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Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction

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Published on May 12, 2020

Atmodiwirjo P, Ramadan MR, Triatmoko SE, Arina MN. Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction. J Plast Rekons 2020;7(1):38-42. DOI: https://doi.org/10.14228/jpr.v7i1.298

This is supplementary information from Jurnal Plastik Rekonstruksi (www.jprjournal.com) video article as follow:

TITLE
Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction

AUTHORS
1. Parintosa Atmodiwirjo
Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital. Jakarta, Indonesia.
2. Mohamad Rachadian Ramadan
Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital. Jakarta, Indonesia.
3. Sara Ester Triatmoko
Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo National Hospital. Jakarta, Indonesia
4. Maryam Nur Arina
Faculty of Medicine, Universitas Indonesia. Jakarta, Indonesia

ABSTRACT
Introduction: Multi-stages refinement of a bulky flap after composite defects reconstruction of multiple facial units has been a challenging situation. Goals including restoration of periorbital and malar area and redefining the aesthetic aspects of the units as well as the surrounding nasolabial area with multiple refinements and microfat graft.

Methods: A 50-year-old male patient with a history of solitary fibrous tumor underwent wide excision of left periorbital, infraorbital, lateral nasal sidewall, and malar area. The defect is enclosed with Anterolateral Thigh Free Flap (ALT). Bulkiness of the flap, sunken left nasolabial, and asymmetric alar nasal unit were found during outpatient follow-up. These problems lead to the necessity of refinement procedure to reduce the bulkiness to improve the aesthetic outcome of the patient. Microfat graft was the method chosen to volumized the sunken nasolabial and asymmetric alar nasal unit.

Results: Patient is satisfied with the result due to improvement of alar nasal units symmetricity and reduced bulkiness of the flap area. No complication was observed.

Conclusion: Meticulous planning and staging of the surgical refinement procedures in conjunction with microfat graft results in good aesthetic outcome and satisfies the patient and reduces the possibility of complications.

REFERENCES
1. Atmodiwirjo P, Ramadan MR, Triatmoko SE, Arina MN. Simple Yet Functional Reconstruction for Unilateral Total Maxillectomy Defect Using Anterolateral Thigh Free Flap. 2019.
2. Santamaria E, Cordeiro PG. Reconstruction of maxillectomy and midfacial defects with free tissue transfer. J Surg Oncol. 2006;94(6):522-31.
3. Atmodiwirjo P, Aulia, I. How to Harvest The Anterolateral Thigh Free Flap: Step-by-Step Jakarta: Lingkar Studi Bedah Plastik; 2019.
4. Haddock NT, Saadeh PB, Siebert JW. Achieving aesthetic results in facial reconstructive microsurgery: planning and executing secondary refinements. Plast Reconstr Surg. 2012;130(6):1236-45.
5. Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat Grafting: Basic Research and Clinical Applications. Plastic and Reconstructive Surgery. 2013;132(4).
6. Nguyen PS, Desouches C, Gay AM, Hautier A, Magalon G. Development of micro-injection as an innovative autologous fat graft technique: The use of adipose tissue as dermal filler. J Plast Reconstr Aesthet Surg. 2012;65(12):1692-9.
7. Khouri RK, Jr., Khouri RK. Current Clinical Applications of Fat Grafting. Plast Reconstr Surg. 2017;140(3):466e-86e.
8. Ramadan MR, Ralena N, Triatmoko S, Atmodiwirjo P. Early And Recent Development Of Reconstructive Microsurgery Subspeciality In Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia (1983-2020). Jurnal Plastik Rekonstruksi. 2019; 6:281-90.

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