Immediate Emergency Free Anterolateral Thigh Flap Transfer for the Mutilated Upper Extremity
ABSTRACT Immediate emergency free flaps are defined as flaps performed directly following emergency surgery due to the exposure of major reconstructed arteries, major nerves, bones, and tendons. The authors document their experience in using free anterolateral thigh flaps in the immediate reconstruction of complex upper extremity injuries.
From January of 2000 to October of 2006, 12 patients ranging from 10 to 59 years old with complicated upper extremity traumatic injuries were treated with immediate emergency free anterolateral thigh flap transfers. These flaps were performed to cover the exposed vital structures. Flap sizes ranged from 30 x 15 to 8 x 6 cm. A variety of flap designs were used, including six flow-through flaps for upper limb revascularization and three tensor fasciae latae components for gliding planes of exposed repaired tendons. The operative times ranged from 7.2 to 12.1 hours, with an average operative time of about 9.6 hours. The hospital stay was from 13 to 34 days, with average stay of about 27.7 days.
All of the flaps survived. No re-exploration was required. Partial flap necrosis occurred in only one case. Traumatized wound infection occurred in three patients.
The anterolateral thigh flap has been popularized as the versatile flap for soft-tissue reconstruction. It has many advantages, including long pedicle length, large skin territory, flow-though and chimeric concept design, a two-team approach, and no need for changing the position. Thus, it is suitable as the immediate emergency flap for upper extremity salvage.
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ABSTRACT: BACKGROUND:: The recommendations on the timing of microsurgical extremity reconstruction are as variable and numerous as the flaps described for such reconstruction. Original articles suggested reconstruction should take place within 72 hours of injury. However, significant changes in perioperative and intraoperative management have occurred in this field, which may allow for more flexibility in the timing of reconstruction. This article aims to review current literature on timing of upper extremity reconstruction to provide the microsurgeon with up-to-date recommendations. METHODS:: A structured literature search including Spanish and English articles published between January 1995 and December 2011 was performed using MEDLINE and Scopus databases. The search strategy was conducted using groups of key words and articles were subsequently reviewed for relevance. Bibliographies of selected articles were further reviewed for additional relevant publications. Rates of total flap loss, infection, hospital stay and bony nonunion were recorded and analyzed according to Emergent (<24 hours), Early (<5 days), Primary (6-21 days) or Delayed (>21 days) reconstruction. RESULTS:: Fifteen articles met inclusion criteria. There was no significant association between timing of reconstruction and rates of flap loss, infection or bony nonunion. Linear regression analysis displayed a significant association between length of hospital stay and timing of reconstruction. CONCLUSIONS:: No conclusive evidence exists to suggest that emergent, early, primary or delayed reconstruction will eliminate or decrease complications associated with post-traumatic upper extremity reconstruction. Earlier reconstruction may decrease length of hospital stay and limit associated medical costs. LEVEL OF EVIDENCE:: Not gradable.Plastic and Reconstructive Surgery 05/2013; 132(3). DOI:10.1097/PRS.0b013e31829ad012 · 3.33 Impact Factor
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ABSTRACT: The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe.11/2011; 2011:127353. DOI:10.1155/2011/127353
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ABSTRACT: Anterolateral thigh (ALT) flap is one of the most common flaps in the reconstruction armamentarium of plastic surgeons, but there is no published data about the flap characteristics in the Indian population. The aim of this study is to analyse the anthropomorphic characteristics of the ALT flap and the perforator details in Indian population. ALT flap details were studied in 65 patients of Indian origin comprising 45 males and 20 females. The study period is from August 2011 to July 2012. A prospective database of the Doppler findings, perforator and pedicle details and the flap morphology were maintained. The variables are analysed by using the SPSS, PASW statistics 18 software IBM(®). In nearly 75% of cases, the perforator was found within 4 cm of the pre-operative Doppler markings. The percentage of musculocutaneous and septocutaneous perforators was 61.8% and 38.2% respectively. The pedicle variation was found in 6 cases (9.23%). The average thickness of the thigh skin in Indians is similar to the western people, but thicker than the other Asian people. Flap thinning was performed in nine patients without any major complications. The perforator details and type in the Indian population are similar to the published reports from other parts of the world. We advise pre-operative Doppler examination in possible cases. The variation in pedicle anatomy should not be overlooked to avoid complications. The thickness of subcutaneous tissue of the flap is higher in Indians, but still can be safely thinned. The data of this study will serve as a guide for the ALT flap characteristics in Indian patients.Indian Journal of Plastic Surgery 03/2013; 46(1):59-68. DOI:10.4103/0970-0358.113709