Baş Boyun Rekonstrüksiyonunda Defekte Uygun Kalınlıkta Anterolateral Uyluk Flebi Kullanımı

Öz

Giriş ve Amaç: Bu çalışmada doku defektin kalınlığına göre farklı cerrahi planlarda eleve edilen anterolateral uyluk flebi (ALT) ile rekonstrüksiyon deneyimlerimizin paylaşılması amaçlanmıştır. Gereç ve Yöntemler: Mart 2017'den Aralık 2020'ye kadar subfasyal, süper ince, suprafasyal, kimerik ve kompozit flepler dahil olmak üzere farklı ALT flebi cerrahi planları ile baş ve boyun defektlerinin rekonstrüksiyonu yapılan 25 hastada 26 flep içeren retrospektif bir çalışma yapıldı. Flep elevasyon planları, operasyon sırasında cetvel kullanılarak belirlenen defektin kalınlığına göre seçildi. Flep kalınlıkları, komplikasyonlar ve revizyon oranları değerlendirildi. Bulgular: Süper ince fleplerden biri total nekroz oldu; başka flep kaybı olmadı. Postoperatif dönemde üç hasta öldü. Uygun flep elevasyon planı seçilmesine rağmen, 26 flepten 4'ünde revizyon cerrahisi yapıldı. Süper ince ALT flebi ile dudak rekonstrüksiyonu yapılan hastalardan birind postoperatif 6. ayda bulky bir görünüm mevcuttu ve subfasyal ALT flebi uygulanan 3 hastaya inceltme ameliyatı yapıldı. Sonuç: ALT flep, baş boyun bölgesindeki defektin kalınlığına göre farklı planlarda eleve edilebilen güvenilir bir fleptir. Uygun kalınlıktaki ALT flep, revizyon ameliyatları olmadan tek aşamada rekonstrüksiyon sağlar ve optimal estetik sonuçlar alınabilir.

Anahtar Kelimeler

• Anterolateral uyluk flebi
• serbest flep
• baş boyun rekonstrüksiyonu.

Use of Customized Thickness Anterolateral Thigh Flap in Head and Neck Reconstruction

Öz

Objective: This study demonstrates different techniques of anterolateral thigh flap (ALT) with the appropriate surgical planes according to the thickness of the defect, which have not been previously found in the literature, with our reconstruction experiences. Materials and Methods: A retrospective study was performed including 26 flaps in 25 patients who underwent reconstruction of head and neck defects with different surgical planes of ALT flap including subfascial, superthin, suprafascial, chimeric and composite flaps from March 2017 through December 2020. Flap planes were chosen according to the thickness of the defect, determined during surgery by using caliper. We evaluated the characteristics, flap thicknesses, complications and need of revision surgery in postoperative period. Results: One of the superthin flaps was totally lost; there was not any other flap loss. Three patients died in postoperative period. Although appropriate plane of the flaps was chosen, 4 of all 26 flaps needed revision surgery. One of the patients who was performed lip reconstruction with superthin ALT flap had bulky appearance needed liposuction in postoperative 6 months and 3 patients who received subfascial ALT flaps were performed debulking surgeries. Conclusion: ALT flap is a versatile, reliable flap which can be harvested in different planes according to the thickness of the defect in head and neck region. The ALT flap with convenient thickness provides definitive reconstruction in a single stage without revision surgeries and the most optimal aesthetic results can be obtained.

Anahtar Kelimeler

• Anterolateral thigh flap
• Free flaps
• Head and neck reconstruction.
• Anterolateral thigh flap, Free flaps, Head and neck reconstruction.

Kaynakça

1. Song, Y.G, Chen, G.Z, Song, Y.L, The free thigh flap: A new free flap concept based on the septocutaneous artery. British Journal of Plastic Surgery, 1984, 37, 149-159.
2. Wei, F.C, Vivek, J, Naci, C, Hung-chi, C, Chwei-Chin, Have we found an ideal soft-tissue flap An experience with 672 Anterolateral Thigh Flap, Plastic Reconstructive Surgery. 2002, 109(7), 2219-2226.
3. Gong, Z.J, Zhang, S, Ren, Z.H, Zhu, Z.F, Liu, J, Bin, Wu, H.J, Application of anteromedial thigh flap for the reconstruction of oral and maxillofacial defects. Journal of Oral Maxillofacial Surgery, 2014, 72(6), 1212-1225.
4. Shieh, S.J, Chiu, H.Y, Yu, J.C, Pan, S.C, Tsai, S.T, Shen, C.L, Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation, Plastic Reconstructive Surgery, 2000, 105(7), 2358-2360.
5. Kimata, Y, Uchiyama, K, Ebihara, S, et al., Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngology-Head Neck Surgery, 1997, 123(12), 1325-1331.
6. Gong, Z.J, Wang, K, Tan, H.Y, Zhang, S, He, Z.J, Wu, H.J, Application of Thinned Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects, Journal of Oral Maxillofacial Surgery, 2015, 73(7), 1410-1419.
7. Sun, G, Lu, M, Hu, Q, Tang, E, Yang, X, Wang, Z, Clinical application of thin anterolateral thigh flap in the reconstruction of intraoral defects, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, 2013, 115(2), 185-191.
8. Demirkan, F, Chen, H, Wei, F, Jung, S, Hau, S, Liao, C, The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction, British Journal of Plastic Surgery, 2000, 53, 30-36.

9. Khadakban, D, Kudpaje, A, Thankappan, K, et al., Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction, Craniomaxillofac Trauma Reconstruction, 2016, 9(1), 040-045.
10. Kim, E.K, Evangelista, M, Evans, G.R.D, Use of free tissue transfers in head and neck reconstruction, Journal of Craniofacial Surgery, 2008, 19(6), 1577-1582.
11. Lutz, B.S, Wei, F.C, Microsurgical workhorse flaps in head and neck reconstruction, Clinical Plastic Surgery, 2005, 32(3 SPEC. ISS.), 421-430.
12. Koshima, I, Fukuda H, Utunomiya, R, Soeda, S, The anterolateral thigh flap; variations in its vascular pedicle, British Journal of Plastic Surgery, 1989, 42(3), 260-262.
13. Maruccia, M, Fallico, N, Cigna, E, et al,. Suprafascial versus traditional harvesting technique for free antero lateral thigh flap: A case-control study to assess the best functional and aesthetic result in extremity reconstruction, Microsurgery, 2017, 37(8), 851-857.
14. Agostini, T, Lazzeri, D, Spinelli, G. Anterolateral thigh flap thinning: Techniques and complications, Annals of Plastic Surgery, 2014, 72(2), 246-252.
15. Ross, G.L, Dunn, R, Kirkpatrick, J, et al., To thin or not to thin: The use of the anterolateral thigh flap in the reconstruction of intraoral defects, British Journal of Plastic Surgery, 2003, 56(4), 409-413.
16. Diamond, S, Seth, A.K, Chattha, A.S, Iorio, M.L, Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity, Journal Reconstr Microsurg, 2018, 34(3), 176-184.
17. Kimura, N, Satoh, K, Consideration of a Thin Flap as an Entity and Clinical Applications of the Thin Anterolateral Thigh Flap, Plastic Reconstructive Surgery, 1996, 97(5), 985-992.
18. Kimura, N, Satoh, K, Hasumi, T, Ostuka, T, Clinical Application of the Free Thin Anterolateral Thigh Flap in 31 Consecutive Patients, Plastic Reconstructive Surgery, 2001, 108(5), 1197-1208.
19. Seth, A.K, Iorio, M.L, Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction, Journal of Reconstructive Microsurgery, 2017, 33(7), 466-473.
20. Xie, S, Deng, X, Chen, Y, et al., Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap, Journal of Plastic Surgery Hand Surgery, 2016, 50(6), 367-374.
21. Adani, R, Tarallo, L, Marcoccio, I, Cipriani, R, Gelati, C, Innocenti, M, Hand reconstruction using the thin anterolateral thigh flap, Plastic Reconstructive Surgery, 2005, 116(2), 467-473.
22. Fan, S, Zhang H, qing, Li, Q xing, et al., The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: A pilot study, Plastic Reconstructive Surgery, 2018, 141(6), 902e-910e.
23. Alkureishi, L.W.T, Shaw-Dunn, J, Ross, G.L, Effects of thinning the anterolateral thigh flap on the blood supply to the skin, British Journal of Plastic Surgery, 2003, 56(4), 401-408.
24. Van Landuyt, K, The Anterolateral Thigh Flap for Lower Extremity Reconstruction, Seminars of Plastic Surgery, 2006, 20(2), 127-132.
25. Gong, Z.J, Wu, H.J, Measurement for subcutaneous fat and clinical applied anatomic studies on perforators in the anterior thigh region, Journal of Oral Maxillofacial Surgery. 2013, 71(5), 951-959.
26. Huang, S.H, Wu, S.H, Chang, K.P, et al., Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure, Journal of Cranio-Maxillofacial Surgery, 2009, 37(4), 201-205.