Versatile Anterolateral Thigh Perforator Flap: Case of Tailored Reconstruction for a Large Temporal and Parotidectomy Defect

ABSTRACT

Perforator flaps have introduced an advance in microsurgical reconstruction, by allowing the design of flaps that are tailored for a specific defect. In this report, the reconstructive technique in a case of temporal squamous-cell carcinoma is presented as an example of this trend. Following wide resection of the skin tumor, superficial parotidectomy was performed as a part of the lymph-node dissection. An anterolateral thigh perforator flap was harvested, including a segment of the vastus lateralis muscle in connection with the skin perforators, to reconstruct both the skin defect and the parotidectomy-related soft-tissue deficit. The muscle segment was reinnervated by the greater auricular nerve to diminish atrophy. The aesthetic result was satisfactory. Minor's starch-iodine test demonstrated prevention of Frey's syndrome. The anterolateral thigh flap is a versatile donor that allows individual variations in design for custom-made flaps.

KEYWORDS

Anterolateral thigh perforator flap - custom-made flaps - specific defects

REFERENCES

• 1 Demirkan F, Chen H C, Wei F C. et al . The versatile anterolateral thigh flap: a myocutaneous flap in disguise in head and neck reconstruction.  Br J Plast Surg . 2000;  53 30-36
• 2 Kuo Y R, Jeng S F, Kuo F M. et al . Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases.  Ann Plast Surg . 2002;  48 161-166
• 3 Wei F C, Jain V, Celik N. et al . Have we found an ideal soft-tissue flap?.  <~>An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg . 2002;  109 2219-2226
• 4 Kimata Y, Uchiyama K, Ebihara S. et al . Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects.  Arch Otolaryngol Head Neck Surg . 1997;  123 1325-1331
• 5 Huang W C, Chen H C, Jain V. et al . Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system.  Plast Reconstr Surg . 2002;  109 433-441
• 6 Celik N, Wei F C, Lin C H. et al . Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases.  Plast Reconstr Surg . 2002;  109 2211-2218
• 7 Coleman J J, Sultan M R. The bipedicled osteocutaneous scapula flap: a new subscapular system free flap.  Plast Reconstr Surg . 1991;  87 682-688
• 8 Koshima I, Yamamoto H, Hosoda M. et al . Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck region: an introduction to the chimeric flap principle.  Plast Reconstr Surg . 1993;  92 411-420
• 9 Cesteleyn L, Smith R G, Akuamoa-Boateng E. et al . Current diagnosis and therapy of parotid tumours.  Acta Stomatol Belg . 1991;  88 157-170
• 10 Zaoli G. Filling of the residual depression after parotidectomy with a composite arterial subcutaneous flap [Fr].  Ann Chir Plast Esthet . 1989;  34 123-127
• 11 Bonanno P C, Casson P R. Frey's syndrome: a preventable phenomenon.  Plast Reconstr Surg . 1992;  89 452-456
• 12 Rubinstein R Y, Rosen A, Leeman D. Frey syndrome: treatment with temporoparietal fascia flap interposition.  Arch Otolaryngol Head Neck Surg . 1999;  125 808-811
• 13 Baker D C, Shaw W W, Conley J. Microvascular free dermis-fat flaps for reconstruction after ablative head and neck surgery.  Arch Otolaryngol . 1980;  106 449-453
• 14 Allen R J, Kaplan J. Reconstruction of a parotidectomy defect using a paraumbilical perforator flap without deep inferior epigastric vessels.  J Reconstr Microsurg . 2000;  16 255-257
• 15 Siemionow M, Latifoglu O, Demirkan F. et al . Assessment of muscle flap sensibility by evoked potentials in the rat.  Microsurgery . 2000;  20 85-93
• 16 Eisele D W, Johns M E. Salivary gland neoplasms. In: Bailey BJ, Calhoun KH, eds. Head and Neck Surgery-Otolaryngology, vol 2, 2nd ed Philadelphia: Lippincott - Raven 1998: 1485-1508
• 17 Lee J K. Salivary glands: benign and malignant diseases. In: Lee JK, ed. Essential Otolaryngology, 7th ed Connecticut: Appleton-Lange 1999: 499-526
• 18 Schulze-Bonhage A, Schroder M, Ferbert A. Botulinum toxin in the therapy of gustatory sweating.  J Neurol . 1996;  243 143-147
• 19 Webster K. Early results using a porcine dermal collagen implant as an interpositional barrier to prevent recurrent Frey's syndrome.  Br J Oral Maxillofac Surg . 1997;  35 104-109