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      Free anterolateral thigh flap harvesting from paralytic limbs in post-polio syndrome

      case-report

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          Abstract

          We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate.

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          A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients.

          Matthew M Hanasono, Peirong Yu, Roman J Skoracki (2009)
          The anterolateral thigh free flap may be harvested as a fasciocutaneous perforator flap or as a myocutaneous flap by including variable amounts of the vastus lateralis muscle. The authors sought to determine the donor-site morbidity associated with both types of flap dissection. Between 2005 and 2008, the authors performed 220 reconstructive operations using the anterolateral thigh free flap. Complications and donor-site function were evaluated prospectively. Variable amounts of vastus lateralis muscle were harvested with the flap in this series: 25 percent included no muscle, 38 percent included minimal muscle, 33 percent included the superficial half of the muscle, and 4 percent included the entire muscle. The motor nerve to the vastus lateralis muscle was spared during dissection of the flap pedicle in 78 percent but required division in 22 percent. Complications included seroma (5 percent), wound dehiscence (2 percent), hematoma (1 percent), infection (1 percent), neuroma (1 percent), and partial skin graft loss (1 percent). Eighty-four percent of patients reported a sensory loss in the distribution of the lateral femoral cutaneous nerve. Weakness or instability was reported by 8 percent of patients at their initial postoperative visit but resolved in all patients within 6 months. All patients regained their postoperative level of activity. The anterolateral thigh free flap is associated with a low rate of complications and functional morbidity. Even when the motor nerve to the vastus lateralis is divided, or substantial amounts of thigh fascia or vastus lateralis muscle are included in the flap design, all patients return to their preoperative level of function.
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            Poliomyelitis and the postpolio syndrome.

            Anita R. Howard (2005)
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              Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site.

              Ivana Kuo, C. Kuo, F Wei … (2001)
              From August of 1995 through July of 1998, 38 free anterolateral thigh flaps were transferred to reconstruct soft-tissue defects. The overall success rate was 97 percent. Among 38 anterolateral thigh flaps, four were elevated as cutaneous flaps based on the septocutaneous perforators. The other 34 were harvested as myocutaneous flaps including a cuff of vastus lateralis muscle (15 to 40 cm3), either because of bulk requirements (33 cases) or because of the absence of a septocutaneous perforator (one case). However, vastus lateralis muscle is the largest compartment of the quadriceps, which is the prime extensor of the knee. Losing a portion of the vastus lateralis muscle may affect knee stability. Objective functional assessments of the donor sites were performed at least 6 months postoperatively in 20 patients who had a cuff of vastus lateralis muscle incorporated as part of the myocutaneous flap; assessments were made using a kinetic communicator machine. The isometric power test of the ratios of quadriceps muscle at 30 and 60 degrees of flexion between donor and normal thighs revealed no significant difference (p > 0.05). The isokinetic peak torque ratio of the quadriceps and hamstring muscles, including concentric and eccentric contraction tests, showed no significant difference (p > 0.05), except the concentric contraction test of the quadriceps muscle, which revealed mild weakness of the donor thigh (p < 0.05). In summary, the functional impairment of the donor thighs was minimal after free anterolateral thigh myocutaneous flap transfer.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Reports Plast Surg Hand Surg
                Journal ID (iso-abbrev): Case Reports Plast Surg Hand Surg
                Journal ID (archive): ICRP
                Journal ID (publisher-id): icrp20
                Title: Case Reports in Plastic Surgery & Hand Surgery
                Publisher: Taylor & Francis
                ISSN (Electronic): 2332-0885
                Publication date Collection: 2016
                Publication date (Electronic): 28 June 2016
                Volume: 3
                Issue: 1
                Pages: 50-55
                Affiliations
                [ a ]Department of Plastic and Reconstructive Surgery, Chiayi Christian Hospital , Chiayi City, Taiwan
                Author notes
                CONTACT Wei-Chen Chen s71131@ 123456yahoo.com.tw Department of Plastic and Reconstructive Surgery, Chiayi Christian Hospital , 539 Jhongsiao Rd, Chiayi City 60002, Taiwan, ROC
                Article
                Publisher ID: 1200978
                DOI: 10.1080/23320885.2016.1200978
                PMC ID: 4996063
                SO-VID: 3d0a54b3-4c2e-4d7f-be93-3e667498c00c
                Copyright © © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 February 2016
                Date accepted : 22 May 2016
                Page count
                Pages: 6, Words: 3049
                Categories
                Subject: Case Report
                Subject: Case Report

                Keywords: anterolateral thigh free flap,poliomyelitis,post-polio syndrome,paralytic limb
                Data availability:
                Keywords: anterolateral thigh free flap, poliomyelitis, post-polio syndrome, paralytic limb

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