Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2016; 49(02): 191-197
DOI: 10.4103/0970-0358.191325
Original Article
Association of Plastic Surgeons of India

One plus one: Two free flaps from same donor thigh for simultaneous coverage of two different defects

Susmitha Bandi
Department of Plastic Surgery, Nizam’s Institute of Medical Sciences
,
Rayidi Venkata Koteswara Rao
Department of Plastic Surgery, Nizam’s Institute of Medical Sciences
,
Damalacheruvu Mukunda Reddy
1   Indo American Cancer Center, Hyderabad, Telangana, India
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2019 (online)

Also available at
   Permissions and Reprints

ABSTRACT

Introduction: Primary microvascular reconstruction of multiple defects is challenging particularly if it has to be simultaneous. In trauma cases, harvesting two independent free flaps from different sites is very time-consuming and adds to morbidity. To eliminate these disadvantages, we sought to find out a reliable alternative method of harvesting two independent free flaps based on the descending branch of circumflex femoral artery, i.e., one anterolateral thigh (ALT) flap and one rectus femoris muscle flap. Aim: To study the feasibility of transferring two free flaps, i.e., ALT and rectus femoris muscle flap simultaneously from the same thigh for coverage of two different limb defects. Materials and Methods: From 2003 to 2012, five patients with two defects each were managed with a total of ten flaps harvested from five donor sites based on independent pedicles of descending branch of lateral circumflex femoral artery and used to cover severe injuries of extremities. Three cases had both lower limb defects and two cases had one upper limb and one lower limb defect. In each case, one ALT flap and one rectus femoris muscle flap were used for coverage. Results: All reconstructive procedures were completed without any major complications. All flaps survived well. There were no re-explorations and no complications related to donor sites. Conclusion: We conclude that our approach of simultaneous harvest of ALT and rectus femoris muscle from the same thigh offers two flaps for two different defects in terms of economy of donor site and operating time.

KEY WORDS

Composite tissue transfer - multiple flaps - multiple limb defects - single donor site
 

  • REFERENCES

  • 1 Song YG, Chen GZ, Song YL. The free thigh flap: A new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37: 149-59
    CrossrefPubMedGoogle Scholar
  • 2 Tsuji N, Suga H, Uda K, Sugawara Y. Functional evaluation of anterolateral thigh flap donor sites: Isokinetic torque comparisons for knee function. Microsurgery 2008; 28: 233-7
    CrossrefPubMedGoogle Scholar
  • 3 Townley WA, Royston EC, Karmiris N, Crick A, Dunn RL. Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 2011; 64: 1621-6
    CrossrefPubMedGoogle Scholar
  • 4 Daigeler A, Fansa H, Altmann S, Awiszus F, Schneider W. The pedicled rectus femoris muscle flap for reconstruction of complicated abdominal wall defects. Rozhl Chir 2005; 84: 238-43
    PubMedGoogle Scholar
  • 5 Wei CY, Chuang DC, Chen HC, Lin CH, Wong SS, Wei FC. The versatility of free rectus femoris muscle flap: An alternative flap. Microsurgery 1995; 16: 698-703
    CrossrefPubMedGoogle Scholar
  • 6 Koshima I, Moriguchi T, Inagawa K, Urushibara K. Dynamic reconstruction of the abdominal wall using a reinnervated free rectus femoris muscle transfer. Ann Plast Surg 1999; 43: 199-203
    PubMedGoogle Scholar
  • 7 Koshima I, Moriguchi T, Soeda S, Hamanaka T, Tanaka H, Ohta S. Free rectus femoris muscle transfer for one-stage reconstruction of established facial paralysis. Plast Reconstr Surg 1994; 94: 421-30
    PubMedGoogle Scholar
  • 8 Arai T, Ikuta Y, Ikeda A. A study of the arterial supply in the human rectus femoris muscle. Plast Reconstr Surg 1993; 92: 43-8
    CrossrefPubMedGoogle Scholar
  • 9 Wong CH, Ong YS, Wei FC. The anterolateral thigh – Vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg 2012; 65: 235-9
    CrossrefPubMedGoogle Scholar
  • 10 Tsao CK, Wei FC, Chang YM, Cheng MH, Chwei-Chin Chuang D, Kao HK. et al. Reconstruction of the buccal mucosa following release for submucous fibrosis using two radial forearm flaps from a single donor site. J Plast Reconstr Aesthet Surg 2010; 63: 1117-23
    CrossrefPubMedGoogle Scholar
  • 11 Samir K, Shrirang P, Anurag C. Double flap from amputated opposite lower limb for cover of plantar and dorsal surfaces of a crushed foot. Indian J Plast Surg 2013; 46: 568-71
    CrossrefPubMedGoogle Scholar
  • 12 Tamai S, Komatsu S, Sakamoto H, Sano S, Sasauchi N. Free muscle transplants in dogs, with microsurgical neurovascular anastomoses. Plast Reconstr Surg 1970; 46: 219-25
    CrossrefPubMedGoogle Scholar
  • 13 Schenck RR. Free muscle and composite skin transplantation by microneurovascular anastomoses. Orthop Clin North Am 1977; 8: 367-75
    CrossrefPubMedGoogle Scholar
  • 14 Chen HC, El-Gammal TA, Chen HH, Wei FC, Lin CH, Tang YB. Economy of donor site incisions: Multiple free flaps of the subscapular family for extensive extremity wounds and bilateral foot defects. Ann Plast Surg 1998; 41: 28-35
    CrossrefPubMedGoogle Scholar
  • 15 Lin CH, Wei FC, Lin YT, Yeh JT, Rodriguez Ede J, Chen CT. Lateral circumflex femoral artery system: Warehouse for functional composite free-tissue reconstruction of the lower leg. J Trauma 2006; 60: 1032-6
    CrossrefPubMedGoogle Scholar
  • 16 Safak T, Akyürek M. Creating two independent fasciocutaneous free flaps from a single radial forearm donor site. Ann Plast Surg 2001; 47: 247-51
    CrossrefPubMedGoogle Scholar
  • 17 Huang JJ, Wallace C, Lin JY, Tsao CK, Kao HK, Huang WC. et al. Two small flaps from one anterolateral thigh donor site for bilateral buccal mucosa reconstruction after release of submucous fibrosis and/or contracture. J Plast Reconstr Aesthet Surg 2010; 63: 440-5
    CrossrefPubMedGoogle Scholar
  • 18 Gazyakan E, Engel H, Lehnhardt M, Pelzer M. Bilateral double free-flaps for reconstruction of extensive chest wall defect. Ann Thorac Surg 2012; 93: 1289-91
    CrossrefPubMedGoogle Scholar
  • 19 Acartürk TO. Femur-vastus intermedius-anterolateral thigh osteomyocutaneous composite chimeric free flap: A new free flap for the reconstruction of complex wounds. J Reconstr Microsurg 2011; 27: 187-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109: 2219-26
    CrossrefPubMedGoogle Scholar
  • 21 Ahmad QG, Yadav PS, Shankhdhar VK, Nambi GI. Anterolateral thigh twin free flaps from a single donor site-a modification based on the oblique branch of the lateral circumflex femoral artery. Indian J Surg 2014; 76: 165-8
    CrossrefPubMedGoogle Scholar
  • 22 Yu P, Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg 2011; 128: 151e-7e
    CrossrefPubMedGoogle Scholar
  • 23 Jain L, Kumta S, Purohit S. One on one free: Two free flaps from a single donor site. J Plast Reconstr Aesthet Surg 2015; 68: 140-2
    CrossrefPubMedGoogle Scholar
  • 24 Horn D, Jonas R, Engel M, Freier K, Hoffmann J, Freudlsperger C. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region. J Craniomaxillofac Surg 2014; 42: 1551-6
    CrossrefPubMedGoogle Scholar
  • 25 Gardetto A, Raschner CH, Schoeller T, Pavelka ML, Wechselberger G. Rectus femoris muscle flap donor-site morbidity. Br J Plast Surg 2005; 58: 175-82
    CrossrefPubMedGoogle Scholar
  • 26 Sbitany H, Koltz PF, Girotto JA, Vega SJ, Langstein HN. Assessment of donor-site morbidity following rectus femoris harvest for infrainguinal reconstruction. Plast Reconstr Surg 2010; 126: 933-40
    CrossrefPubMedGoogle Scholar
  • 27 Posch S, Mureau MA, Flood SJ, Hofer SO. A combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction in extensive composite defects. Br J Plast Surg 2005; 58: 1095-103
    CrossrefPubMedGoogle Scholar
  • 28 Chowdary RP, Murphy RX. Delayed debulking of free muscle flaps for aesthetic contouring debulking of free muscle flaps. Br J Plast Surg 1992; 45: 38-41
    CrossrefPubMedGoogle Scholar