PDF herunterladen
J Reconstr Microsurg 2022; 38(02): 151-159
DOI: 10.1055/s-0041-1731763
Original Article

Evaluation of the Suprafascial Thin ALT Flap in Foot and Ankle Reconstruction

J.R. Thiele
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
J. Weiß
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
D. Braig
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
2   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
J. Zeller
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
G.B. Stark
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
S.U. Eisenhardt
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background Distal lower extremity reconstruction can be challenging in terms of flap design. Bulky flaps result in limited mobility accompanied with the need of customized footwear. Raising the ALT-flap in a superficial fascial plane (thin ALT-flap) can be beneficial. This study evaluates thin ALT-flaps for lower distal extremity reconstruction.

Methods In a retrospective study, patients that underwent microvascular extremity reconstruction at the level of the ankle and dorsal foot at the University of Freiburg from 2008–2018 were reviewed.

Results 95 patients could be included in the study (35 perforator flaps, 8 fascia flaps and 54 muscle flaps).

Among the perforator flaps, 21 ALT-flaps were elevated conventionally and 14 in the superficial fascial plane (thin ALT-flap). Among the conventional ALT-flaps, there was one flap loss (5%) and one successful revision (5%). 5(24%) flaps received secondary thinning. 57%(n = 12) were able to wear conventional footwear. There were 2(15%) successful revisions of thin ALT-flaps. 100% of thin ALT-flaps survived and 85%(n = 11) of the patients wore ordinary footwear after defect coverage.

Among fascial flaps, 50%(n = 4) had to be revised with 2(25%) complete and 1 (13%) partial flap loss. All patients achieved mobility in ordinary shoes (n = 8).

In muscle flaps, there were 7(13%) revisions and 5(9%) flap losses. 5(9%) flaps received secondary thinning. Only 33%(n = 18) were mobile in ordinary footwear.

Conclusion The thin ALT-flap is a save one-stage evolution for lower distal extremity reconstruction with a favorable flap survival rate. Compared with conventional ALT-flaps it might be beneficial in reducing the need for expensive custom fitted shoes and secondary thinning procedures.

Keywords

lower limb reconstruction - thin ALT-flap - flap thinning

Ethical Approval

The study was approved by the University of Freiburg Ethics Committee, Germany.




Publikationsverlauf

Eingereicht: 27. Januar 2021

Angenommen: 12. Mai 2021

Artikel online veröffentlicht:
17. August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Saint-Cyr M, Wong C, Buchel EW, Colohan S, Pederson WC. Free tissue transfers and replantation. Plast Reconstr Surg 2012; 130 (06) 858e-878e
    CrossrefPubMedSuche in Google Scholar
  • 2 Song B, Chen J, Han Y, Li Y, Su Y, Guo S. Reconstruction of Complex Defects of Lower Extremities Using Thinned Free Muscle Flaps. Aesthetic Plast Surg 2016; 40 (04) 519-525
    CrossrefPubMedSuche in Google Scholar
  • 3 Demirtas Y, Neimetzade T, Kelahmetoglu O, Guneren E. Comparison of free muscle and perforator skin flaps for soft tissue reconstruction of the foot and ankle. Foot Ankle Int 2010; 31 (01) 53-58
    CrossrefPubMedSuche in Google Scholar
  • 4 Nelson JA, Fischer JP, Haddock NT. et al. Striving for Normalcy after Lower Extremity Reconstruction with Free Tissue: The Role of Secondary Esthetic Refinements. J Reconstr Microsurg 2016; 32 (02) 101-108
    PubMedSuche in Google Scholar
  • 5 Parmaksizoğlu AF, Unal MB, Cansü E. The reconstruction of foot soft tissue defects by tangential debulking of the latissimus dorsi flap. J Reconstr Microsurg 2011; 27 (04) 211-214
    Thieme ConnectPubMedSuche in Google Scholar
  • 6 Nalamlieng MD, Gould DJ, Patel KM. Ultrathin Free Flaps to the Foot and Ankle: New Options for Optimal Soft Tissue Coverage and Functional Contour. J Foot Ankle Surg 2019; 58 (04) 802-806
    CrossrefPubMedSuche in Google Scholar
  • 7 Sommerlad BC, McGrouther DA. Resurfacing the sole: long-term follow-up and comparison of techniques. Br J Plast Surg 1978; 31 (02) 107-116
    CrossrefPubMedSuche in Google Scholar
  • 8 Lee ZH, Abdou SA, Daar DA. et al. Comparing Outcomes for Fasciocutaneous versus Muscle Flaps in Foot and Ankle Free Flap Reconstruction. J Reconstr Microsurg 2019; 35 (09) 646-651
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Cho EH, Shammas RL, Carney MJ. et al. Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis. Plast Reconstr Surg 2018; 141 (01) 191-199
    CrossrefPubMedSuche in Google Scholar
  • 10 Baek SM. Two new cutaneous free flaps: the medial and lateral thigh flaps. Plast Reconstr Surg 1983; 71 (03) 354-365
    CrossrefPubMedSuche in Google Scholar
  • 11 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 (02) 149-159
    CrossrefPubMedSuche in Google Scholar
  • 12 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 (07) 2219-2226 , discussion 2227–2230
    CrossrefPubMedSuche in Google Scholar
  • 13 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996; 97 (05) 985-992
    CrossrefPubMedSuche in Google Scholar
  • 14 Kim TG, Choi MK. Secondary contouring of flaps. Arch Plast Surg 2018; 45 (04) 319-324
    Thieme ConnectPubMedSuche in Google Scholar
  • 15 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 (07) 491-496
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Diamond S, Seth AK, Chattha AS, Iorio ML. Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity. J Reconstr Microsurg 2018; 34 (03) 176-184
    Thieme ConnectPubMedSuche in Google Scholar
  • 17 Ebner PJ, Gould DJ, Patel KM. Thin Perforator Flaps for Reconstruction of the Lower Extremity. J Reconstr Microsurg 2021; 37 (01) 5-11
    Thieme ConnectPubMedSuche in Google Scholar
  • 18 Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth 2014; 113 (03) 424-432
    CrossrefPubMedSuche in Google Scholar
  • 19 Briggs SE, Banis Jr JC, Kaebnick H, Silverberg B, Acland RD. Distal revascularization and microvascular free tissue transfer: an alternative to amputation in ischemic lesions of the lower extremity. J Vasc Surg 1985; 2 (06) 806-811
    CrossrefPubMedSuche in Google Scholar
  • 20 Greenwald LL, Comerota AJ, Mitra A, Grosh JD, White JV. Free vascularized tissue transfer for limb salvage in peripheral vascular disease. Ann Vasc Surg 1990; 4 (03) 244-254
    CrossrefPubMedSuche in Google Scholar
  • 21 Eisenhardt SU, Momeni A, Iblher N. et al. The use of the vacuum-assisted closure in microsurgical reconstruction revisited: application in the reconstruction of the posttraumatic lower extremity. J Reconstr Microsurg 2010; 26 (09) 615-622
    Thieme ConnectPubMedSuche in Google Scholar
  • 22 Eisenhardt SU, Schmidt Y, Thiele JR. et al. Negative pressure wound therapy reduces the ischaemia/reperfusion-associated inflammatory response in free muscle flaps. J Plast Reconstr Aesthet Surg 2012; 65 (05) 640-649
    CrossrefPubMedSuche in Google Scholar
  • 23 Brent B, Upton J, Acland RD. et al. Experience with the temporoparietal fascial free flap. Plast Reconstr Surg 1985; 76 (02) 177-188
    CrossrefPubMedSuche in Google Scholar
  • 24 Wintsch K, Helaly P. Free flap of gliding tissue. J Reconstr Microsurg 1986; 2 (03) 143-151
    Thieme ConnectPubMedSuche in Google Scholar
  • 25 Nojima K, Brown SA, Acikel C. et al. Defining vascular supply and territory of thinned perforator flaps: part I. Anterolateral thigh perforator flap. Plast Reconstr Surg 2005; 116 (01) 182-193
    CrossrefPubMedSuche in Google Scholar
  • 26 Seth AK, Iorio ML. Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction. J Reconstr Microsurg 2017; 33 (07) 466-473
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Yang WG, Chiang YC, Wei FC, Feng GM, Chen KT. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg 2006; 117 (03) 1004-1008
    CrossrefPubMedSuche in Google Scholar
  • 28 Ross GL, Dunn R, Kirkpatrick J. et al. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 2003; 56 (04) 409-413
    CrossrefPubMedSuche in Google Scholar
  • 29 Sharabi SE, Hatef DA, Koshy JC, Jain A, Cole PD, Hollier Jr LH. Is primary thinning of the anterolateral thigh flap recommended?. Ann Plast Surg 2010; 65 (06) 555-559
    CrossrefPubMedSuche in Google Scholar
  • 30 Kimura N, Saitoh M, Hasumi T, Sumiya N, Itoh Y. Clinical application and refinement of the microdissected thin groin flap transfer operation. J Plast Reconstr Aesthet Surg 2009; 62 (11) 1510-1516
    CrossrefPubMedSuche in Google Scholar
  • 31 Di Candia M, Lie K, Kumiponjera D, Simcock J, Cormack GC, Malata CM. Versatility of the anterolateral thigh free flap: the four seasons flap. Eplasty 2012; 12: e21
    PubMedSuche in Google Scholar
  • 32 Woods IV JM, Shack RB, Hagan KF. Free temporoparietal fascia flap in reconstruction of the lower extremity. Ann Plast Surg 1995; 34 (05) 501-506
    CrossrefPubMedSuche in Google Scholar
  • 33 Ludolph I, Arkudas A, Schmitz M. et al. Cracking the perfusion code?: Laser-assisted Indocyanine Green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps. J Plast Reconstr Aesthet Surg 2016; 69 (10) 1382-1388
    CrossrefPubMedSuche in Google Scholar
  • 34 Chowdary RP, Murphy RX. Delayed debulking of free muscle flaps for aesthetic contouring debulking of free muscle flaps. Br J Plast Surg 1992; 45 (01) 38-41
    CrossrefPubMedSuche in Google Scholar