scholarly journals Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

2008 ◽  
Vol 2008 ◽  
pp. 1-5 ◽  
Author(s):  
N. Lumen ◽  
S. Monstrey ◽  
P. Ceulemans ◽  
E. van Laecke ◽  
P. Hoebeke
Keyword(s):  
Free Flaps ◽  
Functional Results ◽  
Good Alternative ◽  
Radial Forearm Flap ◽  
Anterolateral Thigh Flap ◽  
Forearm Flap ◽  
Free Radial Forearm Flap ◽  
Anterolateral Thigh ◽  
Aesthetic Results ◽  
Radial Forearm

Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy.Methods. Eleven males (age 15 to 42 years) were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4–49 months). Aesthetic and functional results were evaluated.Results. There were no complications related to the flap. Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula). Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion.Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.

Hypopharyngeal, Esophageal, and Neck Reconstruction

2018 ◽  
Author(s):  
Steven B Chinn ◽  
Peirong Yu
Keyword(s):  
Perforator Flap ◽  
Ulnar Artery ◽  
Good Alternative ◽  
Radial Forearm Flap ◽  
Anterolateral Thigh Flap ◽  
Forearm Flap ◽  
Anterolateral Thigh ◽  
Pharyngoesophageal Reconstruction ◽  
Radial Forearm ◽  
Artery Perforator

Organ preservation protocols with radiotherapy have become the primary treatment for stage I to III laryngeal and hypopharyngeal carcinoma. Many pharyngoesophageal defects are the result of salvage laryngopharyngectomy following radiation failure, making reconstruction more challenging. Given the detrimental effects of radiation on wound healing, reconstruction bathed in saliva, and the frozen neck with poor recipient vessels, pharyngoesophageal reconstruction requires great attention to detail to avoid catastrophic complications. In this review, we detail the commonly used flaps for pharyngoesophageal reconstruction, including the radial forearm flap, anterolateral thigh flap, and jejunal flap. In recent years, the anterolateral thigh flap has become the optimal flap for this type of reconstruction due to its minimal donor-site morbidity and excellent functional outcomes. Use of a two-skin island anterolateral flap allows for pharyngoesophageal reconstruction with simultaneous neck resurfacing. The profundus artery perforator flap can be a good alternative to the anterolateral thigh flap, whereas the ulnar artery perforator flap may be a good alternative to the radial forearm flap in certain cases. We discuss recipient vessel selection and conclude by outlining important postoperative considerations. This review contains 23 figures, 3 tables and 39 references Key words: anterolateral thigh flap, anteromedial thigh flap, frozen neck, gastro-omental flap, hypopharynx, laryngeal cancer, perforator flaps, pharyngocutaneous fistula, pharyngoesophageal reconstruction, profundus artery perforator flap, radial forearm flap, tracheoesophageal puncture, transverse cervical vessels, ulnar artery perforator flap

Hypopharyngeal, Esophageal, and Neck Reconstruction

2018 ◽  
Author(s):  
Steven B Chinn
Keyword(s):  
Perforator Flap ◽  
Ulnar Artery ◽  
Good Alternative ◽  
Radial Forearm Flap ◽  
Anterolateral Thigh Flap ◽  
Forearm Flap ◽  
Anterolateral Thigh ◽  
Pharyngoesophageal Reconstruction ◽  
Radial Forearm ◽  
Artery Perforator

Organ preservation protocols with radiotherapy have become the primary treatment for stage I to III laryngeal and hypopharyngeal carcinoma. Many pharyngoesophageal defects are the result of salvage laryngopharyngectomy following radiation failure, making reconstruction more challenging. Given the detrimental effects of radiation on wound healing, reconstruction bathed in saliva, and the frozen neck with poor recipient vessels, pharyngoesophageal reconstruction requires great attention to detail to avoid catastrophic complications. In this review, we detail the commonly used flaps for pharyngoesophageal reconstruction, including the radial forearm flap, anterolateral thigh flap, and jejunal flap. In recent years, the anterolateral thigh flap has become the optimal flap for this type of reconstruction due to its minimal donor-site morbidity and excellent functional outcomes. Use of a two-skin island anterolateral flap allows for pharyngoesophageal reconstruction with simultaneous neck resurfacing. The profundus artery perforator flap can be a good alternative to the anterolateral thigh flap, whereas the ulnar artery perforator flap may be a good alternative to the radial forearm flap in certain cases. We discuss recipient vessel selection and conclude by outlining important postoperative considerations. This review contains 23 figures, 3 tables and 39 references Key words: anterolateral thigh flap, anteromedial thigh flap, frozen neck, gastro-omental flap, hypopharynx, laryngeal cancer, perforator flaps, pharyngocutaneous fistula, pharyngoesophageal reconstruction, profundus artery perforator flap, radial forearm flap, tracheoesophageal puncture, transverse cervical vessels, ulnar artery perforator flap

scholarly journals Refinement of the free radial forearm flap reconstructive technique after resection of large oropharyngeal malignancies with excellent functional results

Head & Neck ◽  
2003 ◽  
Vol 25 (9) ◽  
pp. 772-777 ◽  
Author(s):  
Mieke Moerman ◽  
Hubert Vermeersch ◽  
Kristiane Van Lierde ◽  
Hossein Fahimi ◽  
Paul Van Cauwenberge
Keyword(s):  
Functional Results ◽  
Radial Forearm Flap ◽  
Forearm Flap ◽  
Free Radial Forearm Flap ◽  
Radial Forearm ◽  
Reconstructive Technique

scholarly journals Microvascular skin coverage in wounds that expose the Achilles tendon

2021 ◽  
Vol 9 (12) ◽  
pp. 3733
Author(s):  
Baltazar Barrera-Mera ◽  
Israel Salgado-Adame ◽  
Obed Horacio Grajeda-Chávez ◽  
Jazmín Danaé Chávez-Hernández ◽  
Cuauhtémoc Aguilar-Barragán ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Free Flaps ◽  
The Body ◽  
Radial Forearm Flap ◽  
Forearm Flap ◽  
Skin Defects ◽  
Free Radial Forearm Flap ◽  
Radial Forearm ◽  
Skin Coverage

Achilles tendon rupture is one of the most frequent tendon ruptures. Surgical intervention is the best option, but it has a high rate of complications leading to skin infections and necrosis. Extensive and aggressive debridement is necessary, producing tendon exposure and large skin defects. There are many alternatives for the skin coverage of the Achilles tendon, like sequential closures, vacuum assisted closure, local flaps, regional flaps, and more recently and efficiently microsurgery flaps. Skin defects in the Achilles tendon region have many peculiarities in comparison with other parts of the body: it is a zone that is always under mechanical stress due to footwear, this is why it must be highly resistant but thin. Its coverage must have sensitive properties, endure tendon gliding and allow early rehabilitation. Sometimes tendon reinforcement or creation or a neo tendon will be needed. For fulfilling these requirements free flaps by microsurgery are the only option in 90% of the cases. In this review article, we analyze three of the most frequently used free flaps in reconstructive medicine for complex Achilles tendon defects; free radial forearm flap, free radial forearm flap with vascularized flexor carpi radialis tendon and free anterolateral thigh (ALT) flap with vascularized fascia lata. This choice will be determined by the number of tissues involved, size of the defect, etiology of the defect, overall condition of the affected extremity and quality of neighboring tissues.

scholarly journals Iatrogenic Damage of the Pedicle of Radial Forearm Free Flap Repaired with Super-Microsurgery Techniques: A Case Report

2020 ◽  
Vol 14 (1) ◽  
pp. 31
Author(s):  
Jonathan Velazquez- Mujica ◽  
Hung Chi Chen ◽  
Juan Carlos Reyes Cerda
Keyword(s):  
Superficial Temporal Artery ◽  
Free Flaps ◽  
Temporal Artery ◽  
Radial Forearm Flap ◽  
Salvage Procedure ◽  
Large Defect ◽  
Forearm Flap ◽  
Free Radial Forearm Flap ◽  
Iatrogenic Damage ◽  
Radial Forearm

Introduction: Accidental Iatrogenic damage of the pedicle or perforators has been frequently reported as a cause of failure of free flaps. Free radial forearm flap helps to cover defects that are not possible to cover with local flaps or skin graft.Case Presentation: A 91 years old patient with Bowen Disease had multiple actinic keratosis and a history of squamous cell carcinoma over the forehead, which was removed 4 years before. The recurrent tumor was detected and wide excision of the tumor was done. It resulted in a large defect of 8 x 5.5 cm2 in diameter at the forehead with exposure of bone, therefore, a free radial forearm flap was performed for reconstruction with right superficial temporal artery and vein as recipient’s vessel. We observed leakage of blood through the radial artery near to the anastomosis due to iatrogenic damage during flap harvesting.Conclusions: Nowadays, repairing iatrogenic damage through the main pedicle or perforators of the pedicle is possible with super-microsurgery technique due to the improvement of the skills and smaller sutures avoiding the obstruction of the lumen of the pedicle or perforator. This is considered a salvage procedure instead of harvesting new free flaps and can be useful for all kinds of free flaps.

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