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Successful retrograde arterial inflow through a muscular branch in a free anterolateral thigh chimeric flap transfer
Author(s) -
Numajiri Toshiaki,
Sowa Yoshihiro,
Nishino Kenichi,
Sugimoto Kayo,
Iwashina Yuki,
Ikebuchi Kaichiro,
Nakano Hiroshi,
Shimada Taketoshi,
Hisa Yasuo
Publication year - 2012
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.21943
Subject(s) - medicine , free flap , surgery , microsurgery , artery , anatomy , circumflex , superior thyroid artery , thyroid
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. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.