Thin Anterolateral Thigh Perforator Flap Using a Modified Perforator Microdissection Technique and Its Clinical Application for Foot Resurfacing (original) (raw)
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Role of Perforator Flaps in Leg and Foot Reconstruction
The Egyptian Journal of Hospital Medicine
Background: Lower extremity wounds have been always a challenge for reconstructive surgeons. Free perforator flaps are considered to be the best option for this problem but require the complexity of microsurgery. So, pedicled perforator flaps have emerged as an alternative option. The aim of the present study is the assessment of efficacy of perforator flaps (either free flaps or pedicled flaps) regarding the coverage of traumatic soft tissue defects on the leg and foot. Patients and methods: A prospective study was conducted upon 40 patients with traumatic soft tissue defects in the leg and foot. The free flaps used were anterolateral thigh flap (ALT) and medial sural artery perforator flap (MSAP). In pedicled perforator flaps group, 10 cases were designed as propeller flaps, while the other 10 flaps were designed as perforator plus flaps. Results: Free flaps were mainly used for large sized defects; one case of partial flap loss and one case of complete flap necrosis. MSAP flap was the first option for coverage of large sized defects on foot and ankle as it's a thin and pliable flap, while ALT flap was used for coverage of larger defects on the leg. Pedicled perforator flaps were used mainly for small to medium-sized defects especially in the lower third of the leg; we had 3 cases of flap loss in propeller flap design while we had no cases of flap loss in perforator plus flap. Conclusion: Perforator flaps have become a reasonable solution for soft tissue defects of the lower extremity. Careful assessment of the dimensions, location, patient comorbidities, availability of surrounding soft tissue and presence of adequate perforators are mandatory for proper perforator flap selection.
Indian Journal of Plastic Surgery, 2019
Lower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors' experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.
Versatility and "flap efficiency" of pedicled perforator flaps in lower extremity reconstruction
Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2017
The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects. Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects. Flaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin graft...
Pedicled Perforator Flaps for the Lower Limb
Seminars in Plastic Surgery, 2006
The use of local perforator-based flaps for reconstruction of soft tissue defects of the lower extremity is a simple and safe alternative to the more complex and timeconsuming microsurgical reconstructions. This has been made possible through better understanding of the cutaneous circulation and local vascular anatomy and innovations in flap design. This review describes the evolution, technique, and modifications of pedicled perforator-based flaps, particularly in the reconstruction of posttraumatic defects of the lower third of the leg. Attention is focused on the perforator-based posterior tibial, adipofascial, and dorsal foot flaps. We also highlight the concept of the ad hoc perforator flap, a flap that decreases dependence on preconceived designs.
Our Experience in Lower Limb Reconstruction With Perforator Flaps
Annals of Plastic Surgery, 2007
The application of Taylor's concept about body angiosomes, referred to tissue transfers, has meant that the development of the perforator flaps and musc1es is no longer needed as a carrier of skin flap vascularity. In this papel', \Ve revise 59 lower limb reconstructions with local and free perforator flaps perfonned in the last 5 years, and a basic reconstructive algorithm is also suggested lo help with the management of the lower limb soft tissue reconstruction with perforator flaps. The advantages of the perforator flaps are (1) muscles and their function are preserved; (2) the main vascular lrunks are spared; (3) it is possible to make a more specific rcconstruclion, replacing "likc with like" (even perfonning compound or chimeric flaps); (4) the donar site can often be c10sed primarily; (5) the general morbidity is reduced; (6) a bener cosmetic result can be achieved.
The Egyptian Journal of Plastic and Reconstructive Surgery, 2022
Background: The objective of this study is to compare between the free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot as regard the function, the aesthetic outcome, the complications and the patient satisfaction. Patients and Method: The study was conducted on 40 patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were allocated randomly into two groups. In group 1 (20 patients), the defect was reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap. Result: In group 1 (ALT flap), Complete flap survival was achieved in all cases. Thirteen patients required secondary debulking procedures and scar revisions. In group 2 (MSAP Flap), Complete flap survival was achieved in 17 cases with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement. Conclusion: MSAP flap is good alternative in soft tissue reconstruction of the dorsum of the foot. It has many advantages: It is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases. ALT flap is better than MSAP flap in larger defects coverage but may need secondary debulking procedures or primary thinning at the time of reconstruction.
Medial Sural Artery Perforator Flap in Resurfacing Superficial Dorsal Defect of the Foot
مجلة سوهاج لشباب الباحثين, 2022
We assessed the suitability and relevance of the medial sural artery perforator flap in covering shallow defects of the dorsum of the foot. The study was conducted on 30 patients with-post raumatic t soft tissue defects of the dorsum of the foot between August 2018 and August 2020. All defects were covered with medial sural artery perforator flap. Complete flap survival was achieved in 27 cases with one flap totally lost and two flaps had distal necrosis. 26 patients were satisfied with the result need no debulking. The flap had a good aesthetic appearance in most cases. MSAP flap is a good option in covering dorsal foot defect. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases. Keywords Reconstruction, free flaps, medial sural artery perforator flap, dorsal foot 1. Introduction Reconstruction of the soft tissue defects of the dorsum of the foot is difficult. The Dorsum of the foot has unique anatomy of thin skin, less subcutaneous tissue , and superficial tendons. It requires a thin flap to cover (Fitzgerald O'Connor et al., 2020). Many options for coverage were described, but there is no ideal method for reconstruction. Distorting the aesthetic appearance and bulky flaps are major problems (Lorenzetti et al., 2010). Free tissue transfer is a perfect solution for coverage. Soft tissue defects of the dorsum of the foot need thin, pliable flaps, early mobilization, less donor morbidity, and normal footwear fitting. Cavadas described the use of a medial sural artery perforator flap (MSAP) for lower limb defects. A series of 30 MSAP flaps was conducted to assess the use of this flap to reconstruct soft tissue defects of the dorsum of the foot. 2. Materials and Methods The study was approved by the medical research ethics committee of the Sohag Faculty of Medicine. Written informed consent was obtained from each participant patient or his /her legal guardians. Article info.
Customized reconstruction with the free anterolateral thigh perforator flap
Microsurgery, 2008
70 free anterolateral thigh (ALT) flaps were transferred for reconstructing soft-tissue defects. The overall success rate was 96%. Among 70 free ALT flaps, 11 were elevated as cutaneous ALT septocutaneous vessel flaps. Fifty-seven were harvested as cutaneous ALT myocutaneous ' 'true' ' perforator flaps. Two flaps were used as fasciocutaneous perforator flaps based on independent skin vessels. Fifty-four ALT flaps were used for lower extremity reconstruction, 11 flaps were used for upper extremity reconstruction, 3 flaps were used for trunk reconstruction, and 1 flap was used for head and neck reconstruction. Total flap failure occurred in 3 patients (4.28% of the flaps), and partial failure occurred in 5 patients (7.14% of the flaps). The three flaps that failed completely were reconstructed with a free radial forearm flap, a latissimus dorsi flap and skin grafting, respectively. Among the five flaps that failed partially, three were reconstructed with skin grafting, one with a sural flap, and one with primary closure. The free ALT flap has become the workhorse for covering defects in most clinical situations in our center. It is a reliable flap with consistent anatomy and a long, constant pedicle diameter. Its versatility, in which thickness and volume can be adjusted, leads to a perfect match for customized reconstruction of complex defects. V V C 2008 Wiley-Liss, Inc. Microsurgery 28:489-494, 2008.
Microsurgery, 2015
Background: The use of a transverse pattern for perforator flap design and its possible clinical applications in the field of lower leg reconstruction are previously unreported in the medical literature. The purpose of this report is to describe our clinical experience with the use of transversally oriented pedicled perforator flaps in lower leg reconstruction. Patients and methods: Seven patients underwent lower leg reconstruction with transversally oriented pedicled perforator flaps. Patients age ranged from 42 to 68 years. All defects resulted from skin cancer ablation. Defect sizes ranged from 9 3 5 to 5 3 2.5 cm. The technique was applied to patients presenting with vertically oriented, long, and narrow defects, not feasible for primary closure, with the only audible perforators detected at a significant distance from the wound. Results: All flaps were based on a single perforator vessel. One of them was converted to a perforator-plus peninsular flap design, which retained an additional source of blood supply from the opposite skin bridge. The flaps were always mobilized in V-Y fashion. Donor sites were always closed primarily. Flap dimensions ranged from 15 3 7 to 8 3 3.5 cm. Operative time ranged from 40 to 90 minutes. All flaps survived uneventfully. Follow-up ranged from 6 months to 2 years. All patients were satisfied with the surgical outcome. Conclusions: The use of transversally oriented pedicled perforator flaps proved to be a reliable alternative option to reconstruct small to medium size defects of the lower leg.
Anatomical and clinical evaluation of perforator-based flaps of lower limb
International Surgery Journal
Background: Wound of lower leg have a poor and delayed healing due to paucity of blood supply. Coverage of defects of leg and foot has always posed a problem for reconstructive surgeon. The objective of this study was to evaluate anatomical basis of various perforator-based flaps in lower limb and their clinical outcome and usefulness.Methods: All patients with post traumatic defects with exposed bones/tendons in the leg and ankle region presenting in MLN Medical college, Allahabad from August 2011 to July 2012 were included in the study.Results: A total 12 patients were included in study. Majority of cases are of compound fracture following accidents involving lower one third of leg. Majority of flaps were based on peroneal artery (5) and posterior tibial artery (5), only 2 flaps were based on anterior tibial artery. Maximum flap length was 21cm and maximum flap rotation was 180º. Complications occurred more in cases having maximum rotation. Result were good in 11 patients and sati...