Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap

William W. Thomas, Haley E. Calcagno, James Azzi, Daniel Petrisor, Taylor Cave, Brittany Barber, Brett Miles, Ernest D. Gomez, Steven Cannady, Mohin Bhadkamkar, Matthew M. Hanasono, Mark Wax

Research output: Contribution to journalArticle

Abstract

Objective: The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction. Methods: Multicenter review of 1,079 cases of planned ALT flaps where 28 initial flaps (2.6%) were discarded for nonviable skin paddle or lack of cutaneous perforators. Iatrogenic perforator injury was calculated separately. The total flap loss rate was 3.2%. Results: In 12 cases, no perforators were noted after performing the anterior incision (early). Sixteen ALT flaps were discarded immediately before pedicle ligation (late). Reconstruction was salvaged by seven anteromedial thigh (AMT), six radial forearm, five contralateral ALT, four rectus abdominus myocutaneous, three vastus lateralis, three profunda artery perforator, two tensor fascia lata, one rectus femoris, two pectoralis major, one cervicofacial rotational, and one fibula flap. Of the 28 cases, 12 salvage cases did not involve an additional wound for the patient. Five of the seven AMT flaps were harvested after the ALT was identified as nonviable in the early time point. Two patients had no viable ALT flaps on bilateral lower extremities. Conclusion: The ALT flap is a reliable soft tissue flap, and rarely cutaneous perforators are not adequate to support the skin paddle. Multiple options exist to salvage the reconstruction without significant additional morbidity to the patient if said inadequacy is identified early. Level of Evidence: 4 Laryngoscope, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StatePublished - Jan 1 2019

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Free Tissue Flaps
Thigh
Incidence
Skin
Quadriceps Muscle
Neck
Head
Fascia Lata
Laryngoscopes
Rectus Abdominis
Fibula
Wounds and Injuries
Forearm
Ligation
Lower Extremity
Arteries
Morbidity

Keywords

  • Anterolateral thigh
  • anterolateral thigh
  • free flap
  • free tissue transfer
  • Head and neck reconstruction

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap. / Thomas, William W.; Calcagno, Haley E.; Azzi, James; Petrisor, Daniel; Cave, Taylor; Barber, Brittany; Miles, Brett; Gomez, Ernest D.; Cannady, Steven; Bhadkamkar, Mohin; Hanasono, Matthew M.; Wax, Mark.

In: Laryngoscope, 01.01.2019.

Research output: Contribution to journalArticle

Thomas, WW, Calcagno, HE, Azzi, J, Petrisor, D, Cave, T, Barber, B, Miles, B, Gomez, ED, Cannady, S, Bhadkamkar, M, Hanasono, MM & Wax, M 2019, 'Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap', Laryngoscope. https://doi.org/10.1002/lary.28176
Thomas, William W. ; Calcagno, Haley E. ; Azzi, James ; Petrisor, Daniel ; Cave, Taylor ; Barber, Brittany ; Miles, Brett ; Gomez, Ernest D. ; Cannady, Steven ; Bhadkamkar, Mohin ; Hanasono, Matthew M. ; Wax, Mark. / Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap. In: Laryngoscope. 2019.
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abstract = "Objective: The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction. Methods: Multicenter review of 1,079 cases of planned ALT flaps where 28 initial flaps (2.6{\%}) were discarded for nonviable skin paddle or lack of cutaneous perforators. Iatrogenic perforator injury was calculated separately. The total flap loss rate was 3.2{\%}. Results: In 12 cases, no perforators were noted after performing the anterior incision (early). Sixteen ALT flaps were discarded immediately before pedicle ligation (late). Reconstruction was salvaged by seven anteromedial thigh (AMT), six radial forearm, five contralateral ALT, four rectus abdominus myocutaneous, three vastus lateralis, three profunda artery perforator, two tensor fascia lata, one rectus femoris, two pectoralis major, one cervicofacial rotational, and one fibula flap. Of the 28 cases, 12 salvage cases did not involve an additional wound for the patient. Five of the seven AMT flaps were harvested after the ALT was identified as nonviable in the early time point. Two patients had no viable ALT flaps on bilateral lower extremities. Conclusion: The ALT flap is a reliable soft tissue flap, and rarely cutaneous perforators are not adequate to support the skin paddle. Multiple options exist to salvage the reconstruction without significant additional morbidity to the patient if said inadequacy is identified early. Level of Evidence: 4 Laryngoscope, 2019.",
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AU - Thomas, William W.

AU - Calcagno, Haley E.

AU - Azzi, James

AU - Petrisor, Daniel

AU - Cave, Taylor

AU - Barber, Brittany

AU - Miles, Brett

AU - Gomez, Ernest D.

AU - Cannady, Steven

AU - Bhadkamkar, Mohin

AU - Hanasono, Matthew M.

AU - Wax, Mark

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction. Methods: Multicenter review of 1,079 cases of planned ALT flaps where 28 initial flaps (2.6%) were discarded for nonviable skin paddle or lack of cutaneous perforators. Iatrogenic perforator injury was calculated separately. The total flap loss rate was 3.2%. Results: In 12 cases, no perforators were noted after performing the anterior incision (early). Sixteen ALT flaps were discarded immediately before pedicle ligation (late). Reconstruction was salvaged by seven anteromedial thigh (AMT), six radial forearm, five contralateral ALT, four rectus abdominus myocutaneous, three vastus lateralis, three profunda artery perforator, two tensor fascia lata, one rectus femoris, two pectoralis major, one cervicofacial rotational, and one fibula flap. Of the 28 cases, 12 salvage cases did not involve an additional wound for the patient. Five of the seven AMT flaps were harvested after the ALT was identified as nonviable in the early time point. Two patients had no viable ALT flaps on bilateral lower extremities. Conclusion: The ALT flap is a reliable soft tissue flap, and rarely cutaneous perforators are not adequate to support the skin paddle. Multiple options exist to salvage the reconstruction without significant additional morbidity to the patient if said inadequacy is identified early. Level of Evidence: 4 Laryngoscope, 2019.

AB - Objective: The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction. Methods: Multicenter review of 1,079 cases of planned ALT flaps where 28 initial flaps (2.6%) were discarded for nonviable skin paddle or lack of cutaneous perforators. Iatrogenic perforator injury was calculated separately. The total flap loss rate was 3.2%. Results: In 12 cases, no perforators were noted after performing the anterior incision (early). Sixteen ALT flaps were discarded immediately before pedicle ligation (late). Reconstruction was salvaged by seven anteromedial thigh (AMT), six radial forearm, five contralateral ALT, four rectus abdominus myocutaneous, three vastus lateralis, three profunda artery perforator, two tensor fascia lata, one rectus femoris, two pectoralis major, one cervicofacial rotational, and one fibula flap. Of the 28 cases, 12 salvage cases did not involve an additional wound for the patient. Five of the seven AMT flaps were harvested after the ALT was identified as nonviable in the early time point. Two patients had no viable ALT flaps on bilateral lower extremities. Conclusion: The ALT flap is a reliable soft tissue flap, and rarely cutaneous perforators are not adequate to support the skin paddle. Multiple options exist to salvage the reconstruction without significant additional morbidity to the patient if said inadequacy is identified early. Level of Evidence: 4 Laryngoscope, 2019.

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KW - anterolateral thigh

KW - free flap

KW - free tissue transfer

KW - Head and neck reconstruction

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