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Engineered Vascularized Muscle Flap
Published on: January 11, 2016
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Thigh reconstruction between form and function: An algorithm for flap selection based on a series of 70 oncological
Beniamino Brunetti1,2, Marco Morelli Coppola1,2, Stefania Tenna1,2
1Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Microsurgery
|October 6, 2023
Summary
Thigh reconstruction after cancer surgery can be effectively managed with pedicled perforator flaps. Microsurgical reconstruction provides reliable outcomes for extensive defects, previously irradiated areas, or functional restoration needs.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Reconstructive Microsurgery
Background:
- Thigh reconstruction following oncological resection presents significant morphological and functional challenges.
- Existing literature often lacks comprehensive approaches, relying on small case series.
- This study reviews institutional experience to propose an algorithm for selecting optimal thigh soft-tissue reconstruction methods.
Observation:
- Seventy thigh flap reconstructions were performed for sarcoma, melanoma, and non-melanoma skin cancer resections between 2014 and 2021.
- Pedicled flaps (predominantly perforator flaps) were used in 55 cases, while microsurgical reconstruction (including free functional muscle transfer) was employed in 15 extensive or functionally critical cases.
- Predictors for free flap use included extensive defect size, prior irradiation, and neoadjuvant chemotherapy.
Findings:
- Complication and readmission rates were comparable between pedicled and free flap groups.
- Patients with prior irradiation showed worse outcomes with pedicled flaps compared to free flaps, particularly concerning reintervention and readmission rates.
- Overall patient satisfaction with aesthetic and functional outcomes was high (mean scores of 4.31 and 4.12, respectively).
Implications:
- Pedicled perforator flaps are a reliable option for most oncological thigh defects.
- Microsurgical reconstruction is indicated for extensive defects, previously irradiated tissues, and when functional restoration of the quadriceps or hamstrings is required.
- The findings support an algorithmic approach to thigh reconstruction, optimizing outcomes based on defect characteristics and patient factors.
