Flow-Through Flaps in the Absence of an Arterial Gap for Extremity Defect Reconstruction: Minimizing the Donor-Site Morbidity

Abstract

Background The use of flow-through flaps was popularized in the early 1990s by Costa, Soutar and Lamberty in cases where an arterial gap was present or a major artery of the limb was damaged. We hypothesized that flow-through flaps can be used in all extremity reconstruction cases, where there is an indication for a free-flap, irrespective of the existence of arterial defect due to its many advantages while not increasing the flap loss significantly.

Methods A retrospective study was performed by examining patient status and surgery reports of all patients who underwent extremity reconstruction with a flow-through flap from January 2011 to January 2016. This procedure was applied to all the patients, irrespective of the presence of an arterial gap.

Results Forty-seven patients were included. The most frequently used flaps were the anterolateral thigh flap and the latissimus dorsi flap. Reconstructions were either posttraumatic or after oncological resection. Two cases of flap loss were encountered. The mean total operating time was 480 ± 153 minutes. The mean follow-up was 10 ± 3 months. There were no donor-site wound complications.

Conclusion Based on our results, the flow-through flap technique can be considered a safe alternative to the end-to-side technique for complex extremity defect reconstruction irrespective of the vascular status. The additional arterial anastomosis, even in the absence of an arterial gap or a vascular compromised extremity, did not increase the complication rate in the hands of experienced microsurgeons.

Keywords

flow-through flaps - extremity reconstruction

• References

• 1 Costa H, Guimarães I, Cardoso A, Malta A, Amarante J, Guimarães F. One-staged coverage and revascularisation of traumatised limbs by a flow-through radial mid-forearm free flap. Br J Plast Surg 1991; 44 (07) 533-537
• 2 Soutar DS, Scheker LR, Tanner NS, McGregor IA. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36 (01) 1-8
• 3 Lamberty BG, Cormack GC. The antecubital fascio-cutaneous flap. Br J Plast Surg 1983; 36 (04) 428-433
• 4 Ozkan O, Ozkan O, Bektas G, Cinpolat A. Experiences with the flow-through radial forearm flap as a bridge in lower extremity reconstruction. Microsurgery 2016; 36 (02) 128-133
• 5 Toia F, Zabbia G, Roggio T, Pirrello R, D'Arpa S, Cordova A. Vascular grafts and flow-through flaps for microsurgical lower extremity reconstruction. J Reconstr Microsurg 2017; 33 (S 01): S14-S19
• 6 Bullocks J, Naik B, Lee E, Hollier Jr L. Flow-through flaps: a review of current knowledge and a novel classification system. Microsurgery 2006; 26 (06) 439-449
• 7 Hsiao YC, Yang JY, Chang CJ, Lin CH, Chang SY, Chuang SS. Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity. Burns 2013; 39 (03) 515-521
• 8 Koshima I, Fujitsu M, Ushio S, Sugiyama N, Yamashita S. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg 2005; 115 (01) 155-162
• 9 Cho EH, Garcia RM, Blau J. , et al. Microvascular anastomoses using end-to-end versus end-to-side technique in lower extremity free tissue transfer. J Reconstr Microsurg 2016; 32 (02) 114-120
• 10 Verhelle NAC, Heymans O. How to deal with difficult microsurgical end-to-side anastomoses. Microsurgery 2005; 25 (03) 203-208
• 11 Nasir S, Aydin MA, Sonmez E, Baykal B. Flow-through free latissimus dorsi flap for reconstruction of injured limbs: evaluation of hemodynamic effects on extremity circulation. Ann Plast Surg 2010; 65 (02) 164-169
• 12 Miyamoto S, Kayano S, Fujiki M, Kamizono K, Fukunaga Y, Sakuraba M. Flow-through divided latissimus dorsi musculocutaneous flap for large extremity defects. Ann Plast Surg 2015; 74 (02) 199-203
• 13 Fujiki M, Miyamoto S, Sakuraba M. Flow-through anastomosis for both the artery and vein in leg free flap transfer. Microsurgery 2015; 35 (07) 536-540
• 14 Pellini R, Pichi B, Ruggieri M, Ruscito P, Spriano G. Venous flow-through flap as an external monitor for buried radial forearm free flap in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2006; 59 (11) 1217-1221
• 15 Yokota K, Sunagawa T, Suzuki O, Nakanishi M, Ochi M. Short interposed pedicle of flow-through anterolateral thigh flap for reliable reconstruction of damaged upper extremity. J Reconstr Microsurg 2011; 27 (02) 109-114
• 16 Koshima I, Saisho H, Kawada S, Hamanaka T, Umeda N, Moriguchi T. Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs. Plast Reconstr Surg 1999; 103 (05) 1483-1490
• 17 Yajima H, Kobata Y, Shigematsu K, Kawamura K, Omokawa S, Takakura Y. Dysvascular lower extremity reconstruction using free flaps with a “Y” configuration of the arterial pedicle. J Reconstr Microsurg 2004; 20 (04) 291-295
• 18 Gencel E, Eser C, Kesiktas E, Tabakan I, Yavuz M. A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns. Burns 2016; 42 (04) e55-e60
• 19 Miyamoto S, Fujiki M, Sakuraba M. Clinical analysis of 33 flow-through latissimus dorsi flaps. J Plast Reconstr Aesthet Surg 2015; 68 (10) 1425-1431
• 20 Zhan Y, Fu G, Zhou X. , et al. Emergency repair of upper extremity large soft tissue and vascular injuries with flow-through anterolateral thigh free flaps. Int J Surg 2017; 48: 53-58
• 21 Qing L, Wu P, Liang J, Yu F, Wang C, Tang J. Use of flow-through anterolateral thigh perforator flaps in reconstruction of complex extremity defects. J Reconstr Microsurg 2015; 31 (08) 571-578
• 22 Miyamoto S, Fujiki M, Nakatani F, Sakisaka M, Sakuraba M. Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery. Microsurgery 2015; 35 (06) 485-488
• 23 Chun JK, Marin ML. Radial artery flow-through flap for distal lower-extremity arterial bypass for limb salvage. Plast Reconstr Surg 2003; 111 (01) 361-365
• 24 Ozkan O, Ozgentaş HE, Dikici MB. Flow-through, functioning, free musculocutaneous flap transfer for restoration of a mangled extremity. J Reconstr Microsurg 2005; 21 (03) 167-172
• 25 Devansh S. Lateral thigh free flap with flow-through vascular pedicle. Ann Plast Surg 2011; 67 (01) 44-48
• 26 Ao M, Nagase Y, Mae O, Namba Y. Reconstruction of posttraumatic defects of the foot by flow-through anterolateral or anteromedial thigh flaps with preservation of posterior tibial vessels. Ann Plast Surg 1997; 38 (06) 598-603