title: Successful retrograde arterial inflow through a muscular branch in a free anterolateral thigh chimeric flap transfer.
abstract: In this report, we present a case in which a free anterolateral thigh (ALT) flap was transferred for head and neck reconstruction after oropharyngeal cancer ablation, and a retrograde arterial inflow was used to salvage the flap when the main arterial pedicle showed usual repeated spasms. The flap was raised as a chimera flap comprising a fasciocutaneous flap and a vastus lateralis muscle flap. After reperfusion, the pedicle artery exhibited spasms repeatedly and vascular flow was unstable. Therefore, we performed arterial supercharge. In the distal portion of the muscle flap, a small arterial branch was dissected as a reverse-flow arterial pedicle. The recipient artery was also a retrograde limb of the superior thyroid artery. The flap survived; however, postoperative ultrasonographic echo evaluation revealed that the spastic descending branch of the lateral circumflex femoral artery was obstructed and that the reverse-flow muscular perforator alone nourished the whole flap. In free ALT flap transfer, a small perforator level artery was able to nourish a flap, even in a retrograde manner. Moreover, when the vasculature of the free flap is unstable, retrograde arterial supply to a small perforator can be an option to save the flap transfer.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. prs-bin@koto.kpu-m.ac.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Numajiri
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sowa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nishino
authors.forename: Kayo
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Yuki
authors.initials: Y
authors.lastname: Iwashina
authors.forename: Kaichiro
authors.initials: K
authors.lastname: Ikebuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakano
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Shimada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hisa
mesh_terms: D001158:Arteries; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow; D013848:Thigh / Q000601:surgery