Top

European Archives of Oto-Rhino-Laryngology

Published in:

Open Access 01-06-2020 | Head and Neck

The vascularized fascia lata free flap: an anatomical study and clinical considerations

Authors: Stefan Janik, Lena Hirtler, Hannes Traxler, Wolfgang J. Weninger, Rudolf Seemann, Boban M. Erovic

Published in: European Archives of Oto-Rhino-Laryngology | Issue 6/2020

Abstract

Purpose

Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap.

Methods

We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined.

Results

Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo- or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6–60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm². In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL.

Conclusion

We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.

Song YG, Chen GZ, Song YL (1984) The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 37(2):149–159CrossRef

Wong CH, Wei FC (2010) Anterolateral thigh flap. Head Neck 32(4):529–540PubMed

Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH (2002) Have we found an ideal soft-tissue flap? an experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 109(7):2219–2226CrossRef

Lee YC, Chiu HY, Shieh SJ (2011) The clinical application of anterolateral thigh flap. Plast Surg Int 2011:127353PubMedPubMedCentral

Xu Z, Zhao XP, Yan TL, Wang M, Wang L, Wu HJ, Shang ZJ (2015) A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases. Int J Oral Maxillofac Surg 44(9):1088–1094CrossRef

Wu CC, Lin PY, Chew KY, Kuo YR (2014) Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute. Microsurgery 34(5):339–344CrossRef

Ren ZH, Wu HJ, Wang K, Zhang S, Tan HY, Gong ZJ (2014) Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects. J Craniomaxillofac Surg 42(8):1583–1589CrossRef

Ehrl D, Heidekrueger PI, Schmitt A, Liska F, Ninkovic M, Giunta R, Broer PN (2019) The anterolateral thigh flap for achilles tendon reconstruction: functional outcomes. Plast Reconstr Surg 143(6):1772–1783CrossRef

Xie RG (2018) Medial versus lateral approach to harvesting of anterolateral thigh flap. J Int Med Res 46(11):4569–4577CrossRef

10.

Stecco C, Tiengo C, Stecco A, Porzionato A, Macchi V, Stern R, De Caro R (2013) Fascia redefined: anatomical features and technical relevance in fascial flap surgery. Surg Radiol Anat 35(5):369–376CrossRef

11.

Koshima I, Fukuda H, Utunomiya R, Soeda S (1989) The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 42(3):260–262CrossRef

12.

Wavreille G, Bricout J, Mouliade S, Lemoine S, Prodhomme G, Khanchandani P, Chantelot C, Fontaine C (2010) Anatomical bases of the free posterior brachial fascial flap. Surg Radiol Anat 32(4):393–399CrossRef

13.

Mosahebi A, Disa JJ, Pusic AL, Cordeiro PG, Mehrara BJ (2008) The use of the extended anterolateral thigh flap for reconstruction of massive oncologic defects. Plast Reconstr Surg 122:492–496CrossRef

14.

Saint-Cyr M, Schaverien M, Wong C, Nagarkar P, Arbique G, Brown S, Rohrich RJ (2009) The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg 123(4):1245–1255CrossRef

15.

Gosain AK, Yan JG, Aydin MA, Das DK, Sanger JR (2002) The vascular supply of the extended tensor fasciae latae flap: how far can the skin paddle extend? Plast Reconstr Surg 110(7):1655–1661CrossRef

16.

Steinbacher J, Yoshimatsu H, Meng S, Hamscha UM, Chan CS, Weninger WJ, Wu CT, Cheng MH, Tzou CH (2017) Visualization of skin perfusion by indocyanine green fluorescence angiography-A feasibility Study. Plast Reconstr Surg Glob Open 5(9):e1455CrossRef

17.

Saint-Cyr M, Mujadzic M, Wong C, Hatef D, Lajoie AS, Rohrich RJ (2010) The radial artery pedicle perforator flap: vascular analysis and clinical implications. Plast Reconstr Surg 125(5):1469–1478CrossRef

18.

Chen YC, Scaglioni MF, Carrillo Jimenez LE, Yang JC, Huang EY, Lin TS (2016) Suprafascial anterolateral thigh flap harvest: a better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg 138(3):689–698CrossRef

19.

Shaw RJ, Batstone MD, Blackburn TK, Brown JS (2010) The anterolateral thigh flap in head and neck reconstruction: "pearls and pitfalls". Br J Oral Maxillofac Surg 48(1):5–10CrossRef

20.

Fox P, Endress R, Sen S, Chang J (2014) Fascia-only anterolateral thigh flap for extremity reconstruction. Ann Plast Surg 72(Suppl 1):S9–13CrossRef

21.

Seth R, Revenaugh PC, Scharpf J, Shipchandler TZ, Fritz MA (2013) Free anterolateral thigh fascia lata flap for complex nasal lining defects. JAMA Facial Plast Surg 15(1):21–28CrossRef

22.

Kerr RP, Hanick A, Fritz MA (2018) Fascia lata free flap reconstruction of limited hard palate defects. Cureus 10(3):e2356PubMedPubMedCentral

23.

Bhadkamkar MA, Wolfswinkel EM, Hatef DA, Albright SB, Echo A, Hsu PW, Izaddoost SA (2014) The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg 30(9):599–606CrossRef

24.

Haffey T, Winters R, Kerr R, Fritz M (2019) Mandibular rescue: Application of the ALT fascia free flap to arrest osteoradionecrosis of the mandible. Am J Otolaryngol. 40(6):102262CrossRef

25.

Peppas G, Gkegkes ID, Makris MC, Falagas ME (2010) Biological mesh in hernia repair, abdominal wall defects, and reconstruction and treatment of pelvic organ prolapse: a review of the clinical evidence. Am Surg 76(11):1290–1299PubMed

26.

Collins J, Ayeni O, Thoma A (2012) A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg 20:17–23CrossRef

27.

Lakhiani C, Lee MR, Saint-Cyr M (2012) Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 130(6):1254–1268CrossRef

28.

Coskunfirat OK, Ozkan O (2006) Free tensor fascia lata perforator flap as a backup procedure for head and neck reconstruction. Ann Plast Surg 57(2):159–163CrossRef

29.

Hsieh CH, Yang JC, Chen CC, Kuo YR, Jeng SF (2009) Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available. Head Neck 31(5):571–575CrossRef

30.

Powers JM, Martinez M, Zhang S, Kale SS (2018) A description of the vascular anatomy of the tensor fascia lata perforator flap using computed tomography angiography. Ann Plast Surg 80:S421–S425CrossRef

31.

Hubmer MG, Schwaiger N, Windisch G, Feigl G, Koch H, Haas FM, Justich I, Scharnagl E (2009) The vascular anatomy of the tensor fasciae latae perforator flap. Plast Reconstr Surg 124(1):181–189CrossRef

Title: The vascularized fascia lata free flap: an anatomical study and clinical considerations
Authors: Stefan Janik
Lena Hirtler
Hannes Traxler
Wolfgang J. Weninger
Rudolf Seemann
Boban M. Erovic
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 6/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-05861-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The vascularized fascia lata free flap: an anatomical study and clinical considerations

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2020

Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo

Importance of signal intensity on T1-weighted spin-echo sequence for the diagnosis of chronic cholesteatomatous otitis

Elective neck dissection in T1/T2 oral squamous cell carcinoma with N0 neck: essential or not? A systematic review and meta-analysis

Lateral pharyngoplasty techniques for obstructive sleep apnea syndrome: a comparative experimental stress test of two different techniques

Lateral cervical approach for salvage total laryngectomy without pharyngeal reinforcement with pedicled or free flaps: our preliminary experience in six patients

Reply to the letter to the editor concerning ‘The of elevation of the mucosal flap without additional anterior canal wall incisions for repairing anterior perforations using endoscopic cartilage tympanoplasty’