Ricerc@Sapienza

Clinical applications of ALT flap have currently extended to extremity (hand and foot) as well as oral cavity reconstruction. In these anatomical areas, the traditional harvesting technique presents a few disadvantages such as bulkiness of the recipient site and potential donor site morbidity including damage to the deep fascia and skin graft adhesions. The purpose of the present study was to compare the functional and aesthetic outcomes of upper and lower extremity reconstruction with either suprafascial or subfascial harvested anterolateral (ALT) flaps. Sixty patients who underwent hand or foot reconstruction with an ALT flap between January 2013 and January 2015 were included in the study (34 flaps elevated on a subfascial plane and 26 on a suprafascial plane). Group 1 (subfascial harvested ALT flap) was composed of 23 male and 11 female patients with an average age of 53.4 years (range, 36-72 years). Group 2 (suprafascial harvested ALT flap) was composed of 18 male and 8 female patients with an average age of 48.7 years (range, 32-69 years). Surgical indication was tumor resection for 20 patients in group 1 and 16 patients in group 2, chronic ulcer for 8 patients in group 1 and 6 patients in group 2, and trauma for 6 patients in group 1 and 4 patients in group 2. Complications were documented. Aesthetic outcomes were considered in terms of bulkiness of the recipient site, subsequent request for a debulking procedure, and donor site morbidity. Donor site scars were evaluated for cosmesis using a modified Hollander Wound Evaluation Scale (HWES). Skin grafts outcomes were assessed according to the modified Vancouver Scar Scale (VSS). Functional outcome at the recipient site was measured using the Enneking functional outcome score (ESS). Total range of motion (ROM) was recorded. All flaps were successfully elevated with at least one viable perforator with both approaches. The survival rates of suprafascial and subfascial harvested ALT flaps were 96.2 and 97% respectively (P?=?.85). The mean flap size was 110.4?±?27.8 cm2 in group 1 and 159.7?±?44.4 cm2 in group 2. The average flap thickness was 26.2± 5.2 mm in group 1 and 13.9 mm?±?4.1 in group 2. Complications included total flap loss (1 case in group 1 and 1 case in group 2), partial flap loss (2 cases in group 1 and 1 case in group 2), skin graft failure (3 cases in group 1), and muscle herniation at the donor site (1 case in group 1; P?.17). Secondary debulking procedures were needed for 20 flaps in the subfascial group and for one flap in the suprafascial group (P-value <.01 donor="" site="" closure="" with="" skin="" grafts="" was="" necessary="" in="" cases:="" group="" and="" the="" suprafascial="" harvested="" alt="" flap="" reported="" a="" significant="" difference="" terms="" of="" morbidity.="" hwes="" score="" scars="" significantly="" lower="" than="" p="" similarly="" vss="" for="" graft="" outcomes="" patients="" there="" also="" postoperative="" ess="" when="" compared="" total="" rom="" improved="" on="" average="" after="" surgery="" plane="" elevating="" flaps="" presented="" several="" advantages="" over="" traditional="" subfascial="" approach="" functional="" aesthetic="" providing="" thin="" allowing="" increased="" versatility="" to="" achieve="" better="" contour="" minimizing="" need="" secondary="" debulking.="">