Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ...Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ALT flaps have been criticized due to variability in vasculature, which may result in inadequate or non-existent perforators. This retrospective study aims to investigate the utility and validity of positron emission tomography (PET) scan to identify the location and characteristics of perforators to the ALT flap. Methods: We performed a 10-year retrospective review of ALT flaps at our institution to identify patients with preoperative PET scans available for analysis. Three reviewers (attending physician, fellow, and resident) were asked to identify the number, location, and characteristics (myocutaneous versus septocutaneous) of ALT perforators on imaging, and reviewer agreement was assessed. Results were then compared to available operative data. Results: One hundred twenty-one patients were identified who underwent ALT free flap surgery. Thirty-eight preoperative PET scans were identified for review. At least one perforator was identified in 92.1% of scans. Agreement percentages regarding the number of perforators ranged from 53% - 61% whereas agreement regarding the location of a single perforator ranged from 79% - 90%. However, reviewers did not agree regarding the type of perforator, with agreement ranging from 34% - 53%. Poor agreement was observed when compared to intraoperative data, with the number of perforators ranging from 26% - 34% and the type of perforator 11% - 24%. These findings are likely due to insufficient data available in operative reports. Conclusion: Although initial studies suggest that PET scan shows promising evidence to support the capacity to preoperatively identify ALT perforators, future prospective studies are warranted to fully validate these findings.展开更多
Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in s...Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.展开更多
Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and Februa...Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.展开更多
目的探讨远端蒂股前外侧(distally based anterolateral thigh,dALT)皮瓣的特点及手术注意事项以提高手术成功率。方法回顾性分析在2010年11月至2023年2月期间收治的41例患者,以dALT皮瓣修复膝关节周围软组织缺损,将以降支为蒂者定义为...目的探讨远端蒂股前外侧(distally based anterolateral thigh,dALT)皮瓣的特点及手术注意事项以提高手术成功率。方法回顾性分析在2010年11月至2023年2月期间收治的41例患者,以dALT皮瓣修复膝关节周围软组织缺损,将以降支为蒂者定义为Ⅰ型皮瓣,以斜支为蒂者为Ⅱ型皮瓣,以横支为蒂者为Ⅲ型皮瓣,对比不同类型皮瓣的血管蒂长度、修复的缺损位置以及皮瓣转归。结果Ⅰ型皮瓣24块,Ⅱ型皮瓣13块,Ⅲ型皮瓣4块。Ⅰ型皮瓣血管蒂较短,修复的缺损主要位于大腿远端1/3和膝关节前/外侧(62.5%,15/24);Ⅱ型和Ⅲ型皮瓣血管蒂较长,修复的缺损主要位于膝关节后/内侧和小腿近端1/3(84.7%,11/13;100.0%,4/4)。Ⅲ型皮瓣的并发症发生率(50.0%)和皮瓣坏死率(25.0%)较高。结论dALT皮瓣术前应注意评估可切取的血管蒂长度,术中需注意血管解剖、小心操作,避免破坏逆行血供,影响皮瓣血运。展开更多
This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. ...This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.展开更多
文摘Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ALT flaps have been criticized due to variability in vasculature, which may result in inadequate or non-existent perforators. This retrospective study aims to investigate the utility and validity of positron emission tomography (PET) scan to identify the location and characteristics of perforators to the ALT flap. Methods: We performed a 10-year retrospective review of ALT flaps at our institution to identify patients with preoperative PET scans available for analysis. Three reviewers (attending physician, fellow, and resident) were asked to identify the number, location, and characteristics (myocutaneous versus septocutaneous) of ALT perforators on imaging, and reviewer agreement was assessed. Results were then compared to available operative data. Results: One hundred twenty-one patients were identified who underwent ALT free flap surgery. Thirty-eight preoperative PET scans were identified for review. At least one perforator was identified in 92.1% of scans. Agreement percentages regarding the number of perforators ranged from 53% - 61% whereas agreement regarding the location of a single perforator ranged from 79% - 90%. However, reviewers did not agree regarding the type of perforator, with agreement ranging from 34% - 53%. Poor agreement was observed when compared to intraoperative data, with the number of perforators ranging from 26% - 34% and the type of perforator 11% - 24%. These findings are likely due to insufficient data available in operative reports. Conclusion: Although initial studies suggest that PET scan shows promising evidence to support the capacity to preoperatively identify ALT perforators, future prospective studies are warranted to fully validate these findings.
文摘Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.
文摘Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.
文摘目的探讨远端蒂股前外侧(distally based anterolateral thigh,dALT)皮瓣的特点及手术注意事项以提高手术成功率。方法回顾性分析在2010年11月至2023年2月期间收治的41例患者,以dALT皮瓣修复膝关节周围软组织缺损,将以降支为蒂者定义为Ⅰ型皮瓣,以斜支为蒂者为Ⅱ型皮瓣,以横支为蒂者为Ⅲ型皮瓣,对比不同类型皮瓣的血管蒂长度、修复的缺损位置以及皮瓣转归。结果Ⅰ型皮瓣24块,Ⅱ型皮瓣13块,Ⅲ型皮瓣4块。Ⅰ型皮瓣血管蒂较短,修复的缺损主要位于大腿远端1/3和膝关节前/外侧(62.5%,15/24);Ⅱ型和Ⅲ型皮瓣血管蒂较长,修复的缺损主要位于膝关节后/内侧和小腿近端1/3(84.7%,11/13;100.0%,4/4)。Ⅲ型皮瓣的并发症发生率(50.0%)和皮瓣坏死率(25.0%)较高。结论dALT皮瓣术前应注意评估可切取的血管蒂长度,术中需注意血管解剖、小心操作,避免破坏逆行血供,影响皮瓣血运。
文摘This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.
