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Increasing Pedicle Reach with Musculocutaneous Perforator Dissection in Anterolateral Thigh Free Flaps
Karolina A Plonowska-Hirschfeld1, Adrian House2, Andrea M Park3
1UCSF Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, U.S.A.
The Laryngoscope
|July 5, 2023
Summary
Microdissection of musculocutaneous perforators during anterolateral thigh (ALT) free flap harvest significantly increases effective pedicle length by 5.2 cm. This technique enhances the ability to achieve tension-free anastomoses in reconstructive surgery.
Area of Science:
- Plastic Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Anterolateral thigh (ALT) free flaps are crucial for oncologic reconstruction.
- Effective pedicle length (EPL) is a critical factor in successful free flap surgery.
- Optimizing pedicle length can improve surgical outcomes and reduce complications.
Approach:
- Retrospective review of 314 ALT free tissue transfers from February 2017 to August 2022.
- Measured EPL before and after intramuscular dissection of musculocutaneous perforators in 85 cases.
- Analyzed clinicopathologic variables from electronic medical records.
Key Points:
- Mean EPL increased from 8.8 cm to 14.0 cm after perforator dissection, a gain of 5.2 cm (p < 0.001).
- This represents a nearly 60% increase in effective pedicle reach.
- Complication rates including revision, hematoma, dehiscence, and flap loss were noted.
Conclusions:
- Microdissection of perforators during ALT flap harvest significantly extends EPL.
- This technique facilitates tension-free anastomoses, especially when long pedicle length or tunneling is needed.
- Improved EPL can enhance reconstructive surgical procedures.
