Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study
Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complicat...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-09-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/19/6208 |
| _version_ | 1797575680395837440 |
|---|---|
| author | Julius Moratin Philip Dao Trong Karl Semmelmayer Jan Mrosek Sven Zittel Moritz Bleymehl Oliver Ristow Christian Freudlsperger Jürgen Hoffmann Michael Engel |
| author_facet | Julius Moratin Philip Dao Trong Karl Semmelmayer Jan Mrosek Sven Zittel Moritz Bleymehl Oliver Ristow Christian Freudlsperger Jürgen Hoffmann Michael Engel |
| author_sort | Julius Moratin |
| collection | DOAJ |
| description | Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complication rates, hospitalization and surgery time. Cases with defect situations of the scalp and consecutive microvascular free flap reconstructions using either ALT flaps or vastus lateralis muscle flaps between 2014 and 2022 were retrospectively analyzed. Indications, perioperative handling and outcomes were compared. Twenty patients were included in the analysis. Ten patients (50%) received a free flap reconstruction using an ALT flap and ten patients (50%) received a vastus lateralis flap. A simultaneous two-team approach was possible in each case and the flap success rate was 100% with the need for one successful anastomosis revision. The mean defect size in our cohort was 147 ± 46 cm<sup>2</sup>. There were no significant differences in surgery time, duration of hospitalization or complication rate between both cohorts. Both free flaps, the ALT and the vastus lateralis flap, are suitable for the closure of large scalp defects. They provide high success rates, short surgery times without the need for patient repositioning and low donor-site morbidity. The vastus lateralis muscle flap bares the advantage of being perforator-independent and allows for the preparation of long vessels for anastomosis if needed while baring the disadvantage of a prolonged period of healing via granulation or the need for secondary surgery in terms of covering by split-thickness skin grafts which may interfere with necessary adjuvant treatment in oncological patients. |
| first_indexed | 2024-03-10T21:41:42Z |
| format | Article |
| id | doaj.art-5c765e15b538470eaaf3eacfff49829e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:41:42Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-5c765e15b538470eaaf3eacfff49829e2023-11-19T14:35:35ZengMDPI AGJournal of Clinical Medicine2077-03832023-09-011219620810.3390/jcm12196208Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort StudyJulius Moratin0Philip Dao Trong1Karl Semmelmayer2Jan Mrosek3Sven Zittel4Moritz Bleymehl5Oliver Ristow6Christian Freudlsperger7Jürgen Hoffmann8Michael Engel9Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyDepartment of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, GermanyFree flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complication rates, hospitalization and surgery time. Cases with defect situations of the scalp and consecutive microvascular free flap reconstructions using either ALT flaps or vastus lateralis muscle flaps between 2014 and 2022 were retrospectively analyzed. Indications, perioperative handling and outcomes were compared. Twenty patients were included in the analysis. Ten patients (50%) received a free flap reconstruction using an ALT flap and ten patients (50%) received a vastus lateralis flap. A simultaneous two-team approach was possible in each case and the flap success rate was 100% with the need for one successful anastomosis revision. The mean defect size in our cohort was 147 ± 46 cm<sup>2</sup>. There were no significant differences in surgery time, duration of hospitalization or complication rate between both cohorts. Both free flaps, the ALT and the vastus lateralis flap, are suitable for the closure of large scalp defects. They provide high success rates, short surgery times without the need for patient repositioning and low donor-site morbidity. The vastus lateralis muscle flap bares the advantage of being perforator-independent and allows for the preparation of long vessels for anastomosis if needed while baring the disadvantage of a prolonged period of healing via granulation or the need for secondary surgery in terms of covering by split-thickness skin grafts which may interfere with necessary adjuvant treatment in oncological patients.https://www.mdpi.com/2077-0383/12/19/6208free flapmuscle flapscalp defecthead and neckreconstruction |
| spellingShingle | Julius Moratin Philip Dao Trong Karl Semmelmayer Jan Mrosek Sven Zittel Moritz Bleymehl Oliver Ristow Christian Freudlsperger Jürgen Hoffmann Michael Engel Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study Journal of Clinical Medicine free flap muscle flap scalp defect head and neck reconstruction |
| title | Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study |
| title_full | Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study |
| title_fullStr | Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study |
| title_full_unstemmed | Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study |
| title_short | Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study |
| title_sort | comparison of antero lateral thigh flap and vastus lateralis muscle flap for the treatment of extensive scalp defects a retrospective cohort study |
| topic | free flap muscle flap scalp defect head and neck reconstruction |
| url | https://www.mdpi.com/2077-0383/12/19/6208 |
| work_keys_str_mv | AT juliusmoratin comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT philipdaotrong comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT karlsemmelmayer comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT janmrosek comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT svenzittel comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT moritzbleymehl comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT oliverristow comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT christianfreudlsperger comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT jurgenhoffmann comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy AT michaelengel comparisonofanterolateralthighflapandvastuslateralismuscleflapforthetreatmentofextensivescalpdefectsaretrospectivecohortstudy |