which were 12 males and 3 females, and aged from 18 to 52 years old. The skin and soft tissue defect ranged from 8.0 cm×5.5 cm to 22.0 cm×12.0 cm. All accompanied with extensor digitorum tendon loss. The tendon defect ranged from 5.0 cm to 12.0 cm (7.6 cm on average). The flap size ranged from 9.0 cm×6.5 cm to 23.0 cm×13.0 cm. The pedicle length ranged from 4.0 cm to 7.0 cm (5.3 cm on average). Results All flaps survived, and no postoperative complications occurred. The followed-up time ranged from 12 months to 36 months, and the texture of flap was flexible. No bulky was noted, and skin color was similar to the hand skin. The flexor and extensor function of wrist recovered satisfying. The 2-point discrimination of flap ranged from 9 mm to 15 mm(12.5 mm on average). Conclusion Free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap is a good option for repairing the complex tissue defect of dorsum wrist. Key words: Anterolateral thigh flap; Transplantation; Rectus femoris muscle; Chimeric flap; Tendon defect; Wrist

Reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting

Objective To investigate the clinical effect of reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting. Methods From January, 2009 to January, 2017, 25 patients with soft tissue defect in foot and ankle were treated with transplantation of the trimmed free anterolateral thigh muscle flap combined with skin grafting. Of the 25 cases, there were 5 cases located in medial foot, 10 cases in dorsum of foot, 7 cases in external of foot and 3 cases in the toe. The areas of wounds were 8.0 cm×6.0 cm to 18.0 cm×10.0 cm. The anterolateral thigh muscle flap was from 4.0 cm×3.0 cm×0.3 cm to 10.0 cm×8.0 cm×1.5 cm. All the cases were operated in fracture fixation and wound without obvious infection. Early rehabilitative exercise under the protection of orthosis were done after 4 weeks of the operation and to assess. The injuried limb function were assessed in 1 year postoperatively according to Marylands scale. Results All cases were followed-up for 12 to 24 months (average, 16.2 months) . All the muscle flaps and skin survived. The healing time were 12 to 24 days, averaged of 17.1 days. Patients could wear shoes normally and resume normal life and work. The appearance and walking function were satisfying and no further debulking procedures were needed. The surgery function were assessed according to Marylands scale, and the results was 22 cases for excellent, and 3 cases for good. Conclusion Ttrimmed free anterolateral thigh muscle flap combined with skin grafting is a good option for the repair of foot and ankle defect at non-weight-bearing area, and it has the advantages such as the doner site is small invasive, the muscle flap is easy to be harvested, and can avoid debulking surgery to wear shoes normally. Key words: Anterolateral thigh muscle flap; Foot; Transplantation; Soft tissue defect; Microsurgical technique

Sinonasal intestinal-type adenocarcinoma in the frontal sinus.

Sinonasal intestinal-type adenocarcinoma is a rare neoplasm which can be diagnosed by pathologic report. Nasal obstruction, epistaxis, and rhinorrhea are common symptoms, but presenting with a benign-looking palpable mass is also possible. This is a report of our experience in diagnosing and treating a sinonasal intestinal-type low grade adenocarcinoma. A 63-year-old man initially presented with a rapidly growing palpable mass in the glabella region for 4 months. A malignancy of sinus origin was suspected on imaging studies. We performed further preoperative evaluations for cancer staging, and curative surgery was planned. Radical resection and immediate reconstruction with free anterolateral thigh flap were performed. The pathology findings confirmed a diagnosis of sinonasal intestinal-type adenocarcinoma.

Abstract: Fasciocutaneous Free Flaps in Extremity Reconstruction: Safety of Re-Elevation

PURPOSE: Free flap-based extremity reconstruction in the settings of chronic osteomyelitis and acute traumatic wounds can be a complex, multi-staged process that requires elevation of the free flap at each stage. Use of fasciocutaneous flaps is a safe and effect option in this situation, and may actually be preferable to muscle or musculocutaneous flaps despite traditional recommendations. Here the authors present their experience in utilizing fasciocutaneous flaps for reconstruction of the lower extremity in the settings of chronic osteomyelitis and acute traumatic wounds. METHODS: A retrospective review of a single-center’s experience with lower extremity fasciocutaneous free flap reconstruction in the setting of chronic osteomyelitis and acute traumatic wounds was performed. Patients were identified from the senior surgeon’s prospective database. Osteomyelitis was diagnosed with tissue culture as well as corresponding radiographic changes. Charts were reviewed for relevant risk factors, operative details, and outcomes. RESULTS: Twenty-one patients underwent reconstruction with free anterolateral thigh fasciocutaneous flaps. Of the fourteen trauma patients, there were seven Gustilo IIIB lower extremity injuries, three open hand or wrist fractures, two degloving injuries of the foot, one crush injury to the foot, and one traumatic hand amputation. Of the seven chronic osteomyelitis patients, the original mechanism of injury leading to chronic osteomyelitis was traumatic bony fracture in five patients and neoplasm excision in two patients. Mean patient age in our series was 44.3 (7 to 80) years. Mean BMI at time of reconstruction was 27.8 kg/m2 (21.5 to 36.5 kg/m2). The average defect size was 270 cm2 (32 cm2 to 525 cm2). The average length of hospital stay was 32 days. Patients required a mean of 3.7 debridements prior to flap reconstruction and a mean of 6.9 surgeries to complete the reconstructive process. The average time from initial debridement to flap was 15.5 days; mean time from flap to final surgery was 122 days. Mean follow-up time period was 10 months. There were two urgent returns to the operating room with two flap losses. Nine flaps were re-elevated 13 times (1 to 4 re-elevations per flap) for flap debulking, draining wound, antibiotic spacer replacement or removal, bone grafting, and ligament or tendon reconstruction; there were no major complications following flap re-elevation. CONCLUSION: Use of fasciocutaneous flaps in lower extremity reconstruction in the settings of chronic osteomyelitis and acute traumatic wounds appears to be safe and effective, even when the flap is subsequently re-elevated during revision surgery. Fasciocutaneous flaps allow for soft tissue coverage and the potential for protective sensation. Despite operating on a Western population with an overweight BMI, it was possible to utilize fasciocutaneous flaps for reconstruction. The optimal time from the initial injury to flap reconstruction may actually be longer than once thought.

Synoviosarcoma of arm in 4-month-old infant reconstructed with sensate free anterolateral thigh flap.

Synoviosarcoma of arm in 4-month-old infant reconstructed with sensate free anterolateral thigh flap.

Clinical application of anterolateral thigh flap in wound around the knee with descending genicular artery as the recipient vessel

Objective To explore the clinical application of anterolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel, when anterior or posterior tibial vessel could not be utilized. Methods From January, 2015 to May, 2017, free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients, after preoperative color Doppler sonography ultrasound (CDU) for precise positioning. There were 4 males and 3 females, with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm. All of the donor sites were sutured directly. Postoperative followed-up was done termly. Results All the patients were followed-up for 6 to 14 months, with an average of 8.9 months. Typically, 2 cases had large defect areas, with distal flap necrosis of 6.0 cm and 4.0 cm, respectively, which were resected and achieved secondary skin graft healing on the residual surface. Additionally, 4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface. The remaining 1 case had completely survived flap, but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis. As a result, the patient received gastrocnemius myocutaneous flap to repair the wound. Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee, with descending genicular artery as the recipient vessel, can achieve satisfactory clinical efficacy, which can serve as one choice for flap repair in wound around the knee. Key words: Anterolateral thigh flap; Descending genicular artery; Knee joint; Transplantation

Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect

To investigate clinical effect of vacuum sealing drainage(VSD) with anterolateral thigh perforator flap for repair foot soft tissue defect. From September 2014 to September 2016, 45 patients with foot soft tissue defect repaired by VSD with anterolateral thigh perforator flap, including 31 males and 14 females aged from 17 to 55 years with an average of 36 years old. Thirty patients were dorsal soft tissue defects, and 15 patients were plantar soft tissue defects. Sizes of soft tissue defect ranged from 7 cm×10 cm to 11 cm×18 cm, the wound was contaminated seriously and assisted with deep soft tissue exposure. Emergency surgical wound debridement with VSD treatment were performed, and wound surface was cleaned after 5 to 7 days, free anterolateral thigh flap were repaired. Sizes of flap ranged from 9 cm×12 cm to 13 cm×21 cm. Appropriate method was used to repair flap donor area. All 45 free propeller flap were survived without skin edge necrosis, ulcerative infection. Forty patients were followed up from 3 to 24 months with an average of 13 months. Flap showed good color, beautiful appearance, good elasticity, soft texture, but without obvious bloated, the wood of leg healed well. VSD with anterolateral thigh perforator flap for repair foot soft tissue defect could effective control wound soft tissue infection, receive reliable flap blood supply and skin flap could repaired at stage I. It is an effective method for repairing foot soft tissue defects.

Using intestinal segments during secondary salvage procedures after failed reconstructions of the cervical oesophagus

The free anterolateral thigh (ALT) flap is commonly used for the reconstruction of the cervical oesophagus with satisfactory results. Its convenience and popularity make it a popular flap for reconstructive surgeons. The use of intestinal flaps, however, carries a higher level of technical difficulty and is normally performed as a primary reconstructive procedure. This report investigates the feasibility of intestinal flaps for the reconstruction of the cervical oesophagus and strategies to optimize its success when used as a secondary flap after primary ALT flap failure. We retrospectively reviewed 22 patients (age 39-72 years) who were men, between April 2013 and January 2015, with intestinal segments (free and pedicled ileocolon, jejunal and colon flaps) that were used secondarily to salvage failed primary free ALT flap reconstructions after hypopharyngeal cancer resection. Ten patients presented with leakage and 2 with tracheo-oesophageal fistulae as complications from the primary flap failure. Oral intake commenced around 1-month postoperatively. One case of flap failure was observed. The majority had no major postoperative complications. Patients were followed up (6-27 months), and 21 cases of a secondary intestinal flap were successful with the restoration of oesophageal continuity and oral intake. Intestinal flaps, free or pedicled, can be used secondarily after failed ALT flap reconstructions with minimal complications or morbidity. Intestinal flaps successfully allow restoration of gastrointestinal continuity with early commencement of oral intake and swallowing function.

Reconstruction of a full-thickness buccal defect with anterolateral thigh flap – case report

Extensive tissue defects resulting from tumor resection within the head and neck require simultaneous reconstruction. One of the most commonly used free flaps in reconstruction oral cavity is the free anterolateral thigh flap. A case of a 57-year-old woman with squamous cell carcinoma of the cheek has been presented, in which the reconstruction of the full thickness of the cheek with a folded free anterolateral thigh flap has been performed. The authors provide treatment methods and the possibility of using ALT flap.

Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps.

Without well recognizing the vascular territories of the perforator, surgery might damage the pedicle and diminish flap survival. This study described a transillumination method for intraoperative mapping of the subfascial plexus of the perforator in the head and neck reconstruction with an anterolateral thigh (ALT) flap and also compared the perioperative outcomes and complications of the method with those of the conventional two-pedicle ALT flap. Between January 2011 and December 2017, 26 patients who underwent head and neck reconstruction with ALT flaps were evaluated as follows: 13 underwent the transillumination method (case group), and 13 (age- and sex-matched) underwent standard two-pedicle flap procedures (control group). Demographic factors, diagnosis, flap size, recipient site, perioperative data, and postoperative complications were compared between the two groups. There was no significant difference in age, sex, diagnosis, recipient sites, and flap size between the case and control groups. Regarding the perioperative outcomes, the harvesting time was significantly shorter in the case group than in the control group (60 vs. 100 minutes, p < 0.001). The operative time was shorter in the case group than in the control group, but this difference was not statistically significant (300 vs. 420 minutes, p = 0.058). The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the ALT flap, which facilitates intraoperative flap design in head and neck reconstruction.

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

Free antero-lateral thigh flap for total knee prosthesis coverage after infection complicating malignant tumour resection.

Infection is a common complication of major lower limb-sparing surgery with massive total knee prosthesis (MTKP) reconstruction after extensive tumour resection. When free tissue transfer is required to cover the prosthesis, musculo-cutaneous flaps are usually preferred based on proven efficacy when used in both one-stage and two-stage procedures. The use of a free fascio-cutaneous antero-lateral thigh (FC-ALT) flap in 3 patients with infected knee reconstructions is reported here. A retrospective study was performed of 3 patients in whom a free FC-ALT flap was used during a two-stage procedure to treat MTKP infection after femoral sarcoma resection. Free FC-ALT flap transfer and exchange arthroplasty were successful in all 3 patients. Two years after the procedure, no patient had required amputation or experienced recurrent infection. A free FC-ALT flap can provide adequate coverage of infected MTKP and deserves to be viewed as a valid alternative to free muscle flaps.

Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity: Vessel Selection In Lieu of Obligatory Number.

Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer. All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed. An algorithm was used to determine the type and number of venous anastomoses, emphasizing patient anatomy, venous quality, and size match. Patients were divided into single- and dual-venous-anastomosis groups. Univariate analysis determined differences between the groups. A multivariable analysis identified independent risk factors. Fifty patients met the inclusion criteria. Patient demographics, recipient sites, wound type, and flap characteristics were similar in 1 and 2 vein groups. Average follow-up was 9.6 months. Forty-two percent underwent single venous drainage anastomoses. Mean age was 52.7 years, 78.0% were male, and 60% had defects of the foot and ankle. Increased flap area and early dangling did not increase flap demise. Thirty-three percent of single-drainage patients and 31.0% of dual-drainage patients had a complication. A body mass index of greater than 30 kg/m 2 was a predictor for both flap complication ( P = 0.025) and partial flap loss ( P = 0.031) in univariate analysis. No independent predictors were found in multivariate analysis. The number of venous anastomoses, area, and dangling protocol did not influence outcomes while using our lower extremity vein method. Thoughtful evaluation of venous egress should outweigh the routine use of multiple veins in perforator flap reconstructions of the lower extremity.

Versatility of the Pedicled ALT Flap in Defect Reconstruction: Experience of a Unit in Rural Sub-Saharan African

Background : The free anterolateral thigh flap with its large caliber vessels, a reliable skin territory and minimal donor site morbidity is the reconstructive surgeons’ workhorse. The pedicled flap though not as popular, has been used extensively for the reconstruction of defects from the mid-leg to the epigastrium. The favorable profile of the anterolateral thigh flap, with minimal variability of its vascular anatomy and donor site complications is well described in most races; literature of its use in sub-Saharan Africa is scanty. Methods : The author describes the use of the anterolateral thigh flap in a series of 17 patients in a rural African hospital, illustrating its versatility as well as the complications associated with its use in this patient population. Results : Seventeen patients withtwenty antero-lateral thigh flaps were followed for an average of 24 months. Conclusions : The pedicled antero-lateral thigh flap is an excellent reconstructive tool with very good results in the black African population. This versatile flap has low donor site morbidity. The risk of developing hypertrophic scars and keloids remains a real concern in Black patients and longer term follow-up and a larger number of patients are needed to establish this potential complication. Key words : Anterolateral thigh flap, Africa

Complex Intraoral Reconstruction Using a Single Free Anterolateral Thigh Flap and Supermicrosurgery After Corrosive Ingestion in a 14-Month-Old Child

Oral chemical burn injuries induce more damage to the underlying tissues with extensive scarring. It is very well known that alkali causes severe liquefaction necrosis and injury to the deeper tissues. Pediatric facial burns must be managed thoroughly and always require complex reconstruction, which is a challenging process. So, any reconstructive surgeon must be aware of all the deformities that may have significant functional and aesthetic impact on the burn survivors especially children. Few medical studies addressed pediatric microsurgical reconstruction for oral burn injuries induced by chemical materials. Anterolateral thigh (ALT) free flap is a common flap with a multitude of indications. The purpose of this article is to present the youngest case in the medical literature of caustic intraoral scarring managed with a very thin free anterolateral thigh flap in a 14-month-old child who underwent reconstruction of his inner cheek, the angle of the mouth and tongue using supermicrosurgery techniques. Further development of the surgical techniques is required to establish early and safe intraoral pediatric microsurgery with a long-term follow-up.