Impact of intraoperative use of vasopressors in lower extremity reconstruction: Single centre analysis of 437 free gracilis muscle and fasciocutaneous anterolateral thigh flaps

2019 ◽  
Vol 71 (2) ◽  
pp. 193-201 ◽  
Author(s):  
A. Heine-Geldern ◽  
P.N. Broer ◽  
L. Prantl ◽  
V. Brebant ◽  
A.M. Anker ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Gracilis Muscle ◽  
Single Centre ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Anterolateral Thigh Flaps

One versus two venous anastomoses in microvascular lower extremity reconstruction using gracilis muscle or anterolateral thigh flaps

Injury ◽  
2016 ◽  
Vol 47 (12) ◽  
pp. 2828-2832 ◽  
Author(s):  
Paul I. Heidekrueger ◽  
Denis Ehrl ◽  
Albrecht Heine-Geldern ◽  
Milomir Ninkovic ◽  
P. Niclas Broer
Keyword(s):  
Lower Extremity ◽  
Gracilis Muscle ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Anterolateral Thigh Flaps

Algorithmic Approach to Anterolateral Thigh Flaps Lacking Suitable Perforators in Lower Extremity Reconstruction

2015 ◽  
Vol 135 (5) ◽  
pp. 1476-1485 ◽  
Author(s):  
Johnny Chuieng-Yi Lu ◽  
Jonathan Zelken ◽  
Chung-Chen Hsu ◽  
Nai-Jen Chang ◽  
Chih-Hung Lin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Algorithmic Approach ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Anterolateral Thigh Flaps

scholarly journals Role of Anterolateral Thigh Flaps in Distal Lower Extremity Reconstruction: Assessment of Functionality, Aesthetics, and Patient Satisfaction

2017 ◽  
Vol 02 (02) ◽  
pp. e83-e89
Author(s):  
Michael Trostler ◽  
Johnathan Shih ◽  
Gabriel Klein ◽  
Alexander Dagum ◽  
Duc Bui ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lower Extremity ◽  
Traumatic Injury ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Custom Made ◽  
Reconstructive Option ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Anterolateral Thigh Flaps

Background Distal lower extremity reconstruction presents many challenges due to the suboptimal vascular supply, the weight-bearing necessity, movement, and multiple tissue types that can be easily damaged by trauma, from bones, tendons, ligaments, muscle, and soft tissue loss. The anterolateral thigh flap provides a reconstructive option for large defects with good coverage and minimal donor-site morbidity. Methods After a chart review of all anterolateral thigh flaps, the patients were contacted to take a survey regarding their satisfaction and functional ability and to meet for measurements of their feet after debulking procedures. Results A total of 13 patients were included in the study, with traumatic injuries comprising 84% of cases. There was a significant difference in sizes of the midfoot (mean: 10.27 vs. 9.53, p = 0.004) and the hindfoot (mean: 12.92 vs. 12.2, p = 0.023) when comparing the affected side to the unaffected side. The majority, 77%, of our patients underwent debulking procedures. Overall, 75% of traumatic injury patients had > 90% maximum functionality score. All posttraumatic reconstruction results were rated satisfied to very satisfied by the patients. All posttraumatic patients were able to walk after their procedures, although three patients did require custom-made shoes with inserts or braces. Conclusion The anterolateral thigh flap is a versatile reconstructive option that can be used in the distal lower extremity and is especially useful after a traumatic injury as it allows for functional recovery and high patient satisfaction after debulking.

Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction

Microsurgery ◽  
2015 ◽  
Vol 35 (8) ◽  
pp. 634-639 ◽  
Author(s):  
Sang Woo Kim ◽  
Kyu Nam Kim ◽  
Joon Pio Hong ◽  
Sung Woo Park ◽  
Chae Ri Park ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

Challenges of Setting up a Lower Extremity Reconstruction Practice in a Constrained Environment

2020 ◽  
Author(s):  
Asli Datli ◽  
Ismail Karasoy ◽  
Yucel Genc ◽  
Ozgur Pilanci
Keyword(s):  
Lower Extremity ◽  
Administrative Support ◽  
Tertiary Care ◽  
Perforator Flap ◽  
Operation Time ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Set Up

Abstract Background Microsurgical lower extremity reconstruction remains challenging, especially when resources are limited such as lack of proper equipment, human resources, administrative support, and located in a remote area far from tertiary care. Nevertheless, reconstructive solutions are required, especially when in urgent trauma situations. In this article, we evaluate ways of overcoming challenges and issues that should be considered in a newly established unit by sharing our initial lower extremity reconstruction experience. Methods We report a local hospital's initial lower extremity reconstruction experience in February 2017 to January 2018. Through a total of seven patients, we tried to enhance the environment, instruments, nurses' contribution, and perspective of the peers and community in terms of factors related to the surgeon, hardware, environment, supporting faculty, reimbursement, and patients. Results Four patients underwent reconstruction with a freestyle propeller flap and three with an anterolateral thigh flap; in one case, a superficial circumflex iliac artery perforator flap was chosen to salvage partial flap necrosis. Increased experience of the surgeon, new equipment, continuing nurse/patient education, and collaborating with other departments allowed us to choose more challenging flaps and be more meticulous while decreasing the operation time and hospital stay. Conclusion To start a lower extremity reconstruction practice in a resource-poor environment, the surgeon needs to evaluate the relevant factors; moreover, he or she should continuously improve them until a working methodology is achieved. Despite all the challenges, the adaptations learned at this center can be applied to other local hospitals around the world to set up a lower extremity reconstruction practice and improve its outcomes.

scholarly journals Lower Extremity Reconstruction with Vascularized Free-Tissue Transfer: 20 Years of Experience in the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

2021 ◽  
Vol 73 (7) ◽  
pp. 462-470
Author(s):  
Nutthawut Akaranuchat
Keyword(s):  
Survival Rate ◽  
Lower Extremity ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
The Mean

Objective: The reconstruction of extensive soft-tissue defects in the lower extremity still poses a great challenge to plastic and reconstructive surgeons. The ideal approach is to achieve a proper soft-tissue coverage with a well-vascularized flap, which results in a durable weight-bearing surface and permits normal joint motion. This study aims to retrospectively analyze the outcomes of lower-extremity reconstruction with vascularized free-tissue transfer performed at our plastic surgery division. Materials and Methods: A retrospective chart review was performed regarding 58 patients with defects in the lower extremity which were reconstructed with vascularized free-tissue transfers between 2000 and 2019. Forty-four of the patients were male, and 14 were female. The mean age was 44.4 years (range: 6-89 years). The most common indication for free-flap surgery was a secondary reconstruction after tumor eradication (23 cases, 39.7%), and 84.8% of the defects were exposed bare bones, tendons, or joints.Results: In our 58 reviewed cases, the foot was the most common area requiring reconstruction with a free flap (68.9%), and the mean defect size was 12.5 x 8.1 cm. The most commonly used free flap was the Anterolateral thigh free flap (39.7%), followed by the Gracilis free flap (29.3%), and the Superficial circumflex iliac artery-perforator free flap (10.4%). The recipient vessels most frequently used were posterior tibialis vessels (53.4%). The overall flap-survival rate was 75.9%, though there was an increased survival rate of up to 85.7% in the last five years of the period studied. The flap-salvage rate was 40.9%, and arterial thrombosis was the major cause of flap loss (50%). Factors associated with free-flap failure were re-exploration and free flap surgery after tumor or cancer eradication. The most common post-operative complication was flap-wound dehiscence (10.3%). Two patients received a flap correction due to bulkiness, and three had recurrence of ulceration. Conclusion: Microvascular free-tissue transfers for lower- extremity-defect reconstructions are reliable and valuable as a surgical technique. In over 20 years of experience in our division, we’ve had an overall flap-survival rate of 75.9%. Our flap of choice was the Anterolateral thigh free flap.

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