Comparison between Free Anterolateral Thigh Flap and Free Medial sural Artery Perforator Flap in Reconstruction of Posttraumatic Soft Tissue Defects of Dorsum of the Foot | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 5, Volume 46, Issue 1, January 2022, Pages 21-27 PDF (9.65 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2022.220426 | ||
| Authors | ||
| Waleed Abo Elhassan* 1; Tarek A. AbulElezz2; Amr E. Ali3; Gamal Y. Elsayed4 | ||
| 1The Department of Plastic & Reconstructive Surgery*, Faculty of Medicine, Sohag University , | ||
| 2The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Sohag University | ||
| 3The Department of Hand & Reconstructive Microsurgery Unit, Assiut University Hospital | ||
| 4The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Sohag | ||
| Abstract | ||
| Background: The objective of this study is to compare between the free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot as regard the function, the aesthetic outcome, the complications and the patient satisfaction. Patients and Method: The study was conducted on 40 patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were allocated randomly into two groups. In group 1 (20 patients), the defect was reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap. Result: In group 1 (ALT flap), Complete flap survival was achieved in all cases. Thirteen patients required secondary debulking procedures and scar revisions. In group 2 (MSAP Flap), Complete flap survival was achieved in 17 cases with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement. Conclusion: MSAP flap is good alternative in soft tissue reconstruction of the dorsum of the foot. It has many advantages: It is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases. ALT flap is better than MSAP flap in larger defects coverage but may need secondary debulking procedures or primary thinning at the time of reconstruction. | ||
| Keywords | ||
| Anterolateral thigh flap; Medial sural artery perforator flap; Foot reconstruction; Ankle reconstruction; Dorsum of the foot; Microsurgery | ||
| References | ||
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1- Khurram M.F., Ahmad I. and M.N.: Soft tissue reconstruction of foot and ankle defects: Free vs pedicled flaps with the use of 6 different flaps in 50 cases of road traffic accidents. Austin J. Surg., 1 (7): 1031, 2014. 2- Hong J.P. and Kim E.K.: Sole reconstruction using anterolateral thigh perforator free flaps. Plast. Reconstr. Surg., 119 (1): 186-93, 2007. 3- Chen S.L., Chuang C.J., Chou T.D., Chen T.M. and Wang H.J. Free medial sural artery perforator flap for ankle and foot reconstruction. Ann. Plast. Surg., 54: 39-43, 2005. 4- Song Y.G., Chen G.Z. and S.Y.L.: The free thigh flap: A new free flap concept based on the septocutaneous artery. Br. J. Plast. Surg., 37: 149-55, 1984. 5- Cavadas PC1, Sanz-Giménez-Rico J.R., Gutierrez-de la Cámara A., Navarro-Monzonís A. and Soler-Nomdedeu S. M-SF.: The medial sura artery perforator flap. Plast. Reconstr. Surg., 108 (6): 1609-15, 2001. 6- Fitzgerald O'Connor E., Ruston J., Loh C.Y.Y. and Tare M.: Technical refinements of the free medial sural artery perforator (MSAP) flap in reconstruction of multifaceted ankle soft tissue defects. Foot Ankle Surg., 26 (2): 233- 8, 2020. 7- Zhang Q., Qiao Q., Gould L.J., Myers W.T. and Phillips L.G.: Study of the neural and vascular anatomy of the anterolateral thigh flap. J. Plast. Reconstr. Aesthetic Surg., 63 (2): 365-71, 2010. 8- Yener Demirates, M.D., *Osman Kelahmetoglu, M.D., Mehmet Cifci, M.D., Volkan Tayfur, M.D., Ahmet Demir, M.D. and Ethem Guneren M.: Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction in lower extremity. microsurgey, 30: 24-31, 2010. 9- Zhu Y.L., Wang Y., He X.Q., Zhu M., Li F.B. and Xu Y.Q.: Foot and ankle reconstruction: An experience on the use of 14 different flaps in 226 cases. Microsurgery, 33: 600-4, 2013. 10- Khan U., Smitham P. and Pearse M.N.J.: Management of severe open ankle injuries. Plast. Reconstr. Surg., 119 (2): 578-89, 2007. 11- Wei F.C., Jain V., Celik N., Chen H.C. and Chuang D.C. L.C.: Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast. Reconstr. Surg., 109: 2219-2226, 2002. 12- Masia J., Moscatiello F., Pons G., Fernandez M. and Lopez S. SP.: Our experience in lower limb reconstruction with perforator flaps. Ann. Plast. Surg., 58: 507-512, 2007. 13- Ohjimi H., Taniguchi Y., Kawano K. and Kinoshita K. M.T.: A comparison of thinning and conventional freeflap transfers to the lower extremity. Plast. Reconstr. Surg., 105: 558-566, 2000. 14- Yazar S., Lin C.H., Lin Y.T. and Ulusal A.E. WF.: Outcome comparison between free muscle and free fasciocutaneous Egypt, J. Plast. Reconstr. Surg., January 2022 27 flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast. Reconstr. Surg., 117: 2468- 2475, 2006. 15- Yildirim S. and Gideroglu K. AT.: Anterolateral thigh flap: Ideal free flap choice for lower extremity soft-tissue reconstruction. J. Reconstr. Microsurg., 19: 225-233, 2003. 16- Ozkan O. and Cos¸kunfirat O.K. OH.: The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann. Plast. Surg., 53: 455-461, 2004. 17- Hollenbeck S.T., Toranto J.D., Taylor B.J., Ho T.Q., Zenn M.R., Erdmann D., et al.: Perineal and lower extremity reconstruction. Plast Reconstr Surg., 128 (5): 551e-63e, 2011. 18- Park J.E., Rodriguez E.D., Bluebond-Langer R., Bochicchio G.C., M.R. and Bochicchio K. ST.: The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma. J. Trauma, 62: 162-5, 2007. 19- Jandali Z., Lam M.C., Aganloo K., Merwart B., Buissink J., Müller K., et al.: The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small-to-moderate size defects of the foot and ankle. Microsurgery, 38 (1): 34-45, 2018. 20- Kimura N., Satoh K., Hasumi T. and Ostuka T.: Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast. Reconstr. Surg., 108: 1197- 208, 2001. 21- Agostini T., Perello R. and Spinelli G.: Suprafascial Anterolateral Thigh Flap Dissection: Limits and Advantages. Plast. Reconstr. Surg., 139 (3): 809e-810e, 2017. 22- Yang W.G., Chiang Y.C., Wei F.C., Feng G.M. and Chen K. Te.: Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast. Reconstr Surg., 117 (3): 1004-8, 2006. 23- Alkureishi L.W.T., Shaw-Dunn J. and Ross G.L.: Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br. J. Plast. Surg., 56: 401-408, 2003. 24- Hallock G.G.: Medial sural artery perforator free flap: Legitimate use as a solution for the ipsilateral distal lower extremity defect. J. Reconstr. Microsurg., 30 (3): 187-92, 2014. 25- Chen S.L., Yu C.C., Chang M.C., Deng S.C., Wu Y.S. and Chen M.: Medial sural artery perforator flap for intraoral reconstruction following cancer ablation. Ann. Plast. Surg., 61: 274-9, 2008. 26- Choi J.W., Nam S.Y., Choi S.H., Roh J.L., Kim S.Y. and Hong J.P.: Applications of medial sural perforator free flap for head and neck reconstructions. J. Reconstr. Microsurg., 29: 437-42, 2013. 27- Kao H.K., Chang K.P., Chen Y.A., Wie F.C. and Cheng M.: Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast. Reconstr. Surg., 125: 1135-45, 2010. 28- Nugent M., Endersby S., Kennedy M. and Burns A.: Early experience with the medial sural artery perforator flap as an alternative to the radial forearm flap for reconstruction in the head and neck. Br. J. Oral Maxillofac. Surg., 53: 461-3, 2015. 29- Song X., Wu H., Zhang W., Chen J., Ding X., Ye J., Wu Y. and Yuan Y.: Medial sural artery perforator flap for postsurgical reconstruction of head and neck cancer. J. Reconstr. Microsurg., 31: 319-26, 2015;. 30- Zheng H., Liu J., Dai X. and Schilling A.F.: Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J. Plast. Reconstr. Aesthet. Surg., 68: 565-70, 2015. 31- Chen S.L., Chen T.M. and Lee C.H.: Free medial sural artery perforator flap for resurfacing distal limb defects. J. Trauma, 58: 323-7, 2005. 32- Kim E.S., Hwang J.H., Kim K.S. and Lee S.Y.: Plantar reconstruction using the medial sural artery perforator free flap. Ann. Plast. Surg., 62: 679-84, 2009. 33- Kim H.H., Jeong J.H., Seul J.H. and Cho B.: New design and identification of the medial sural perforator flap: An anatomical study and its clinical applications. Plast. Reconstr. Surg., 117: 1609-18, 2006. 34- Wang X., Mei J., Pan J., Chen H., Zhang W. and Tang M.: Reconstruction of distal limb defects with the free medial sural artery perforator flap. Plast. Reconstr. Surg., 131: 95-105, 2013. 35- Toyserkani N.M. and Sørensen J.A.: Medial sural artery perforator flap: A challenging free flap. Eur. J. Plast. Surg., 38 (5): 391-6, 2015. 36- Chalmers R.L., Rahman K.M.A., Young S., Kennedy M., Endersby S., Adams J.R., et al.: The medial sural artery perforator flap in intra-oral reconstruction: A Northeast experience. J. Plast. Reconstr Aesthetic Surg., 69 (5): 687-93, 2016. 37- Ives M. and Mathur B.: Varied uses of the medial sural artery perforator flap. J. Plast. Reconstr. Aesthetic Surg., 68 (6): 853-8, 2015. 38- Lubek J.E. and Engroff S.L.: Anterolateral Thigh Flap [Internet]. Current Therapy in Oral and Maxillofacial Surgery. Elsevier Inc., 584-588 p. Available from: http:// dx.doi.org/10.1016/B978-1-4160-2527-6.00071-2, 2012. 39- Tarek A. El-Gammal, M.D., 1* Amr El-Sayed, M.D., 1 Mohamed M. Kotb, M.D., 1 Waleed Riad Saleh, M.D. 1, Yasser Farouk Ragheb, M.D., 1 Omar El-Refai, M.D., 1 and Mohammed Hassan AlI EL Fahar MD. dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children. Microsurgery, 504-6, 2013. 40- Özkan H.S., I . rkören S., Aydın O.E. and Eryılmaz A.: KHM sural artery perforator flap in head and neck reconstruction. EAO, 273 (12): 4431-4436, 2016. doi:10. 1007/s0040.-016-4078-2. Medial sural artery perforator flap in head and neck reconstruction. Eur. Arch. Otorhinolaryngol., 273 (12): 4431-6, 2016 | ||
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