RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0043-1760829
In-Situ ‘Divide’ and ‘Deliver’: A Simple Technique to Preserve Nerves in Chimeric Anterolateral Thigh Flap Harvest
Abstract
Anterolateral thigh (ALT) flap is the workhorse for reconstruction in head and neck post cancer excision. Chimeric multi-paddle flaps are useful for composite defects involving skin, mucosa, and soft tissue. The nerve to vastus lateralis (VL) runs along the pedicle, frequently interdigitating with it or the perforators. Sometimes, the nerve may be preserved during harvest but needs to be sacrificed frequently, leading to increased donor site morbidity.
We recommend a simple technique to preserve the nerve, wherein the skin paddles or chimeric components are divided in-situ and manipulated around it without causing injury.
This technique was used in 27 cases over 5 years. All involved nerves, perforators and pedicles were preserved.
The technique can be extended to any flap harvest with multiple perforators with nerves in proximity, when multiple skin islands are desired.
Keywords
anterolateral thigh flap - technique of alt harvest - free flap reconstruction - donor site morbidity in alt - chimeric alt flap - multiple paddle alt - bipaddle alt harvestPublikationsverlauf
Artikel online veröffentlicht:
02. Februar 2023
© 2023. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (07) 2219-2226 , discussion 2227–2230
- 2 Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000; 105 (07) 2349-2357 , discussion 2358
- 3 Rozen WM, le Roux CM, Ashton MW, Grinsell D. The unfavorable anatomy of vastus lateralis motor nerves: a cause of donor-site morbidity after anterolateral thigh flap harvest. Plast Reconstr Surg 2009; 123 (05) 1505-1509
- 4 Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh free flap. Ann Plast Surg 1995; 34 (06) 585-592
- 5 Kimata Y, Uchiyama K, Ebihara S. et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000; 106 (03) 584-589
- 6 Lipa JE, Novak CB, Binhammer PA. Patient-reported donor-site morbidity following anterolateral thigh free flaps. J Reconstr Microsurg 2005; 21 (06) 365-370
- 7 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010; 125 (01) 209-214
- 8 Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg 2012; 20 (01) 17-23
- 9 Jaiswal D, Mantri MR, Shankhdhar VK, Wagh SH. Chimeric ALT plus TFL perforator flap for breast reconstruction post radical mastectomy with large skin defect. Indian J Plast Surg 2021; 54 (02) 208-210