Pushing boundaries: Anterolateral thigh free flaps for extensive scalp defects beyond previous limits, leveraging imaging modalities with ultrasound and indocyanine green

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-06-03 DOI:10.1002/micr.31190

Tae Hyung Kim MD, Jong Woo Choi MD, PhD, MMM, Woo Shik Jeong MD, PhD

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引用次数: 0

Abstract

Background

Scalp defect reconstruction poses considerable challenges, with ongoing debates regarding the most effective strategies. While the latissimus dorsi (LD) flap has traditionally been favored, the anterolateral thigh (ALT) flap has been well described as a versatile alternative for addressing extensive scalp defects. This study underscores the success of scalp reconstruction using ALT flaps, notably pushing the boundaries of previously reported flap sizes. Our approach leverages the use of indocyanine green (ICG) perfusion to guide precise preoperative planning and vascular modification, contributing to improved outcomes in challenging cases.

Methods

We performed 43 ALT flap reconstructions for scalp defects between 2016 and 2023. We collected patients' demographic and clinical data and evaluated flap size and recipient vessels and additional surgical techniques. Detailed preoperative plans with ultrasound and ICG use for intraoperative plans were performed to find perforators location. The cohort was divided into two, with or without complications on flaps, and analyzed depending on its surgical details.

Results

This study involved 38 patients with extensive scalp defects (mean age: 69.4 ± 11 years) who underwent ALT perforator flap transfers (mean flap size: 230.88 ± 145.6 cm²). There was only one case of unsuccessful flap transfer, and four cases had a few complications. The characteristics of the complication group included a large flap size (303.1 ± 170.9 vs. 214.9 ± 136.6 cm², P = .211), few perforator numbers without pedicle manipulation, lack of intraoperative indocyanine green administration (75% vs. 25%, P = .607), and the use of superficial temporal vessels as recipient vessels.

Conclusions

Scalp reconstruction using large ALT free flaps with the aid of imaging modalities facilitates the optimization of surgical techniques, such as pedicle manipulation, perforator numbers, and vein considerations, thereby contributing to successful reconstruction.

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突破界限：利用超声波和吲哚青绿成像模式，用大腿前外侧游离皮瓣治疗大面积头皮缺损，突破了以往的局限。

背景：头皮缺损重建是一项相当大的挑战，关于最有效的策略一直存在争议。虽然背阔肌（LD）皮瓣历来受到青睐，但大腿前外侧（ALT）皮瓣已被充分描述为处理大面积头皮缺损的多功能替代方案。本研究强调了使用 ALT 皮瓣重建头皮的成功，尤其是突破了之前报道的皮瓣大小的界限。我们的方法利用吲哚菁绿（ICG）灌注来指导精确的术前规划和血管改造，有助于改善高难度病例的治疗效果：我们在 2016 年至 2023 年间进行了 43 例头皮缺损 ALT 皮瓣重建术。我们收集了患者的人口统计学和临床数据，评估了皮瓣大小和受体血管以及其他手术技术。我们在术前制定了详细的超声计划，并在术中使用 ICG 寻找穿孔器位置。根据手术细节，将患者分为有并发症和无并发症两种：这项研究涉及 38 例头皮大面积缺损患者（平均年龄：69.4 ± 11 岁），他们都接受了 ALT 穿孔皮瓣转移术（平均皮瓣大小：230.88 ± 145.6 平方厘米）。只有一例皮瓣转移不成功，四例出现了一些并发症。并发症组的特点包括：皮瓣面积大（303.1 ± 170.9 vs. 214.9 ± 136.6 cm2，P = .211）、穿孔数量少且未进行基底操作、术中未使用吲哚菁绿（75% vs. 25%，P = .607）以及使用颞浅血管作为受体血管：结论：在成像模式的帮助下，使用大型 ALT 游离皮瓣进行头皮重建有助于优化手术技术，如椎弓根操作、穿孔数量和静脉考虑，从而有助于成功重建。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.