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Reconstruction of Massive Oncologic Defects Using Free Fillet Flaps

Ver Halen, Jon P. M.D.; Yu, Peirong M.D.; Skoracki, Roman J. M.D.; Chang, David W. M.D.

Plastic and Reconstructive Surgery: March 2010 - Volume 125 - Issue 3 - p 913-922
doi: 10.1097/PRS.0b013e3181cb6548
Reconstructive: Trunk: Original Articles

Background: Forequarter and hind-limb amputations are used with curative and palliative intent in the setting of proximal limb, thorax, or truncal malignancies. For these large defects that require a free flap, the distal portions of these limbs can be harvested as fillet flaps and represent the “spare parts” concept of surgical reconstruction.

Methods: The authors performed a retrospective review of 27 patients (mean age, 51.4 years) who had undergone immediate reconstruction with free fillet extremity flaps between 1991 and 2008. Seventeen patients received preoperative radiotherapy, and 21 received preoperative chemotherapy. Resections included seven hemipelvectomies, 16 forequarter amputations, and four hindquarter amputations.

Results: The mean defect size was 1126 cm2 (range, 480 to 3500 cm2). All 27 flaps survived and all wounds healed. Four patients (15 percent) had complications; three patients developed partial flap necrosis and required operative débridement, and there were two episodes of flap vascular compromise. Mean follow-up time was 14 months. One patient was lost to follow-up. Eight patients (30 percent) were still alive at the end of the study. The remaining 18 patients died within 22 months of resection, for a mean survival of 7 months. There was no cancer recurrence within the flap itself. Phantom pain occurred in 11 patients. At the time of discharge, pain, tissue necrosis, and infection were improved in all patients.

Conclusion: The use of the fillet flap is oncologically sound, has no associated donor sites, has an acceptable incidence of major complications, and allows for a healed wound with an improvement in the quality of life.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication July 24, 2009; accepted September 15, 2009.

Presented at Plastic Surgery 2009: The Annual Meeting of the American Society of Plastic Surgeons, in Seattle, Washington, October 25, 2009.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

David W. Chang, M.D., Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, dchang@mdanderson.org

©2010American Society of Plastic Surgeons