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Shyh-jou Shieh - One of the best experts on this subject based on the ideXlab platform.
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reply one versus two venous anastomoses in Anterolateral Thigh Flap reconstruction after oral cancer ablation
Plastic and Reconstructive Surgery, 2017Co-Authors: Yao Chou Lee, Shyh-jou ShiehAbstract:Background:Whether one-vein or two-vein drainage yields better outcomes in Anterolateral Thigh Flap reconstruction after oral cancer ablation is still being debated. Thus, the authors investigated this question.Methods:In this retrospective cohort study, the authors reviewed the charts of 321 patien
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Anatomical variability of the Anterolateral Thigh Flap perforators: vascular anatomy and its clinical implications.
Plastic and reconstructive surgery, 2015Co-Authors: Yao Chou Lee, Wei Chen Chen, Ting Mao Chou, Shyh-jou ShiehAbstract:Background: Anatomical variability of perforators of the Anterolateral Thigh Flap has been reported. The authors introduce a classification based on the number, location, and origin of the cutaneous perforators to comprehensively illustrate their vascular patterns in hopes that unfavorable anatomical variations of the Anterolateral Thigh Flap can be overcome in clinical applications. Methods: The authors enrolled and reviewed 110 Anterolateral Thigh Flaps created between September of 2010 and January of 2013 for head and neck reconstruction after cancer ablation. The location of the perforators was defined by Yu's ABC system. Its corresponding origin from the descending or transverse branch of the lateral circumflex femoral artery was clarified by Shieh's vascular anatomical classification for the Anterolateral Thigh Flap. Results: Of the 110 Flaps, a single perforator (A or B or C) was observed in 20 Flaps (18.2 percent), double perforators (A + B or B + C or A + C) were observed in 59 Flaps (53.6 percent), and triple perforators (A + B + C) in 31 Flaps (28.2 percent). The origin of perforators was the descending branch in 76 Flaps (69.1 percent), the transverse branch in 10 Flaps (9.1 percent), and both descending and transverse branches in 24 Flaps (21.8 percent). The authors observed 16 vascular patterns. The most common type was double perforators, with perforators B and C originating from the descending branch [n = 40 (36.4 percent)]. Conclusions: The clinical significance of each pattern is delineated, and surgical technical considerations are suggested according to Flap requirements and types of vascular anatomy.
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distally based Anterolateral Thigh Flap an anatomic and clinical study
Plastic and Reconstructive Surgery, 2004Co-Authors: Jui Chin Yu, Shyh-jou Shieh, Bu Miin Huang, Haw Yen ChiuAbstract:The distally based Anterolateral Thigh Flap has been used for coverage of soft-tissue defects of the knee and upper third of the leg. This Flap is based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral system. The purpose of this study was to examine the results of anatomical variations of the descending branch of the lateral circumflex femoral artery and the retrograde blood pressure of the descending branch of the lateral circumflex femoral artery so that the surgical technique for raising and transferring a distally based Anterolateral Thigh Flap to the knee region could be improved. The authors have actually used this Flap in three cases. In 11 Thighs of six cadavers, the descending branch of the lateral circumflex femoral artery had a rather consistent connection with the lateral superior genicular artery or profunda femoral artery in the knee region. The pivot point, located at the distal portion of the vastus lateralis muscle, ranges from 3 to 10 cm above the knee. In their three cases, the maximal Flap size was 7.0 X 16.0 cm and was harvested safely, without marginal necrosis. The mean pedicle length was 15.2 ± 0.7 cm (range, 14.5 to 16 cm). The average proximal and distal retrograde blood pressure of the descending branch of the lateral circumflex femoral artery was also studied in another 11 patients, and the Anterolateral Thigh Flap being used for reconstruction of head and neck defects showed 58.3 and 77.7 percent of proximal antegrade blood pressure, respectively. The advantages of this Flap include a long pedicle length, a sufficient tissue supply, possible combination with fascia lata for tendon reconstruction, and favorable donor-site selection, without sacrifice of major vessels or muscles.
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free Anterolateral Thigh Flap for reconstruction of head and neck defects following cancer ablation
Plastic and Reconstructive Surgery, 2000Co-Authors: Shyh-jou Shieh, Haw Yen Chiu, Shin Chen Pan, Sen Tien Tsai, Ching Liang ShenAbstract:Thirty-seven consecutive free Anterolateral Thigh Flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer ablation between January of 1997 and June of 1998. The success rate was 97 percent (36 of 37), with one Flap lost due to a twisted perforator. The anatomic variations and length of the vascular pedicle were investigated to obtain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators were always found and presented as musculocutaneous or septocutaneous perforators in this series of 37 Anterolateral Thigh Flaps. They were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle. In type I, vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In type IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascular pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitable for anastomosis with the neck vessels. Reconstruction of one-layer defect, external skin or intraoral lining, was carried out in 18 cases, through-and-through defect in 17 cases, and composite mandibular defect in two cases. With increasing knowledge of anatomy and refinements of surgical technique, the Anterolateral Thigh Flap can be harvested safely to reconstruct complicated defects of head and neck following cancer ablation with only minimal donor-site morbidity.
Yoshihiro Kimata - One of the best experts on this subject based on the ideXlab platform.
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Anterolateral Thigh Flap for abdominal wall reconstruction
Plastic and Reconstructive Surgery, 1999Co-Authors: Yoshihiro Kimata, Kiyotaka Uchiyama, Mitsuru Sekido, Minoru Sakuraba, Hideo Iida, Takashi Nakatsuka, Kiyonori HariiAbstract:: The free or pedicled Anterolateral Thigh Flap was introduced for the reconstruction of large abdominal wall defects. This Flap is superior to the tensor fasciae latae musculocutaneous Flap in several respects. These include the wide, reliable skin territory (which can reach the level of the knee) and the long pedicle. Therefore, a pedicled Anterolateral Thigh Flap with reliable blood circulation can easily be positioned above the umbilicus. In addition, the free Anterolateral Thigh Flap has greater freedom of orientation and can be used to repair larger abdominal wall defects than can the tensor fasciae latae Flap. Seven patients in whom abdominal wall defects had been reconstructed with pedicled or free Anterolateral Thigh Flaps were reviewed. Their average age was 47.1 years (range, 21 to 74 years), and the average follow-up period was 10.7 months (range, 2 to 21 months). The size of the abdominal wall defects ranged from 12 x 12 cm to 18 x 24 cm, and the size of the transferred Flap ranged from 10 x 20 cm to 20 x 20 cm. Three Flaps were pedicled and four were free, of which three incorporated the tensor fasciae latae Flap. All Flaps survived completely, and no postoperative abdominal hernias developed. Despite some variations in vascular anatomy and technical difficulties in elevating the Anterolateral Thigh Flap, the authors conclude that the pedicled or free Anterolateral Thigh Flap is superior to the tensor fasciae latae Flap for reconstruction of large abdominal wall defects.
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anatomic variations and technical problems of the Anterolateral Thigh Flap a report of 74 cases
Plastic and Reconstructive Surgery, 1998Co-Authors: Yoshihiro Kimata, Kiyotaka Uchiyama, Takashi Nakatsuka, Satoshi Ebihara, Kiyonori HariiAbstract:We have transferred 74 free or pedicled Anterolateral Thigh Flaps, including those combined with other Flaps, for reconstruction of various types of defects. We report several anatomic variations of the lateral circumflex arterial system and discuss some technical problems with this Flap. Septocutaneous perforators were found in 28 of 74 cases (37.8 percent), and no perforators were found in 4 cases (5.4 percent). In the 70 cases with perforators, 171 tiny cutaneous perforators (an average of 2.31 per case) were found. Musculocutaneous perforators (81.9 percent) were much more common than septocutaneous perforators (18.1 percent). Perforators were concentrated near the midpoint of the lateral Thigh, and the selection of perforators as nutrient vessels for the Anterolateral Thigh Flap was related to the length of the pedicle and the thickness of the skin Flap. Anatomic variations of the branching pattern of perforators were classified into eight types. Flaps with perforators that arise directly from the profunda femoris artery are difficult to combine with other free Flaps. Because the perforators are extremely small and tend to thrombose soon after congestion develops, these Flaps are difficult to salvage with recirculation surgery. Therefore, several perforators should be included with the Flap, if possible. The descending artery of the lateral circumflex femoral artery was always accompanied by two veins with different back-flow strengths. Therefore, veins for microsurgical anastomosis must be chosen carefully. Because it is nourished by several perforators arising from the descending artery, the vastus lateralis muscle can be combined with the Anterolateral Thigh Flap. However, splitting the muscle longitudinally without harvesting its blood supply is complicated because its fibers are oblique. The rectus femoris muscle can also be combined with the Anterolateral Thigh Flap, but its pedicle is short and its origin is very near the site of anastomosis. When the Anterolateral Thigh Flap is combined with the tensor fasciae latae musculocutaneous Flap, the large skin area of the lateral part of Thigh can be transferred to repair the massive defects. The Anterolateral Thigh Flap has many advantages and can be used to reconstruct many types of defect. However, anatomic variations must be considered if the Flap is to be used safely and reliably.
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versatility of the free Anterolateral Thigh Flap for reconstruction of head and neck defects
Archives of Otolaryngology-head & Neck Surgery, 1997Co-Authors: Yoshihiro Kimata, Kiyotaka Uchiyama, Satoshi Ebihara, Takashi Yoshizumi, Masao Asai, Masahisa Saikawa, Ryuichi Hayashi, Yoko Jitsuiki, Kazuhiko Majima, Waichiro OhyamaAbstract:Objective: The Anterolateral Thigh Flap has many advantages in head and neck reconstruction. However, it has not yet come into widespread use because of the anatomic variations of its perforators. Herein, we describe a safe operative technique related to the patterns of the perforators and discuss its wide versatility. Setting: A national cancer center hospital. Patients: Thirty-eight Anterolateral Thigh Flaps were transferred. Confirmation and dissection of the Flap pedicle were simultaneously performed with tumor resection. The design and elevation of the Flap were carried out immediately after the tumor resection was completed. Results: From the study of the anatomic variations of the perforators, septocutaneous patterns were recognized in 10 cases (26.3%) and musculocutaneous patterns in 28 cases (73.7%). All Flaps were easily and safely elevated with our techniques. Thirty-six Flaps survived. Partial necrosis was noted owing to excessive thinning procedure in one patient and total necrosis was noted owing to venous thrombosis at the anastomosis part in another patient. Conclusions: We found that the Anterolateral Thigh Flap has numerous advantages. It is possible to perform the Flap elevation and the tumor resection simultaneously. The Flap is generally thin and is suitable for reconstruction of intraoral defects. Combined Flaps with neighboring tissues and other, distant Flaps can be used. Furthermore, since our technique minimizes the problems of confirmation and dissection of the perforators, we conclude that this Flap can be successfully used to repair a variety of large defects of the head and neck. Arch Otolaryngol Head Neck Surg. 1997;123:1325-1331
Kiyonori Harii - One of the best experts on this subject based on the ideXlab platform.
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Anterolateral Thigh Flap for abdominal wall reconstruction
Plastic and Reconstructive Surgery, 1999Co-Authors: Yoshihiro Kimata, Kiyotaka Uchiyama, Mitsuru Sekido, Minoru Sakuraba, Hideo Iida, Takashi Nakatsuka, Kiyonori HariiAbstract:: The free or pedicled Anterolateral Thigh Flap was introduced for the reconstruction of large abdominal wall defects. This Flap is superior to the tensor fasciae latae musculocutaneous Flap in several respects. These include the wide, reliable skin territory (which can reach the level of the knee) and the long pedicle. Therefore, a pedicled Anterolateral Thigh Flap with reliable blood circulation can easily be positioned above the umbilicus. In addition, the free Anterolateral Thigh Flap has greater freedom of orientation and can be used to repair larger abdominal wall defects than can the tensor fasciae latae Flap. Seven patients in whom abdominal wall defects had been reconstructed with pedicled or free Anterolateral Thigh Flaps were reviewed. Their average age was 47.1 years (range, 21 to 74 years), and the average follow-up period was 10.7 months (range, 2 to 21 months). The size of the abdominal wall defects ranged from 12 x 12 cm to 18 x 24 cm, and the size of the transferred Flap ranged from 10 x 20 cm to 20 x 20 cm. Three Flaps were pedicled and four were free, of which three incorporated the tensor fasciae latae Flap. All Flaps survived completely, and no postoperative abdominal hernias developed. Despite some variations in vascular anatomy and technical difficulties in elevating the Anterolateral Thigh Flap, the authors conclude that the pedicled or free Anterolateral Thigh Flap is superior to the tensor fasciae latae Flap for reconstruction of large abdominal wall defects.
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anatomic variations and technical problems of the Anterolateral Thigh Flap a report of 74 cases
Plastic and Reconstructive Surgery, 1998Co-Authors: Yoshihiro Kimata, Kiyotaka Uchiyama, Takashi Nakatsuka, Satoshi Ebihara, Kiyonori HariiAbstract:We have transferred 74 free or pedicled Anterolateral Thigh Flaps, including those combined with other Flaps, for reconstruction of various types of defects. We report several anatomic variations of the lateral circumflex arterial system and discuss some technical problems with this Flap. Septocutaneous perforators were found in 28 of 74 cases (37.8 percent), and no perforators were found in 4 cases (5.4 percent). In the 70 cases with perforators, 171 tiny cutaneous perforators (an average of 2.31 per case) were found. Musculocutaneous perforators (81.9 percent) were much more common than septocutaneous perforators (18.1 percent). Perforators were concentrated near the midpoint of the lateral Thigh, and the selection of perforators as nutrient vessels for the Anterolateral Thigh Flap was related to the length of the pedicle and the thickness of the skin Flap. Anatomic variations of the branching pattern of perforators were classified into eight types. Flaps with perforators that arise directly from the profunda femoris artery are difficult to combine with other free Flaps. Because the perforators are extremely small and tend to thrombose soon after congestion develops, these Flaps are difficult to salvage with recirculation surgery. Therefore, several perforators should be included with the Flap, if possible. The descending artery of the lateral circumflex femoral artery was always accompanied by two veins with different back-flow strengths. Therefore, veins for microsurgical anastomosis must be chosen carefully. Because it is nourished by several perforators arising from the descending artery, the vastus lateralis muscle can be combined with the Anterolateral Thigh Flap. However, splitting the muscle longitudinally without harvesting its blood supply is complicated because its fibers are oblique. The rectus femoris muscle can also be combined with the Anterolateral Thigh Flap, but its pedicle is short and its origin is very near the site of anastomosis. When the Anterolateral Thigh Flap is combined with the tensor fasciae latae musculocutaneous Flap, the large skin area of the lateral part of Thigh can be transferred to repair the massive defects. The Anterolateral Thigh Flap has many advantages and can be used to reconstruct many types of defect. However, anatomic variations must be considered if the Flap is to be used safely and reliably.
Haw Yen Chiu - One of the best experts on this subject based on the ideXlab platform.
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distally based Anterolateral Thigh Flap an anatomic and clinical study
Plastic and Reconstructive Surgery, 2004Co-Authors: Jui Chin Yu, Shyh-jou Shieh, Bu Miin Huang, Haw Yen ChiuAbstract:The distally based Anterolateral Thigh Flap has been used for coverage of soft-tissue defects of the knee and upper third of the leg. This Flap is based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral system. The purpose of this study was to examine the results of anatomical variations of the descending branch of the lateral circumflex femoral artery and the retrograde blood pressure of the descending branch of the lateral circumflex femoral artery so that the surgical technique for raising and transferring a distally based Anterolateral Thigh Flap to the knee region could be improved. The authors have actually used this Flap in three cases. In 11 Thighs of six cadavers, the descending branch of the lateral circumflex femoral artery had a rather consistent connection with the lateral superior genicular artery or profunda femoral artery in the knee region. The pivot point, located at the distal portion of the vastus lateralis muscle, ranges from 3 to 10 cm above the knee. In their three cases, the maximal Flap size was 7.0 X 16.0 cm and was harvested safely, without marginal necrosis. The mean pedicle length was 15.2 ± 0.7 cm (range, 14.5 to 16 cm). The average proximal and distal retrograde blood pressure of the descending branch of the lateral circumflex femoral artery was also studied in another 11 patients, and the Anterolateral Thigh Flap being used for reconstruction of head and neck defects showed 58.3 and 77.7 percent of proximal antegrade blood pressure, respectively. The advantages of this Flap include a long pedicle length, a sufficient tissue supply, possible combination with fascia lata for tendon reconstruction, and favorable donor-site selection, without sacrifice of major vessels or muscles.
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free Anterolateral Thigh Flap for reconstruction of head and neck defects following cancer ablation
Plastic and Reconstructive Surgery, 2000Co-Authors: Shyh-jou Shieh, Haw Yen Chiu, Shin Chen Pan, Sen Tien Tsai, Ching Liang ShenAbstract:Thirty-seven consecutive free Anterolateral Thigh Flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer ablation between January of 1997 and June of 1998. The success rate was 97 percent (36 of 37), with one Flap lost due to a twisted perforator. The anatomic variations and length of the vascular pedicle were investigated to obtain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators were always found and presented as musculocutaneous or septocutaneous perforators in this series of 37 Anterolateral Thigh Flaps. They were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle. In type I, vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In type IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascular pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitable for anastomosis with the neck vessels. Reconstruction of one-layer defect, external skin or intraoral lining, was carried out in 18 cases, through-and-through defect in 17 cases, and composite mandibular defect in two cases. With increasing knowledge of anatomy and refinements of surgical technique, the Anterolateral Thigh Flap can be harvested safely to reconstruct complicated defects of head and neck following cancer ablation with only minimal donor-site morbidity.
Tayfun Akoz - One of the best experts on this subject based on the ideXlab platform.
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one stage reconstruction of large scalp defects Anterolateral Thigh Flap
Microsurgery, 2006Co-Authors: Gaye Taylan Calikapan, Serkan Yildirim, Tayfun AkozAbstract:Seven patients with large scalp and calvarial defects underwent reconstruction with free tissue transfer. Patients fell into two groups according to etiology: tumoral (five) or traumatic (two). A single type of free Flap was used in each patient, i.e., the Anterolateral Thigh Flap. Duraplasties with the Flaps' vascularized fasciae were performed in two patients with minor calvarial defects, and nonvascularized fasciae were used in another two, with a cranioplasty using methylmethacrylate. One postoperative death and one venous congestion necessitating exploration were observed. The explored anastomosis revealed occlusion of the venous anastomosis; drainage with a venous graft into the neck veins was performed. Minor tissue loss with secondary healing was observed in the Flap. Extensive scalp defects often necessitate challenging reconstructive procedures. Single-stage reconstruction with good qualified tissue is possible with a free tissue transfer. The Anterolateral Thigh Flap provides a large amount of tissue with decreased donor-site morbidity and good cosmetic results.
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soft tissue reconstruction using a free Anterolateral Thigh Flap experience with 28 patients
Annals of Plastic Surgery, 2003Co-Authors: Serkan Yildirim, Gulden Avci, Tayfun AkozAbstract:The authors present their experience using the free Anterolateral Thigh fasciocutaneous Flap for head and neck and extremity reconstruction. From January 2000 through March 2002, 28 free Anterolateral Thigh Flaps were transferred to reconstruct various soft-tissue defects. All patients were operated by two teams. All Flaps were elevated based on one perforator only. The sizes of the Flaps ranged from 9 x 11 to 20 x 26 cm. The success rate was 96.5% (27 of 28), with one partial failure. The cutaneous perforators were always found. Septocutaneous perforators were found in 3 of 28 patients (10.7%). Musculocutaneous perforators (89.3%) were found in the remaining patients, and the number of perforators ranged from two to five (average, three perforators). In 4 patients, Flaps were used for sensate reconstruction. The authors used the Anterolateral Thigh Flap as a thin Flap in 10 patients. Mean follow-up was 13.5 months (range, 2-25 months). Soft-tissue reconstruction with the free Anterolateral Thigh Flap in various regions of the body provides an excellent functional and cosmetic result with minimal donor site morbidity. The Anterolateral Thigh Flap has many advantages over other conventional free Flaps and it seems to be an ideal choice for the reconstruction of soft-tissue defects.
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Anterolateral Thigh Flap ideal free Flap choice for lower extremity soft tissue reconstruction
Journal of Reconstructive Microsurgery, 2003Co-Authors: Serkan Yildirim, Kaan Gideroglu, Tayfun AkozAbstract:This article presents the authors' experience with the Anterolateral Thigh free Flap for lower extremity reconstruction. Twenty-one consecutive Anterolateral Thigh Flaps were transferred for reconstruction of soft-tissue defects of the lower extremity from March 2000 to May 2002. Total Flap survival was 90.5 percent, with two partial failures. Venous congestion was observed in one Flap (4.7 percent) and the venous anastomosis was revised immediately in the postoperative second hour. The mean follow-up time was 13.4 months (range: 5 to 26 months). The cutaneous perforators were consistently found and presented as musculocutaneous in 19 patients (90.5 percent) or septocutaneous in two other patients (9.5 percent). A thinned Anterolateral Thigh Flap was used in 11 patients. Sensate Flaps were used in four patients (19.05 percent) for the reconstruction of amputation stumps. Five Flaps (23.8 percent) were used also as flow-through Flaps. All patients were satisfied with the cosmetic and functional results. The Anterolateral Thigh Flap has many advantages over other free Flap donors in lower extremity reconstruction. These include a long and large caliber vascular pedicle, large and pliable skin paddle, good color and texture matching, and minimal donor-site morbidity. Moreover, the Flap can be used successfully and safely as a sensate, thin, or flow-through Flap. The Anterolateral Thigh Flap can be accepted as an ideal free Flap choice for lower extremity reconstruction because it has maximal reconstructive capacity and produces minimal donor-site morbidity.