The Anterolateral Thigh Perforator Flap
The anterolateral thigh (ALT) flap is a popular flap for lower extremity reconstruction despite its varied pedicle anatomy. Beyond its use for soft tissue coverage, using the chimeric flap concept, the ALT flap is useful for tendon and ligament reconstruction and the creation of a gliding surface with the fascia lata component. The vastus lateralis muscle can be included for dead-space obliteration. The main pedicle is long and is a similar size match for major artery reconstruction. If several perforators are available, a split flap could be fashioned into a multitude of shapes all arising from the same pedicle. (Source: ...
Source: Clinics in Plastic Surgery - February 4, 2021 Category: Cosmetic Surgery Authors: Chung-Chen Hsu, Charles Yuen Yung Loh, Fu-Chan Wei Source Type: research
The Medial Sural Artery Perforator Flap in Lower Extremity Reconstruction
Medial sural artery perforator (MSAP) flap is a thin, pliable, and versatile flap. It is a fasciocutaneous flap with chimeric design capacity. The donor site permits the synchronous harvesting of nonvascularized tendons and nerves. Free MSAP flap is suitable for foot, ankle, and distal one-third of the leg reconstructions. Pedicled MSAP flap is an alternative flap for knee and proximal two-thirds of leg defects, covering classical lower limb reconstruction territories of soleus, medial, and lateral gastrocnemius muscle flap. Computed tomography angiography, indocyanine green, and endoscopic-assist dissection enhances MSAP ...
Source: Clinics in Plastic Surgery - February 4, 2021 Category: Cosmetic Surgery Authors: Cheng-Hung Lin, Yun-Huan Hsieh, Chih-Hung Lin Source Type: research
Functional Restoration in Lower Extremity Reconstruction
Daily walking stance benefits the health, whereas lower extremity reconstruction aims to accomplish balanced walking and posture control. If local flap or tendon transfer cannot provide the basic function, microsurgical reconstruction is indicated for bony, soft tissue, and sensation restoration. Wound repair can use every modality and can achieve varying wound coverage results. However, all reconstruction should have functional goals using either local flap or free flap to restore the lost function. With less recipient site secondary damage, microsurgery can provide healthy composite tissue with like-replaces-like approac...
Source: Clinics in Plastic Surgery - February 4, 2021 Category: Cosmetic Surgery Authors: Chih-Hung Lin Source Type: research
Freestyle Local Island Pedicle Flap in Lower Leg Reconstruction
The freestyle local perforator flap is an advanced version of the conventional island pedicle flap. Intramuscular dissection can provide a longer pedicle, which allows restoration of defects that are future from the donor site. Without microsurgery, the flap can be either rotated or advanced toward the defect, making it particularly useful for reconstructing soft tissue defects in the lower third of the leg. Careful preoperative design with vessel mapping, skillful intramuscular dissection of the pedicle, and a well-considered backup plan in case of unexpected difficulty are crucial for freestyle local perforator flaps to ...
Source: Clinics in Plastic Surgery - January 29, 2021 Category: Cosmetic Surgery Authors: Seng-Feng Jeng, Marios Papadakis, Hsiang-Shun Shih Source Type: research
Management of Gustilo Type IIIC Injuries in the Lower Extremity
Gustilo IIIC injuries of the lower extremity pose a significant challenge to the reconstructive surgeon. Key principles include early vascular repair and serial debridement followed by definitive coverage within 10 days. Primary reconstructive options following vascular repair include the anterolateral thigh flap or the latissimus dorsi muscle flap. Complications include elevated rates of microvascular thrombosis requiring return to the operating room, partial and complete flap loss, and infection. There is also an elevated rate of secondary amputation. However, in spite of higher complication rates, when approached thou...
Source: Clinics in Plastic Surgery - January 29, 2021 Category: Cosmetic Surgery Authors: Heather A. McMahon, John T. Stranix, Z-Hye Lee, Jamie P. Levine Source Type: research
Lower Extremity Reconstruction in the Pediatric Population
Indications for lower extremity reconstruction in children are unique because most result from congenital conditions (eg, constriction ring, lymphedema, syndactyly, nevi, vascular anomalies). Like adults, pediatric patients also suffer from effects following extirpation and trauma. Principles of reconstruction are based on the condition and type of deformity. The pediatric population typically has fewer comorbidities than adults that can negatively affect outcomes (eg, diabetes, peripheral vascular disease), although children can be less compliant with postoperative care. Growth, development, appearance, and postoperative ...
Source: Clinics in Plastic Surgery - January 29, 2021 Category: Cosmetic Surgery Authors: Arin K. Greene, Christopher L. Sudduth, Amir H. Taghinia Source Type: research
Contemporary Approach to Lower Extremity Reconstruction
Lower extremity reconstruction, as a subspecialty of plastic surgery, is an important part of the reconstructive surgery we do as plastic surgeons. For the past 20 years, many innovative techniques for lower extremity reconstruction have been discovered, for example, advanced wound management and microvascular free-tissue transfer, and development of new perforator-based flaps for lower extremity reconstruction. At many tertiary medical centers in developed countries, lower extremity reconstruction has become more than just soft tissue coverage, since functional restoration has also been emphasized through a multidisciplin...
Source: Clinics in Plastic Surgery - January 28, 2021 Category: Cosmetic Surgery Authors: Lee L.Q. Pu Tags: Preface Source Type: research
Contemporary Approach to Lower-Extremity Reconstruction
Lower-extremity reconstruction, as a subspecialty of plastic surgery, is an important part of the reconstructive surgery we do as plastic surgeons. For the past 20 years, many innovative techniques for lower-extremity reconstruction have been discovered, for example, advanced wound management and microvascular free-tissue transfer, and development of new perforator-based flaps for lower-extremity reconstruction. At many tertiary medical centers in developed countries, lower-extremity reconstruction has become more than just soft tissue coverage, since functional restoration has also been emphasized through a multidisciplin...
Source: Clinics in Plastic Surgery - January 28, 2021 Category: Cosmetic Surgery Authors: Lee L.Q. Pu Tags: Preface Source Type: research
Supermicrosurgery in Lower Extremity Reconstruction
Supermicrosurgery is defined as microsurgery working on vessels less than 0.8 mm, allowing applications in smaller-dimension microsurgery, such as lymphedema, minimal invasive reconstruction, small parts replantation, and application of perforator as recipient. To accommodate this technique, developments and use of finer instruments, smaller sutures, new diagnostic tools, a nd higher-magnification microscopes have been made. Although supermicrosurgery has evolved naturally from microsurgery, it has developed into a unique field based on different thinking and tools to solve problems that once were difficult to solve. (So...
Source: Clinics in Plastic Surgery - January 27, 2021 Category: Cosmetic Surgery Authors: Joon Pio Hong, Changsik John Pak, Hyunsuk Peter Suh Source Type: research
Free Flaps in Lower Extremity Reconstruction
Free tissue transfer to the lower extremity for limb salvage remains challenging. A comprehensive approach includes patient selection, flap selection, selection of the recipient vessels, flap dissection, flap preparation, microvascular anastomosis, flap inset, immediate postoperative care, intermediate postoperative care, and further follow-up care. Each step in this comprehensive approach has its unique considerations and should be executed equally to ensure an optimal outcome. Once acquired, some clinical experience along with adequate microsurgical skill, good surgical judgment, well instructed and step-by-step intraope...
Source: Clinics in Plastic Surgery - January 25, 2021 Category: Cosmetic Surgery Authors: Lee L.Q. Pu Source Type: research
The Superficial Circumflex Iliac Artery Perforator Flap in Lower Extremity Reconstruction
The superficial circumflex iliac artery perforator flap is evolved from the groin flap, which was one of the early free flaps with a good concealed donor site. By further understanding the anatomy of perforators and elevating the flap based on it, this will provide added advantage of being a thin flap, harvesting as a composite flap, and help estimate the limit of skin paddle dimension. Despite these advantages, the relatively short pedicle still remains a challenge where long pedicle flaps are needed. One should select the flaps based on the recipient defect condition along with surgeons ’ experience, knowledge, and pre...
Source: Clinics in Plastic Surgery - January 25, 2021 Category: Cosmetic Surgery Authors: Joon Pio Hong Source Type: research
Perforator-Plus Flaps in Lower Extremity Reconstruction
The perforator-plus flap is a new concept for lower extremity reconstruction. It combines a perforator flap with a traditional skin rotation flap. It can be another option for lower extremity soft tissue defects since the flap has an augmented blood supply. The ability to detect cutaneous perforators has improved with the Duplex scan imaging technique. These advances have made the perforator-plus flap a viable option for soft tissue reconstruction. It can be versatile and reduces donor site morbidity; it is technically simple to perform and faster than traditional free flaps. It achieves durable soft tissue coverage for lo...
Source: Clinics in Plastic Surgery - January 22, 2021 Category: Cosmetic Surgery Authors: Ping Song, Lee L.Q. Pu Source Type: research
Free-Style Free Perforator Flaps in Lower Extremity Reconstruction
Improved knowledge of vascular anatomy has enabled surgeons to preoperatively identify perforators and design free-style flaps based on that perforator. Options for choosing the optimal donor site tissues are increased with the free-style technique. This reduces donor site morbidity while providing the same reconstructive success as traditional free skin flaps. The free-style technique allows the surgeon to successfully complete reconstruction when aberrant anatomy is encountered. With the necessary skills in perforator flap dissection and supermicrosurgery, the armamentarium of the reconstructive microsurgeon has been exp...
Source: Clinics in Plastic Surgery - January 21, 2021 Category: Cosmetic Surgery Authors: Matthew R. Zeiderman, Lee L.Q. Pu Source Type: research
Breast Implant –Associated Anaplastic Large Cell Lymphoma
Breast implant –associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging cancer of the immune system that is exclusively associated with textured-surface breast implants. This clinical review provides an update on the diagnosis and management of BIA-ALCL with an emphasis on major advances. The epidemi ology and pathophysiology of the disease are also reviewed, focusing on current paradigm shifts and highlighting current controversies related to disease classification and risk mitigation. Finally, the authors conclude by discussing medicolegal and ethical issues surrounding BIA-ALCL while establis hing a future...
Source: Clinics in Plastic Surgery - November 19, 2020 Category: Cosmetic Surgery Authors: Ryan C. DeCoster, Evan B. Lynch, Alisha R. Bonaroti, Roberto N. Miranda, Kelly K. Hunt, Mark W. Clemens Source Type: research
An Algorithm for the Management of Explantation Surgery
Creating pleasing breast aesthetics after an explantation can be challenging, especially when performed with a total capsulectomy. The necessity of a capsulectomy for a variety of breast issues is not completely agreed on and can increase adverse events, patient morbidity, and cost of the operation and often impairs the final aesthetic result. In this article, an algorithm for the management of explantation patients provides a framework for treatment of the capsule and the breast to optimize outcomes. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - November 19, 2020 Category: Cosmetic Surgery Authors: M. Bradley Calobrace, Chet Mays Source Type: research
