Increasing Pedicle Reach with Musculocutaneous Perforator Dissection in Anterolateral Thigh Free Flaps.

Autor: Plonowska-Hirschfeld KA; UCSF Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, U.S.A., House A; HouseMD Plastics, Menlo Park, California, U.S.A., Park AM; Division of Facial Plastic and Reconstructive Surgery, UCSF Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, U.S.A., Seth R; Division of Facial Plastic and Reconstructive Surgery, UCSF Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, U.S.A., Heaton CM; Division of Head and Neck Surgery, UCSF Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, U.S.A., Fridirici Z; Moreland Ear, Nose & Throat, Waukesha, Wisconsin, U.S.A., Knott PD; Division of Facial Plastic and Reconstructive Surgery, UCSF Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2024 Feb; Vol. 134 (2), pp. 666-670. Date of Electronic Publication: 2023 Jul 05.
DOI: 10.1002/lary.30870
Abstrakt: Objective: To measure the increase in effective pedicle reach with microdissection of musculocutaneous perforators during anterolateral thigh (ALT) free tissue harvest.
Methods: A review of our institution's free flap database was performed to identify ALT free tissue transfers. The distance from pedicle vessel origin to its perforator's insertion at the fascia lata (effective pedicle length [EPL]) was measured prior to and following intramuscular dissection of musculocutaneous perforators. Pertinent clinicopathologic variables were abstracted from the electronic medical record.
Results: A total of 314 ALT free flaps were performed between February 2017 and August 2022. Of these, 85 had documentation of EPL before and after musculocutaneous perforator dissection. ALT reconstruction was primarily performed for reconstruction of oncologic ablative defects (66, 78%). The mean EPL prior to perforator microdissection was 8.8 cm (standard deviation, SD 2.8 cm; range 3-15 cm). Following perforator dissection, mean EPL significantly increased to 14.0 cm (SD 3.0 cm; range 7-22 cm) with a mean net gain of 5.2 cm in distance (95% confidence interval 4.8-5.6 cm; p < 0.001). Nine patients (11%) required operating room take-back for anastomosis revision (3, 3.5%), recipient site hematoma evacuation (4, 4.7%), and wound dehiscence (2, 2.3%); one complete flap loss due to venous thrombosis was observed.
Conclusion: Dissection of musculocutaneous perforators during ALT free flap harvest can increase effective pedicle reach by 5.2 cm or nearly 60%. This harvest technique can facilitate the performance of tension-free anastomoses when substantial vascular pedicle length or vascular pedicle tunneling is required.
Level of Evidence: 4 Laryngoscope, 134:666-670, 2024.
(© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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