Download PDF
Facial Plast Surg 2018; 34(04): 407-411
DOI: 10.1055/s-0038-1666783
Rapid Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps

Jen-Wu Huang
1   Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan
2   Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
,
Chih-Sheng Huang
1   Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan
3   Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
,
Szu-Hsien Wu
3   Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
,
Yu-Chung Shih
4   Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
5   Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
,
Yi-Ying Lin
2   Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
6   Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
,
Cherng-Kang Perng
3   Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
› Author Affiliations
Further Information

Publication History

Publication Date:
28 June 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Without well recognizing the vascular territories of the perforator, surgery might damage the pedicle and diminish flap survival. This study described a transillumination method for intraoperative mapping of the subfascial plexus of the perforator in the head and neck reconstruction with an anterolateral thigh (ALT) flap and also compared the perioperative outcomes and complications of the method with those of the conventional two-pedicle ALT flap. Between January 2011 and December 2017, 26 patients who underwent head and neck reconstruction with ALT flaps were evaluated as follows: 13 underwent the transillumination method (case group), and 13 (age- and sex-matched) underwent standard two-pedicle flap procedures (control group). Demographic factors, diagnosis, flap size, recipient site, perioperative data, and postoperative complications were compared between the two groups. There was no significant difference in age, sex, diagnosis, recipient sites, and flap size between the case and control groups. Regarding the perioperative outcomes, the harvesting time was significantly shorter in the case group than in the control group (60 vs. 100 minutes, p < 0.001). The operative time was shorter in the case group than in the control group, but this difference was not statistically significant (300 vs. 420 minutes, p = 0.058). The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the ALT flap, which facilitates intraoperative flap design in head and neck reconstruction.

Keywords

anterolateral thigh flap - perforator flap - head and neck reconstruction - transillumination
 

  • References

  • 1 Agostini T, Lazzeri D, Agostini V, Shokrollahi K. Anterolateral thigh flap as the ideal flap to full-thickness cheek reconstruction. J Craniofac Surg 2010; 21 (06) 1897-1898
    CrossrefPubMedGoogle Scholar
  • 2 Bhathena HM, Kavarana NM. Folded, bipaddled composite flap in head and neck reconstruction. Head Neck 1990; 12 (05) 386-391
    CrossrefPubMedGoogle Scholar
  • 3 Savant DN, Patel SG, Deshmukh SP, Gujarati R, Bhathena HM, Kavarana NM. Folded free radial forearm flap for reconstruction of full-thickness defects of the cheek. Head Neck 1995; 17 (04) 293-296
    CrossrefPubMedGoogle Scholar
  • 4 Nakatsuka T, Harii K, Yamada A, Ueda K, Ebihara S. Dual free flap transfer using forearm flap for mandibular reconstruction. Head Neck 1992; 14 (06) 452-458
    CrossrefPubMedGoogle Scholar
  • 5 Sanger JR, Yousif NJ, Matloub HS, Larson DL, Sewall SS. Reconstruction of lower third of face with three simultaneous free flaps. Plast Reconstr Surg 1994; 94 (05) 709-713
    CrossrefPubMedGoogle Scholar
  • 6 Heitmann C, Khan FN, Levin LS. Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg 2003; 19 (03) 157-162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Chen WF, Chang KP, Chen CH, Shyu VB, Kao HK. Outcomes of anterolateral thigh flap reconstruction for salvage laryngopharyngectomy for hypopharyngeal cancer after concurrent chemoradiotherapy. PLoS One 2013; 8 (01) e53985
    CrossrefPubMedGoogle Scholar
  • 8 Shaw RJ, Batstone MD, Blackburn TK, Brown JS. The anterolateral thigh flap in head and neck reconstruction: “pearls and pitfalls”. Br J Oral Maxillofac Surg 2010; 48 (01) 5-10
    CrossrefPubMedGoogle Scholar
  • 9 Liu YS, Chen HC, Chung KP, Li TS. Transillumination instrument facilitates faster and more accurate dissection of right colon segment for oesophageal reconstruction. Asian J Surg 2010; 33 (02) 94-96
    CrossrefPubMedGoogle Scholar
  • 10 Blondeel PN, Beyens G, Verhaeghe R. , et al. Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 1998; 51 (03) 202-209
    CrossrefPubMedGoogle Scholar
  • 11 Lam DL, Mitsumori LM, Neligan PC, Warren BH, Shuman WP, Dubinsky TJ. Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery. Br J Radiol 2012; 85 (1020): e1293-e1297
    CrossrefPubMedGoogle Scholar
  • 12 Su W, Lu L, Lazzeri D. , et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg 2013; 131 (01) 80-93
    PubMedGoogle Scholar
  • 13 Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 1990; 43 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 14 Tsukino A, Kurachi K, Inamiya T, Tanigaki T. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg 2004; 113 (01) 241-246
    CrossrefPubMedGoogle Scholar
  • 15 Giunta RE, Geisweid A, Feller AM. The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg 2000; 105 (07) 2381-2386
    CrossrefPubMedGoogle Scholar
  • 16 Khan UD, Miller JG. Reliability of handheld Doppler in planning local perforator-based flaps for extremities. Aesthetic Plast Surg 2007; 31 (05) 521-525
    CrossrefPubMedGoogle Scholar
  • 17 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (04) 910-916
    CrossrefPubMedGoogle Scholar
  • 18 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 2006; 118 (04) 928-933 , discussion 934–935
    CrossrefPubMedGoogle Scholar
  • 19 Matei I, Georgescu A, Chiroiu B, Capota I, Ardelean F. Harvesting of forearm perforator flaps based on intraoperative vascular exploration: clinical experiences and literature review. Microsurgery 2008; 28 (05) 321-330
    CrossrefPubMedGoogle Scholar
  • 20 Fukaya E, Saloner D, Leon P, Wintermark M, Grossman RF, Nozaki M. Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer. J Plast Reconstr Aesthet Surg 2010; 63 (07) 1099-1104
    CrossrefPubMedGoogle Scholar
  • 21 Newman TM, Vasile J, Levine JL. , et al. Perforator flap magnetic resonance angiography for reconstructive breast surgery: a review of 25 deep inferior epigastric and gluteal perforator artery flap patients. J Magn Reson Imaging 2010; 31 (05) 1176-1184
    CrossrefPubMedGoogle Scholar
  • 22 Sacks JM, Nguyen AT, Broyles JM, Yu P, Valerio IL, Baumann DP. Near-infrared laser-assisted indocyanine green imaging for optimizing the design of the anterolateral thigh flap. Eplasty 2012; 12: e30
    PubMedGoogle Scholar
  • 23 Buehrer G, Taeger CD, Ludolph I, Horch RE, Beier JP. Intraoperative flap design using ICG monitoring of a conjoined fabricated anterolateral thigh/tensor fasciae latae perforator flap in a case of extensive soft tissue reconstruction at the lower extremity. Microsurgery 2016; 36 (08) 684-688
    CrossrefPubMedGoogle Scholar
  • 24 Cai EZ, Sankaran K, Tan M, Chan YH, Lim TC. Pen torch transillumination: difficult venepuncture made easy. World J Surg 2017; 41 (09) 2401-2408
    CrossrefPubMedGoogle Scholar
  • 25 Keihani S, Hojjat A, Kajbafzadeh AM. Abdominoscrotal hydrocele: role of physical exam and transillumination in diagnosis. J Pediatr 2015; 167 (06) 1448-e1
    CrossrefPubMedGoogle Scholar
  • 26 Hakim SG, Jacobsen HC, Trenkle T, Sieg P, Wieker H. Impact of body mass index, gender, and smoking on thickness of free soft tissue flaps used for orofacial reconstruction. J Craniomaxillofac Surg 2015; 43 (08) 1325-1329
    CrossrefPubMedGoogle Scholar