Usefulness of Free Tissue Transfer for the Reconstruction of Extensive Thigh Defects

Abstract

Background Despite the increasing popularity of free tissue transfer, thigh defects have been alienated from their potential indication, owing to the abundance of regional reconstruction options. However, some challenging situations where locoregional modalities may lead to suboptimal outcomes often require free flap. Due to lacking studies regarding microvascular reconstruction of thigh defects, this study aimed to investigate the versatility of free tissue transfer for reconstruction of thigh defects.

Methods A retrospective review was performed for patients who underwent microvascular reconstruction of thigh defects between 2003 and 2021. Their demographics and operation-related data were summarized and postoperative outcomes were evaluated.

Results Sixty-five patients were analyzed, with a median follow-up period of 15.5 months. Most common situations requiring free tissue transfer were extensive defects, followed by large dead space with exposure of major neurovascular bundle and chronic wounds surrounded by unhealthy regional tissue. Defects were most frequently located in the anterior compartment horizontally and in the distal thigh vertically. The median surface area of the defects was 180.0 cm². The latissimus dorsi musculocutaneous and thoracodorsal artery perforator flaps were the two most commonly used flaps. Reliable recipient vessels could generally be easily found in the vicinity of defects. Overall complications developed in 12 cases (18.5%), including two of partial flap necrosis. No total flap loss was encountered.

Conclusion Free tissue transfer could provide reliable outcomes and facilitate rapid recovery, and could be actively considered for reconstruction of thigh defects in situations unfavorable to the locoregional option.

Keywords

free flaps - microvascular reconstruction - thigh - defects

Data Availability

The datasets generated and analyzed in this study are available from the corresponding author on a reasonable request.

Publikationsverlauf

Eingereicht: 03. Oktober 2022

Angenommen: 28. Februar 2023

Accepted Manuscript online:
16. März 2023

Artikel online veröffentlicht:
19. April 2023

• References

• 1 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
• 2 Hsu CC, Loh CYY, Wei FC. The anterolateral thigh perforator flap: its expanding role in lower extremity reconstruction. Clin Plast Surg 2021; 48 (02) 235-248
• 3 Luo S, Raffoul W, Luo J. et al. Anterolateral thigh flap: a review of 168 cases. Microsurgery 1999; 19 (05) 232-238
• 4 Engel H, Lin CH, Wei FC. Role of microsurgery in lower extremity reconstruction. Plast Reconstr Surg 2011; 127 (Suppl. 01) 228S-238S
• 5 Engel H, Gazyakan E, Cheng MH, Piel D, Germann G, Giessler G. Customized reconstruction with the free anterolateral thigh perforator flap. Microsurgery 2008; 28 (07) 489-494
• 6 Kim SW, Kim KN, Hong JP, Park SW, Park CR, Yoon CS. Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction. Microsurgery 2015; 35 (08) 634-639
• 7 Boca R, Kuo YR, Hsieh CH, Huang EY, Jeng SF. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg 2010; 126 (05) 1558-1562
• 8 Song K, Nam S, Choi S, Kim J, Lee J, Bae Y. Objective preoperative estimation of the ability of primary closure on anterolateral thigh free flap donor site: circumference and area ratios of deep tissue to thigh. Microsurgery 2013; 33 (04) 270-274
• 9 Elswick SM, Wu P, Arkhavan AA. et al. A reconstructive algorithm after thigh soft tissue sarcoma resection including predictors of free flap reconstruction^✰ . J Plast Reconstr Aesthet Surg 2019; 72 (08) 1304-1315
• 10 Thomas BP, Geddes CR, Tang M, Williams J, Morris SF. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg 2005; 116 (03) 818-822
• 11 Schaverien M, Wong C, Bailey S, Saint-Cyr M. Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap–anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg 2010; 63 (12) 2123-2127
• 12 Lee KT, Kim A, Mun GH. Comprehensive analysis of donor-site morbidity following free thoracodorsal artery perforator flap harvest. Plast Reconstr Surg 2016; 138 (04) 899-909
• 13 Lee KT, Mun GH. A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg 2014; 134 (02) 303-314
• 14 Kurlander DE, Durand P, Couto RA. et al. The muscle-sparing descending branch latissimus dorsi free flap for lower extremity reconstruction. Plast Reconstr Surg 2020; 145 (02) 412e-420e
• 15 Lee SH, Mun GH. Transverse thoracodorsal artery perforator flaps: experience with 31 free flaps. J Plast Reconstr Aesthet Surg 2008; 61 (04) 372-379
• 16 Pu LLQ. Free flaps in lower extremity reconstruction. Clin Plast Surg 2021; 48 (02) 201-214