Free Fillet Flaps For Reconstruction Of Massive Oncologic Resections
Lucas Kreutz-Rodrigues, MD., Tony Chieh-Ting Huang, MD, MSc, Brian T. Carlsen, MD., Samir Mardini, MD., Matthew T. Houdek, MD., Peter S. Rose, MD., Karim Bakri, M.B.B.S..
Mayo Clinic, Rochester, MN, USA.
Purpose: The management of massive upper and lower extremity defects following tumor resections can be challenging (Figure 1). A suitable solution to provide large defect coverage is the fillet flap which is defined as a pedicled or a free flap harvested from a non-salvageable part to provide skin, muscle, fascia, or bone (Figure 2). The purpose of this project is to present our experience using free fillet flaps to reconstruct massive oncological defects.
Methods: A retrospective chart review was conducted to include patients who underwent massive oncologic resection followed by reconstruction using a free fillet flap from July 2001 to October 2018. Patient demographics, medical history, surgical characteristics, and post-operative complications were reviewed.
Results: A total of 12 patients were identified and included in this study. Mean age was 48.9 years old (21 - 67). Five patients (41.7%) had extended forequarter amputation and seven patients (58.3%) had external hemipelvectomy, all for oncologic indications. Five patients (41.7%) received at least one neoadjuvant therapy (chemotherapy or radiation therapy). Eleven patients (91.7%) underwent resection for curative intent (7 patients for recurrent local disease, and 4 as a primary resection). One patient underwent a palliative external hemipelvectomy for life-threatening tumor hemorrhage. The mean tumor size was 15.2 cm (3.5-24.5), and negative tumor margins were achieved for all patients. The mean flap size was 1028 cm2 (534 - 3150) including 8 myocutaneous flaps (66.6%), 3 fasciocutaneous flaps (25%), and 1 osteomyocutaneous flap (8.3%). Average hospital length of stay was 19.8 days (7-38) and mean duration of follow up was 10.7 months. All patients reported some degree of phantom pain postoperatively. Two patients had a superficial wound dehiscence, but there were no partial or total flap losses in the post-operative period. One patient who underwent an upper extremity free fillet flap required urgent re-exploration twice, once for postoperative hemorrhage, and subsequently for venous thrombosis, with an eventual satisfactory outcome.
Conclusion: The free fillet flap may be beneficial in the management of patients who require massive oncologic resections. The free fillet flap is a safe technique that avoids donor site morbidity, with an acceptable complication rate providing a flap that can potentially extend the limits of curative or palliative oncologic resection (Figure 3).
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