대한두개안면성형외과학회지 (Archives of Craniofacial Surgery)

  • 제23권2호
  • /
  • Pages.64-70
  • /
  • 2022
  • /
  • 2287-1152(pISSN)
  • /
  • 2287-5603(eISSN)
대한두개안면성형외과학회 (Korean Cleft Palate-Craniofacial Association)
권호 표지
DOI QR코드

DOI QR Code

Perforating patterns of cutaneous perforator vessels in anterolateral thigh flaps for head and neck reconstruction and clinical outcomes

  • Lee, Sang Soo (Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hong, Jong Won (Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Lee, Won Jae (Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Yun, In-Sik (Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2022.04.04
  • 심사 : 2022.04.20
  • 발행 : 2022.04.20
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Anterolateral thigh (ALT) flaps are versatile soft tissue flaps that have become the standard soft-tissue flaps used for head and neck reconstruction. They provide a long vascular pedicle, constant vessel diameter, abundant soft tissue coverage, and minimal donor site morbidity. The ALT flap was initially designed on the basis of a septocutaneous (SC) perforator. However, more recent research has shown that a substantial number of ALT flaps are now based on musculocutaneous (MC) perforators, and the ratio between MC and SC perforators varies among studies. In this study, we analyzed the perforating pattern of ALT flaps along with their clinical outcomes during head and neck reconstruction in the Korean population. Methods: From October 2016 to July 2020, 68 patients who had undergone an ALT flap procedure for head and neck reconstruction were enrolled retrospectively. The perforating pattern of the cutaneous perforator vessel (MC perforator/SC perforator/oblique branch), pedicle length, and flap size were analyzed intraoperatively. Patient demographics and flap necrosis rates were also calculated. Results: The highest number of cutaneous perforator vessels supplying the ALT flap were the MC perforators (87%). The proportion of MC perforators was significantly higher than that of the SC perforators and oblique branches. Flap necrosis occurred in seven cases (11.86%); sex, hypertension, diabetes mellitus, coronary artery disease, perforator course, and history of radiotherapy did not significantly affect flap necrosis. Conclusion: The ALT free flap procedure remains popular for reconstruction of the head and neck. In this study, we observed that the majority of cutaneous vessels supplying the flaps were MC perforators (87%). When using the MC perforator during flap elevation, careful dissection of the perforator is required to achieve successful ALT flaps because intramuscular dissection is difficult. Perforator pattern and history of radiotherapy did not affect flap necrosis.

키워드

과제정보

This study was supported by a faculty research grant from the Yonsei University College of Medicine (6-2017-0065).

참고문헌

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917. https://doi.org/10.1002/ijc.25516
  2. Kim HS, Chung CH, Chang YJ. Free-flap reconstruction in recurrent head and neck cancer: a retrospective review of 124 cases. Arch Craniofac Surg 2020;21:27-34. https://doi.org/10.7181/acfs.2019.00738
  3. Baek SM. Two new cutaneous free flaps: the medial and lateral thigh flaps. Plast Reconstr Surg 1983;71:354-65. https://doi.org/10.1097/00006534-198303000-00012
  4. 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
  5. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109:2219-30. https://doi.org/10.1097/00006534-200206000-00007
  6. Lutz BS, Wei FC. Microsurgical workhorse flaps in head and neck reconstruction. Clin Plast Surg 2005;32:421-30. https://doi.org/10.1016/j.cps.2005.02.006
  7. Kimata Y, Uchiyama K, Ebihara S, Sakuraba M, Iida H, Nakatsuka T, et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000;106:584-9. https://doi.org/10.1097/00006534-200009030-00009
  8. Yildirim S, Gideroglu K, Akoz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg 2003;19:225-33. https://doi.org/10.1055/s-2003-40578
  9. Yu P. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck 2004;26:1038-44. https://doi.org/10.1002/hed.20106
  10. Kim SH, Lee WJ, Chang JH, Moon JH, Kang SG, Kim CH, et al. Anterior skull base reconstruction using an anterolateral thigh free flap. Arch Craniofac Surg 2021;22:232-8. https://doi.org/10.7181/acfs.2021.00290
  11. Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989;42:260-2. https://doi.org/10.1016/0007-1226(89)90142-2
  12. Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993;92:421-30. https://doi.org/10.1097/00006534-199309000-00005
  13. Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998;102:1517-23. https://doi.org/10.1097/00006534-199810000-00026
  14. Xu DC, Zhong SZ, Kong JM, Wang GY, Liu MZ, Luo LS, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 1988;82:305-10. https://doi.org/10.1097/00006534-198808000-00016
  15. Shimizu T, Fisher DR, Carmichael SW, Bite U. An anatomic comparison of septocutaneous free flaps from the thigh region. Ann Plast Surg 1997;38:604-10. https://doi.org/10.1097/00000637-199706000-00007
  16. Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000;105:2349-60. https://doi.org/10.1097/00006534-200006000-00006
  17. Seth R, Manz RM, Dahan IJ, Nuara MJ, Meltzer NE, McLennan G, et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg 2011;13:347-54. https://doi.org/10.1001/archfacial.2011.16
  18. Seetharaman SS, Yadav PS, Shankhdhar VK, Dushyant J, Prashant P. Anthropomorphic and perforator analysis of anterolateral thigh flap in Indian population. Indian J Plast Surg 2013;46:59-68. https://doi.org/10.4103/0970-0358.113709
  19. Kawai K, Imanishi N, Nakajima H, Aiso S, Kakibuchi M, Hosokawa K. Vascular anatomy of the anterolateral thigh flap. Plast Reconstr Surg 2004;114:1108-17. https://doi.org/10.1097/01.PRS.0000135332.97062.7F
  20. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004;26:759-69. https://doi.org/10.1002/hed.20050
  21. Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004;57:603-9. https://doi.org/10.1016/j.bjps.2004.05.032
  22. Luo S, Raffoul W, Luo J, Luo L, Gao J, Chen L, et al. Anterolateral thigh flap: a review of 168 cases. Microsurgery 1999;19:232-8. https://doi.org/10.1002/(SICI)1098-2752(1999)19:5<232::AID-MICR5>3.0.CO;2-S
  23. Wong CH, Wei FC. Anterolateral thigh flap. Head Neck 2010;32:529-40. https://doi.org/10.1002/hed.21204
  24. Choi SW, Park JY, Hur MS, Park HD, Kang HJ, Hu KS, et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg 2007;18:866-71. https://doi.org/10.1097/scs.0b013e3180a03304
  25. Wong CH, Wei FC, Fu B, Chen YA, Lin JY. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg 2009;123:571-7. https://doi.org/10.1097/PRS.0b013e318195658f
  26. Palackic A, Skias C, Winter R, Hubmer M, Andrianakis A, Feigl G. Terminology of the branches of the lateral circumflex femoral artery: who is who? J Anat 2021;239:1465-72. https://doi.org/10.1111/joa.13507
  27. Deng C, Nie K, Wei Z, Jin W, Li H, Li S, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg 2018;34:478-84. https://doi.org/10.1055/s-0038-1639370
  28. Tasch C, Pattiss A, Maier S, Lanthaler M, Pierer G. Free flap outcome in irradiated recipient sites: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2022;10:e4216. https://doi.org/10.1097/GOX.0000000000004216
  29. Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofac Surg 2021;22:38-44. https://doi.org/10.7181/acfs.2020.00745
  30. Simpson KH, Murphy PG, Hopkins PM, Batchelor AG. Prediction of outcomes in 150 patients having microvascular free tissue transfers to the head and neck. Br J Plast Surg 1996;49:267-73. https://doi.org/10.1016/S0007-1226(96)90154-X