Application of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZUO Liang ,  YU Jianjun , ZHOU Xiao , DAI Jie , TIAN Hao , SHAN Zhenfeng , HU Jie , CHEN Xing , WANG Honghan , CAI Xu , GAO Shuichao

The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China;

Corresponding?author：

YU Jianjun, Email: yujianjun@hnszlyy.com

Keywords：

Kiss flap; free anterolateral thigh flap; scalp malignant tumor; wound repair

DOI：

10.7507/1002-1892.201711046

Video：

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ObjectiveTo investigate the effectiveness of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection.MethodsBetween December 2012 and December 2016, 18 patients with large scalp defect after malignant tumor resection were treated. There were 16 males and 2 females with an average age of 52.6 years (range, 43-62 years). There were 17 cases of squamous carcinoma and 1 case of dermatofibrilsarcoma protuberan. The size of scalp defect ranged from 15 cm×10 cm to 17 cm×12 cm after resection of tumors. The scalp defects were repaired with the free anterolateral thigh Kiss flap. And the size of flap ranged from 15 cm×6 cm to 20 cm×8 cm. The skull was completely resected in 2 cases, and repaired with Titanium mesh. The sizes of skull defects were 12 cm×10 cm and 10 cm×8 cm. The donor site was sutured directly.ResultsEighteen flaps survived with primary healing of wounds; and healing by first intention was obtained at the donor sites. One patient died because of intracranial metastasis at 5 months after operation, and no local recurrence occurred in the other 17 patients. The follow-up time ranged from 6 months to 4 years (mean, 26.6 months). The results of both appearance and function were satisfactory, without ulceration during follow-up. No obvious scar was found at donor sites and no obvious impairment was observed after harvesting free anterolateral thigh flap.ConclusionLarge scalp defects after malignant tumor resection can be effectively repaired by free anterolateral thigh Kiss flap. The donor site can be sutured directly, without skin grafting, thus avoiding the secondary donor site.

Citation： ZUO Liang, YU Jianjun, ZHOU Xiao, DAI Jie, TIAN Hao, SHAN Zhenfeng, HU Jie, CHEN Xing, WANG Honghan, CAI Xu, GAO Shuichao. Application of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(3): 346-349. doi: 10.7507/1002-1892.201711046 Copy

1.	王煒. 整形外科學. 杭州: 浙江科學技術出版社, 1999: 473-474.
2.	王煒, 李華. 游離股前外側皮瓣一期修復頭皮鱗狀細胞癌術后大面積缺損. 實用醫學雜志, 2011, 27(21): 3984-3985.
3.	Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125.
4.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
5.	Chao AH, Yu P, Skoracki RJ, et al. Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer: a 10-year experience. Head Neck, 2012, 34(12): 1759-1764.
6.	Bauer F, Koerdt S, H?lzle F, et al. Eight free flaps in 24 hours: a training concept for postgraduate teaching of how to raise microvascular free flaps. Br J Oral Maxillofac Surg, 2016, 54 (1): 35-39.
7.	Ghali S, Chang EI, Rice DC, et al. Microsurgical reconstruction of combined tracheal and total esophageal defects. J Thorac Cardiovasc Surg, 2015, 150 (5): 1261-1266.
8.	Fanzio PM, Chang KP, Chen HH, et al. Plate exposure after anterolateral thigh free-flap reconstruction in head and neck cancer patients with composite mandibular defects. Ann Surg Oncol, 2015, 22 (9): 3055-3060.
9.	Xu Z, Zhao XP, Yan TL, et al. A 10-year retrospective study of free anterolateral thigh flap application in 872 head andneck tumour cases. Int J Oral Maxillofac Surg, 2015, 44 (9): 1088-1094.
10.	Yamamoto T, Narushima M, Yoshimatsu H, et al. Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma-in-continuity and recurrent carpal tunnel syndrome after carpal tunnel release. Microsurgery, 2014, 34 (2): 145-148.
11.	Baas M, Duraku LS, Corten EM, et al. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits? J Plastic Reconstr Aesthet Surg, 2015, 68 (8): 1025-1035.
12.	Wong C, Nagarkar P, Teotia S, et al. The profunda artery perforator flap: investigating the perforasome using three-dimensional computed tomographic angiography. Plast Reconstr Surg, 2015, 136 (5): 915-919.
13.	Wang Y, Chen SY, Gao WY, et al. Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply. Br J Surg, 2015, 102(4): 375-381.
14.	O’Malley RB, Robinson TJ, Kozlow JH, et al. Computed tomography angiography for preoperative thoracoabdominal flap planning. Radiol Clin North Am, 2016, 54 (1): 131-145.
15.	Tao Y, Hu S, Lui KW, et al. Quantitative regression analysis of the cutaneous vascular territories in a rat model. Surg Radiol Anat, 2011, 33(9): 789-799.
16.	Taylor SR, Jorgensen JB. Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer. Laryngoscope, 2015, 125(6): E192-E197.

1. 王煒. 整形外科學. 杭州: 浙江科學技術出版社, 1999: 473-474.
2. 王煒, 李華. 游離股前外側皮瓣一期修復頭皮鱗狀細胞癌術后大面積缺損. 實用醫學雜志, 2011, 27(21): 3984-3985.
3. Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125.
4. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
5. Chao AH, Yu P, Skoracki RJ, et al. Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer: a 10-year experience. Head Neck, 2012, 34(12): 1759-1764.
6. Bauer F, Koerdt S, H?lzle F, et al. Eight free flaps in 24 hours: a training concept for postgraduate teaching of how to raise microvascular free flaps. Br J Oral Maxillofac Surg, 2016, 54 (1): 35-39.
7. Ghali S, Chang EI, Rice DC, et al. Microsurgical reconstruction of combined tracheal and total esophageal defects. J Thorac Cardiovasc Surg, 2015, 150 (5): 1261-1266.
8. Fanzio PM, Chang KP, Chen HH, et al. Plate exposure after anterolateral thigh free-flap reconstruction in head and neck cancer patients with composite mandibular defects. Ann Surg Oncol, 2015, 22 (9): 3055-3060.
9. Xu Z, Zhao XP, Yan TL, et al. A 10-year retrospective study of free anterolateral thigh flap application in 872 head andneck tumour cases. Int J Oral Maxillofac Surg, 2015, 44 (9): 1088-1094.
10. Yamamoto T, Narushima M, Yoshimatsu H, et al. Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma-in-continuity and recurrent carpal tunnel syndrome after carpal tunnel release. Microsurgery, 2014, 34 (2): 145-148.
11. Baas M, Duraku LS, Corten EM, et al. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits? J Plastic Reconstr Aesthet Surg, 2015, 68 (8): 1025-1035.
12. Wong C, Nagarkar P, Teotia S, et al. The profunda artery perforator flap: investigating the perforasome using three-dimensional computed tomographic angiography. Plast Reconstr Surg, 2015, 136 (5): 915-919.
13. Wang Y, Chen SY, Gao WY, et al. Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply. Br J Surg, 2015, 102(4): 375-381.
14. O’Malley RB, Robinson TJ, Kozlow JH, et al. Computed tomography angiography for preoperative thoracoabdominal flap planning. Radiol Clin North Am, 2016, 54 (1): 131-145.
15. Tao Y, Hu S, Lui KW, et al. Quantitative regression analysis of the cutaneous vascular territories in a rat model. Surg Radiol Anat, 2011, 33(9): 789-799.
16. Taylor SR, Jorgensen JB. Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer. Laryngoscope, 2015, 125(6): E192-E197.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection

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