Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Thin elevation: A technique for achieving thin perforator flaps

  • Jeong, Hyung Hwa (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Joon Pio (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Suh, Hyun Suk (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2017.07.19
  • Accepted : 2018.06.26
  • Published : 2018.07.15
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Abstract

Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.

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References

  1. Garg RK, Poore SO, Wieland AM, et al. Elective free flap revision revision in the head and neck cancer patient: indications and outcomes. Microsurgery 2015;35:591-5. https://doi.org/10.1002/micr.22506
  2. Celik N, Wei FC, Lin CH, 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;109:2211-6. https://doi.org/10.1097/00006534-200206000-00005
  3. Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg 2013;71: 380-3. https://doi.org/10.1097/SAP.0b013e3182503ac5
  4. Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014;30:491-6. https://doi.org/10.1055/s-0034-1369807
  5. Lee MG, Kim JS, Lee DC, et al. Fascial free flap for reconstruction of the dorsolateral hand and digits: the advantage of a thin contour. Arch Plast Surg 2016;43:551-8. https://doi.org/10.5999/aps.2016.43.6.551
  6. Baujat B, Struk S, Lesnik M, et al. Fascia temporalis free flap for cricotracheal reconstruction: a novel approach. Ann Thorac Surg 2017;104:1040-6. https://doi.org/10.1016/j.athoracsur.2017.02.078
  7. Lee KT, Park SJ, Mun GH. Reconstruction outcomes of oncologic foot defect using well-contoured free perforator flaps. Ann Surg Oncol 2017;24:2404-12. https://doi.org/10.1245/s10434-017-5876-5
  8. Kuran I, Turgut G, Bas L, et al. Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area. Plast Reconstr Surg 2000;105:574-80. https://doi.org/10.1097/00006534-200002000-00015
  9. Hollenbeck ST, Woo S, Komatsu I, et al. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125:924-34. https://doi.org/10.1097/PRS.0b013e3181cc9630
  10. Choi DH, Goh T, Cho JY, et al. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg 2014;25:2130-3.
  11. Clemens MW, Colen LB, Attinger CE. Foot reconstruction. In: Neligan PC, Song DH, editors. Plastic surgery. London: Elsevier Saunders; 2013. p. 189-218.
  12. Burusapat C, Nanasilp T, Kunaphensaeng P, et al. Effect of atherosclerosis on the lateral circumflex femoral artery and its descending branch: comparative study to nonatherosclerotic risk. Plast Reconstr Surg Glob Open 2016;4:e856. https://doi.org/10.1097/GOX.0000000000000849
  13. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009;124:1529-44. https://doi.org/10.1097/PRS.0b013e3181b98a6c
  14. Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al. Suprafascial anterolateral thigh flap harvest: a better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg 2016;138:689-98. https://doi.org/10.1097/PRS.0000000000002496
  15. Hong JP, Chung IW. The superficial fascia as a new plane of elevation for anterolateral thigh flaps. Ann Plast Surg 2013; 70:192-5. https://doi.org/10.1097/SAP.0b013e3182367c2f
  16. Seth AK, Iorio ML. Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg 2017;33:466-73. https://doi.org/10.1055/s-0037-1601422
  17. Khuri SF, Daley J, Henderson W, et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185:315-27.
  18. Devoto G, Gallo F, Marchello C, et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem 2006;52:2281-5. https://doi.org/10.1373/clinchem.2006.080366
  19. Suh HS, Oh TS, Lee HS, et al. A new approach for reconstruction of diabetic foot wounds using the angiosome and supermicrosurgery concept. Plast Reconstr Surg 2016;138: 702e-709e. https://doi.org/10.1097/PRS.0000000000002401
  20. Wada H, Vargas CR, Angelo J, et al. Accurate prediction of tissue viability at postoperative day 7 using only two intra- operative subsecond near-infrared fluorescence images. Plast Reconstr Surg 2017;139:354-63. https://doi.org/10.1097/PRS.0000000000003009
  21. Sharabi SE, Hatef DA, Koshy JC, et al. Is primary thinning of the anterolateral thigh flap recommended? Ann Plast Surg 2010;65:555-9. https://doi.org/10.1097/SAP.0b013e3181cbfebc
  22. Sun G, Lu M, Tang E, et al. Clinical application of free an- terolateral thigh flap in the reconstruction of intraoral de- fects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:34-41. https://doi.org/10.1016/j.tripleo.2010.09.062
  23. Shonka DC Jr, Kohli NV, Milam BM, et al. Suprafascial harvest of the radial forearm free flap decreases the risk of postoperative tendon exposure. Ann Otol Rhinol Laryngol 2017;126:224-8. https://doi.org/10.1177/0003489416685322
  24. Fischer S, Klinkenberg M, Behr B, et al. Comparison of donor-site morbidity and satisfaction between anterolateral thigh and parascapular free flaps in the same patient. J Reconstr Microsurg 2013;29:537-44. https://doi.org/10.1055/s-0033-1351394
  25. Ribuffo D, Cigna E, Gargano F, et al. The innervated anterolateral thigh flap: anatomical study and clinical implications. Plast Reconstr Surg 2005;115:464-70. https://doi.org/10.1097/01.PRS.0000149481.73952.F3
  26. Ali RS, Bluebond-Langner R, Rodriguez ED, et al. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009;124(6 Suppl):e395-407. https://doi.org/10.1097/PRS.0b013e3181bcf05c
  27. Adani R, Tarallo L, Marcoccio I, et al. Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 2005;116:467-73. https://doi.org/10.1097/01.prs.0000173059.73982.50

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