title: Free anterolateral thigh flap for reconstruction of complex craniofacial defects after resection of tumors of the fronto-orbitomaxillary complex.
abstract: Tumors of the fronto-orbitomaxillary segment are complex and pose a significant challenge for radical resection and subsequent reconstruction. With evolution in surgical reconstructive techniques, better reconstruction of these complex defects is now possible and facilitates more aggressive surgical management. The anterolateral thigh (ALT) flap has features particularly suited for this reconstruction. We review our single institutional experience with this technique. Sixteen consecutive patients with defects of the fronto-orbitomaxillary segment (from radical resection of craniofacial tumors of this region) were reconstructed using the free ALT flap. The demographic features, radiology, histology, and surgical technique as well as the perioperative events were reviewed retrospectively from a prospective database of all craniofacial resections performed. There were 9 males and 7 females with a mean age of 35 years. Eleven had previously undergone surgery. Dura was resected in 6 and inadvertently breached in another 2. Gross total resection was achieved in 14 (87.5%) of the 16 patients, of which 8 had microscopically negative margins. Thirteen musculocutaneous flaps and 3 chimeric flaps were performed. The mean duration of surgery was 9.4 hours. The average total blood loss was 2000 mL. There was no perioperative mortality. Major complications occurred in 2 patients in the form of venous thrombosis on the next day of surgery. These were detected and salvaged promptly by urgent re-exploration and redo of venous anastomosis, ultimately requiring skin grafting for partial flap loss. In our experience, the free ALT flap is a suitable reconstructive choice for complex craniofacial defects and has favorable results.
authors.affiliation: Neurosurgery Services, Department of Head Neck Surgery, Tata Memorial Centre, Parel, Mumbai, India. aliasgar.moiyadi@gmail.com
authors.forename: Aliasgar V
authors.initials: AV
authors.lastname: Moiyadi
authors.forename: Quazi Ahmad
authors.initials: QA
authors.lastname: Ghazwan
authors.forename: Prathamesh S
authors.initials: PS
authors.lastname: Pai
authors.forename: Gauri
authors.initials: G
authors.lastname: Kelkar
authors.forename: Deepa
authors.initials: D
authors.lastname: Nair
authors.forename: Prabha S
authors.initials: PS
authors.lastname: Yadav
mesh_terms: D000293:Adolescent; D000328:Adult; D003399:Craniotomy; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D013848:Thigh; D016896:Treatment Outcome