Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap.

BACKGROUND: Reconstructing complex soft tissue defects of the finger requires both functional and aesthetic aspects. There are many free tissue transfers as suitable options for digital resurfacing. The anterolateral thigh (ALT) flap is not the first choice for reconstruction of this area because it has the disadvantage that the subcutaneous tissue is too thick; however, its use as a thinned form has yet to be described much. This study presents the flap thinning technique in the small-sized ALT flap for the finger soft tissue defect. METHOD: From May 2009 to March 2018, 10 patients with complete circumferential or semicircumcision defects in the fingers underwent reconstructive procedures that included thinned ALT flap transfer. Finger soft tissue damage due to contusion trauma includes loss of skin and exposure of the bone and tendon. The flap is thinned in 2 different ways: peripheral thinning and total microsurgical thinning, which is selected based on the perforator vessel structure of the flap. RESULT: The ALT flap sizes, averaging 4-9 cm wide and 6-12 cm long, were thinned to 4-7 mm. One perforator was included in the flaps with a pedicle length average of 6.1 cm. The flaps survived entirely in all patients except one with a 30% area in the distal part of the thinned ALT flap that became necrotic because of venous occlusion. Donor sites were closed primarily for all patients. No patients required secondary flap defatting. CONCLUSIONS: The small thinned ALT perforator flap can be an excellent option for full circumferential or semicircumferential soft tissue defects of the finger. Follow-up showed this as an excellent alternative for finger reconstruction in terms of aesthetic appearance and functional outcome.

Reconstructing Skin Defects of the Neck with Subfascial Expanded Anterolateral Thigh Flap: Report of Two Cases.

Reconstruction of functional and aesthetic deformities of the neck after severe burn contracture is challenging. A free anterolateral thigh (ALT) perforator flap may be required, especially if local tissue is affected. To enlarge the surface area of this flap, donor site pre-expansion can be combined with flap transfer. Two patients with large neck defects were treated using pre-expanded free ALT perforator flaps. A rectangular expander was placed under the deep fascia after dissection of the perforator of the descending branch of the lateral circumflex femoral artery. The expansion time was from 3 to 4 months and the final expanded volume was 900-1500 ml. Defect sizes ranged from 14 × 18 to 18 × 27 cm and the expanded ALT flap was measured from 12 × 18 to 27 × 18 cm with one perforator in the flap. After immediate thinning, flap thickness was reduced, ranging from 5 to 11 mm. All flaps survived completely. Two patients were followed for 40 months. The skin color and textures of the flap were good. There was also a clear improvement in appearance and function. In summary, the subfascial expanded ALT perforator flap can be an excellent option for repairing severe neck defects due to its safe harvesting even with the large flaps. The donor area is closed primarily, and the thinned expanded skin is more aesthetically pleasing. The drawbacks are that it is a two-stage procedure, and the expander may be displaced during the expansion period.

Partial replacement of pelvis with the hip joint in osteosarcoma treatment: A case report.

INTRODUCTION: and importance: Pelvic osteosarcoma is quite rare and is a challenging task for orthopedic surgeons. This aim of this study is to present the first case report using customized 3D-printed prosthesis in Vietnam. CASE PRESENTATION: 57-year-old male was diagnosed with pelvic osteosarcoma. After neoadjuvant chemotherapy, we did limb-salvage surgery after partial pelvic resection. He had to undergo another surgery due to an infection complication that exposed part of the prosthesis. At 6 months follow-up, the patient's overall status was stable. VAS score when moving is 2/10. He can walk with one crutch. Patient is still being followed up and treated. CLININCAL DISCUSSION: Management of pelvic osteosarcoma remains a challenging task for orthopedic surgeons. Advancements in customized 3D-printed prosthesis have been applied in treatment of pelvic osteosarcoma. Despite the complications, the results are promising. We believe that this is a new and innovative route in surgery of pelvic osteosarcoma. CONCLUSION: Using customized 3D-printed prosthesis is a good way for management of pelvic osteosarcoma.