Journal List > J Korean Soc Surg Hand > v.17(4) > 1106411

Park, Kim, and Kim: Reconstruction of the Digit Using Anterolateral Thigh Perforator Flap

Abstract

Purpose

We reported the results of the digit reconstruction using anterolateral thigh perforator flap followed by delayed debulking operation.

Methods

We retrospectively reviewed all patients with digital injury who underwent anterolateral thigh perforator flap and delayed debulking operation. Ten digits in 8 patients were included. Three months after the last operation, the circumferences of the reconstructed digits were measured.

Results

There were no partial or complete flap necrosis. Average circumferences of the reconstructed digits were 111 percent (range: 104-120 percent) of those of the normal digits.

Conclusion

Anterolateral thigh perforater flap and delayed debulking operation is a good option for the reconstruction of the large soft tissue defect of the digit.

Figures and Tables

Fig. 1
(A) Elevation of the anterolateral thigh flap. The thickness of the flap was seen. (B) After contouring and debulking procedure, flap thickness was measured 2-3 mm.
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Fig. 2
(A) Bone and soft tissue injury on the middle finger of the right hand. (B) After primary closure, tissue necrosis on the radial half was developed. (C) Postoperative view of anterolateral thigh flap before debulking. (D, E) After the debulking operation, the injured finger was reconstructed with very thin flap.
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Fig. 3
(A) Degloving injury of the right index finger. (B) Postoperative view of anterolateral thigh flap before debulking. (C, D) After the flap debulking operation, the injured finger was reconstructed with very thin flap.
jkssh-17-183-g003
Fig. 4
(A) Severe burn injury on the ring and little finger of the left hand. (B) After the debridement. (C) The injured fingers were covered together by anterolateral thigh flap. Three weeks later, each finger was separated. (D) After the flap debulking and bone shortening operation, the fingers were reconstructed with very thin flaps.
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Table 1
Patient data
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References

1. Henry M, Stutz C. Homodigital antegrade-flow neurovascular pedicle flaps for sensate reconstruction of fingertip amputation injuries. J Hand Surg Am. 2006. 31:1220–1225.
crossref
2. Chang KP, Wang WH, Lai CS, Lai CH, Lin SD. Refinement of reverse digital arterial flap for finger defects: surgical technique. J Hand Surg Am. 2005. 30:558–561.
crossref
3. Woo SH, Kim KC, Lee GJ, Ha SH, Kim KH, Dhawan V, et al. A retrospective analysis of 154 arterialized venous flaps for hand reconstruction: an 11-year experience. Plast Reconstr Surg. 2007. 119:1823–1838.
crossref
4. Hirase Y, Kojima T, Bang HH. Secondary reconstruction by temporoparietal free fascial flap for ring avulsion injury. Ann Plast Surg. 1990. 25:312–316.
crossref
5. Chen HC, el-Gammal TA. The lateral arm fascial free flap for resurfacing of the hand and fingers. Plast Reconstr Surg. 1997. 99:454–459.
crossref
6. Ishiko T, Nakaima N, Suzuki S. Free posterior interosseous artery perforator flap for finger reconstruction. J Plast Reconstr Aesthet Surg. 2009. 62:e211–e215.
crossref
7. Buncke HJ, Rose EH. Free toe-to-fingertip neurovascular flaps. Plast Reconstr Surg. 1979. 63:607–612.
crossref
8. 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. 37:149–159.
crossref
9. Rayan GM, Chung KC. American Society for Surgery of the Hand. Flap reconstruction of the upper extremity. 2009. Rosemont: American Society for Surgery of the Hand.
10. Turner A, Ragowannsi R, Hanna J, Teo TC, Blair JW, Pickford MA. Microvascular soft tissue reconstruction of the digits. J Plast Reconstr Aesthet Surg. 2006. 59:441–450.
crossref
11. Kim KW, Kim JS, Lee DC, Ki SH, Roh SY, Yang JW. Reconstruction of hand using anterolateral thigh fascial free flap. J Korean Soc Plast Reconstr Surg. 2009. 36:571–577.
12. Kim KC, Lee GJ, Kim JS, Woo SH. Revisit of the utilities and indications of reversed radial forearm flap for hand reconstruction. J Korean Soc Surg Hand. 2004. 9:292–298.
13. Nakayama B, Hyodo I, Hasegawa Y, Fujimoto Y, Matsuura H, Yatsuya H, et al. Role of the anterolateral thigh flap in head and neck reconstruction: advantages of moderate skin and subcutaneous thickness. J Reconstr Microsurg. 2002. 18:141–146.
crossref
14. Kim KW, Lee DC, Kim JS, Ki SH, Roh SY, Yang JW. Anterolateral thigh flap for 1st web contracture release. J Korean Soc Plast Reconstr Surg. 2009. 36:147–152.
15. Itoh Y, Arai K. A deep inferior epigastric flap with a prefabricated thin portion obtained from the insertion of a silicone sheet. Br J Plast Surg. 1992. 45:204–207.
crossref
16. Akizuki T, Harii K, Yamada A. Extremely thinned inferior rectus abdominis free flap. Plast Reconstr Surg. 1993. 91:936–941.
crossref
17. 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. 92:421–428.
crossref
18. 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. 97:985–992.
crossref
19. Kimura N. A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg. 2002. 109:69–77.
crossref
20. Askouni EP, Topping A, Ball S, Hettiaratchy S, Nanchahal J, Jain A. Outcomes of anterolateral thigh free flap thinning using liposuction following lower limb trauma. J Plast Reconstr Aesthet Surg. 2012. 65:474–481.
crossref
21. Whitfield RM, Urbaniak R, Rinard J, Jones SR, Shifrin D. Ultrasound-assisted lipoplasty in addition to suction-assisted lipoplasty for perforator free flap thinning. J Reconstr Microsurg. 2011. 27:239–242.
crossref
22. Reuben CM, Bastidas N, Sharma S. Power-assisted suction lipectomy of fasciocutaneous flaps in the extremities. Ann Plast Surg. 2010. 65:60–65.
crossref
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