Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Pedicled sural flaps versus free anterolateral thigh flaps in reconstruction of dorsal foot and ankle defects in children: a systematic review

  • Beecher, Suzanne M. (Department of Plastic and Reconstructive Surgery, St. James's Hospital) ;
  • Cahill, Kevin C. (Department of Plastic and Reconstructive Surgery, St. James's Hospital) ;
  • Theopold, Christoph (Department of Plastic and Reconstructive Surgery, St. James's Hospital)
  • Received : 2020.05.30
  • Accepted : 2021.04.09
  • Published : 2021.07.15
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Abstract

Background This systematic review compared free anterolateral thigh (ALT) flaps versus pedicled distally based sural artery (DBSA) flaps for reconstruction of soft tissue defects of dorsal foot and ankle in children. Methods A systematic literature search was performed to identify cases where an ALT or DBSA was used to reconstruct the dorsal foot in children. A total of 19 articles were included in the systematic review. Results Eighty-three patients underwent an ALT reconstruction and 138 patients underwent a DBSA reconstruction. Patients who had a DBSA were more likely to require grafting of the donor site (P<0.001). The size of ALT flaps was significantly larger than DBSA flaps (P=0.002). Subsequent flap thinning was required in 30% of patients after ALT and 12% of patients after DBSA reconstruction (P<0.001). Complications occurred in 11.6% of DBSA and 8.4% of ALT flaps (8.4%). Conclusions Both flaps are valid options in reconstructing pediatric foot and ankle defects. Each flap has advantages and disadvantages as discussed in this review article. In general for larger defects, an ALT flap was used. Flap choice should be based on the size of the defect.

Keywords

References

  1. Hallock GG. A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps. J Reconstr Microsurg 2013;29:233-40. https://doi.org/10.1055/s-0032-1328919
  2. Harry LE, Sandison A, Pearse MF, et al. Comparison of the vascularity of fasciocutaneous tissue and muscle for coverage of open tibial fractures. Plast Reconstr Surg 2009;124:1211-9. https://doi.org/10.1097/PRS.0b013e3181b5a308
  3. Nuzumlali E, Gurbuz C, Kantarci U, et al. Moving car-tire injuries of the foot: reconstruction with microvascular free flaps. J Reconstr Microsurg 1996;12:297-302. https://doi.org/10.1055/s-2007-1006489
  4. PRISMA Checklist [Internet]. PRISMA [cited 2021 Apr 2]. Available from: http://prisma-statement.org/PRISMAStatement/Checklist.
  5. National Heart, Lung, and Blood Institute. Quality Assessment Tool for Case Series Studies [Internet]. Bethesda, MD: National Institutes of Health; c2014 [cited 2021 Apr 2]. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
  6. Acar MA, Gulec A, Aydin BK, et al. Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients. J Reconstr Microsurg 2015;31:225-32. https://doi.org/10.1055/s-0034-1395888
  7. Almeida MF, da Costa PR, Okawa RY. Reverse-flow island sural flap. Plast Reconstr Surg 2002;109:583-91. https://doi.org/10.1097/00006534-200202000-00027
  8. Chai Y, Zeng B, Zhang F, et al. Experience with the distally based sural neurofasciocutaneous flap supplied by the terminal perforator of peroneal vessels for ankle and foot reconstruction. Ann Plast Surg 2007;59:526-31. https://doi.org/10.1097/01.sap.0000258969.13723.68
  9. Demirtas Y, Neimetzade T, Kelahmetoglu O, et al. Free anterolateral thigh flap for reconstruction of car tire injuries of children's feet. Foot Ankle Int 2010;31:47-52. https://doi.org/10.3113/FAI.2010.0047
  10. El-Gammal TA, El-Sayed A, Kotb MM, et al. Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children. Microsurgery 2013;33:259-64. https://doi.org/10.1002/micr.22074
  11. Grandjean A, Romana C, Fitoussi F. Distally based sural flap for ankle and foot coverage in children. Orthop Traumatol Surg Res 2016;102:111-6. https://doi.org/10.1016/j.otsr.2015.10.010
  12. Hu R, Ren YJ, Yan L, et al. A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles. Injury 2015;46:2019-23. https://doi.org/10.1016/j.injury.2015.06.046
  13. Kim MB, Lee YH, Kim JH, et al. Distally based adipofascial flaps covering soft-tissue defects of the dorsal foot and ankle in children. Ann Plast Surg 2014;73:568-77. https://doi.org/10.1097/SAP.0b013e318276d127
  14. Koladi J, Gang RK, Hamza AA, et al. Versatility of the distally based superficial sural flap for reconstruction of lower leg and foot in children. J Pediatr Orthop 2003;23:194-8. https://doi.org/10.1097/01241398-200303000-00012
  15. Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Injury 2012;43:822-8. https://doi.org/10.1016/j.injury.2011.09.031
  16. Liu L, Liu Y, Zou L, et al. The distally based superficial sural flap for reconstruction of the foot and ankle in pediatric patients. J Reconstr Microsurg 2013;29:199-204. https://doi.org/10.1055/s-0032-1331146
  17. Mahmood F, Mehrose MY, Tasneem S, et al. Distally based superficial sural artery flap for foot and ankle reconstruction in children. J Ayub Med Coll Abbottabad 2011;23:40-2.
  18. Olawoye OA, Ademola SA, Iyun K, et al. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Int Wound J 2014;11:210-4. https://doi.org/10.1111/j.1742-481X.2012.01075.x
  19. Ozkan O, Coskunfirat OK, Ozgentas HE. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap. J Reconstr Microsurg 2004;20:377-83. https://doi.org/10.1055/s-2004-830003
  20. Parajuli NP, Shrestha D, Panse N. Distally based sural faciocutaneous and fascial (adipofascial) flap for reconstruction of distal leg, ankle and foot defects. Kathmandu Univ Med J (KUMJ) 2014;12:126-31. https://doi.org/10.3126/kumj.v12i2.13659
  21. Rajacic N, Darweesh M, Jayakrishnan K, et al. The distally based superficial sural flap for reconstruction of the lower leg and foot. Br J Plast Surg 1996;49:383-9. https://doi.org/10.1016/S0007-1226(96)90007-7
  22. Tan O, Aydin OE, Demir R, et al. Neurotized sural flap: an alternative in sensory reconstruction of the foot and ankle defects. Microsurgery 2015;35:183-9. https://doi.org/10.1002/micr.22325
  23. Vergara-Amador E. Distally-based superficial sural neurocutaneous flap for reconstruction of the ankle and foot in children. J Plast Reconstr Aesthet Surg 2009;62:1087-93. https://doi.org/10.1016/j.bjps.2008.02.004
  24. Zheng H, Liu J, Dai X, et al. The distally based sural flap for the reconstruction of ankle and foot defects in pediatric patients. Ann Plast Surg 2016;77:97-101. https://doi.org/10.1097/SAP.0000000000000341
  25. Boeckx W, van den Hof B, van Holder C, et al. Changes in donor site selection in lower limb free flap reconstructions. Microsurgery 1996;17:380-5. https://doi.org/10.1002/(SICI)1098-2752(1996)17:7<380::AID-MICR7>3.0.CO;2-K
  26. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984;37:149-59. https://doi.org/10.1016/0007-1226(84)90002-X
  27. Cho JY, Suh HS, Hong JP. Do skin perforator flaps accommodate foot growth in children after reconstruction? J Reconstr Microsurg 2016;32:650-6. https://doi.org/10.1055/s-0036-1584806
  28. Viviano SL, Liu FC, Therattil PJ, et al. Peripheral pruning: a safe approach to thinning extra-large anterolateral thigh flaps. Ann Plast Surg 2018;80(4 Suppl 4):S164-7. https://doi.org/10.1097/SAP.0000000000001401
  29. Noaman HH. Microsurgery in children: history, indications, precautions, and differences from that of adults. Microsurgery 2008;28:83-4. https://doi.org/10.1002/micr.20453
  30. Momeni A, Lanni M, Levin LS, et al. Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population. Plast Reconstr Surg 2017;139:998-1004. https://doi.org/10.1097/PRS.0000000000003156
  31. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992;89:1115-21. https://doi.org/10.1097/00006534-199206000-00018
  32. Park SO, Chang H, Imanishi N. Anatomic basis for flap thinning. Arch Plast Surg 2018;45:298-303. https://doi.org/10.5999/aps.2017.01543
  33. Maffi TR, Knoetgen J 3rd, Turner NS, et al. Enhanced survival using the distally based sural artery interpolation flap. Ann Plast Surg 2005;54:302-5. https://doi.org/10.1097/00000637-200503000-00023