الفهرس | Only 14 pages are availabe for public view |
Abstract Reconstruction of the head and neck continues to pose a formidable challenge for maxillofacial and plastic surgeons. Cancer, trauma, and congenital anomalies are the primary reasons for patients to seek repair. The simple fact that this anatomical region lies in such an obvious location makes cosmetic camouflage difficult. Defects of any size can have a dramatic effect on cosmesis, speech, respiration, and alimentation, which may significantly impact a patient’s quality of life, the role of the reconstructive surgeon is to have a diverse armamentarium of reconstructive options to enable an aesthetic and functional reconstruction while minimizing the morbidity to the patient. The anterolateral thigh free flap (ALT) has emerged as a popular option for reconstruction of head and neck defects. It has the attributes of a “workhouse” flap which include absence of patient repositioning, remote location from the potential defect, and a long pedicle. The ALT was first described by Song in 1984. It should be emphasized that the skin associated with this flap is anterolateral thigh skin and that the pedicle is almost the descending branch of the lateral circumflex femoral artery. The unique anatomy of the thigh permits several methods of harvesting the ALT flap. The type of tissues to be included in the flap can be selected according to the defect to be reconstructed. The ALT flap can be harvested at the suprafascial level to include just skin and subcutaneous fat, which is useful when a thin flap is desired. When harvested at the subfascial level, the flap can bring additional tissue bulk including the fascia lata on the deep surface. A musculocutaneous flap can be harvested by including part of the vastus lateralis muscle. In this thesis, a study was made to evaluate indications, advantages, disadvantages and complications of usage of anterolateral thigh flap as a free flap in head & neck reconstruction. The study include 3 patients ( all are females ) ranged in age from 41 to 55y who had extensive soft tissue defect in head & neck after malignant tumor excision and have been reconstructed by free ALT flap. The flap perforator was a musclocutaneous perforator and originated form the descending branch of lateral circumflex femoral in all cases. The length of the pedicle ranged from 10 to 15 cm. In all the cases the pedicle was composed of one artery and two veins. The flaps ranged in size from 10 to 16 cm in length and 7 to 15 cm in width. The donor site was closed primarily in the 3 cases. Two flaps survived completely and one suffered from complete necrosis due to failure of microvascular anastomosis and was managed by replacement of the flap by pedicled pectorals major flap. The duration of post-operative hospital stay ranged from 12- 14 day. There was no post-operative wound infection or dog ear formation in the donor site. According to recipient site, the flap was bulky in one case and no post-operative hemorrhage or local abscess was recorded. |