Assessment of Free Anterolateral Thigh Flap for Extremity Reconstruction

Document Type : Original Article

Author

The Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt

Abstract

Background: Free tissue transfer has undergone substantial
improvement over the past three decades, focusing on functional
and aesthetic results of reconstruction for both the
donor and recipient sites. The free ALT flap is atypical example
of this revolution from its early description by Song et al., in
1984 and its later popularization and wide use to reconstruct
defects all over the body from the head to toes yielding very
good functional and aesthetic results with relatively minimal
donor site morbidity making it a workhorse free flap. For
limb reconstruction, it provides a good size of many tissue
types including skin, subcutaneous fat, muscle, and fascia
with possible sensate flap and flow-through flap for limb
revascularization. The flap pedicle is of adequate size and
length, 2 team approach is possible, and donor site morbidity
is minimal especially with direct closure.
Patients and Methods: From April 2016 – December
2018, 11 male patients aged 5-41 years (mean 27.5 years)
with extremity defects including 6 upper limbs and 5 lower
limbs defects were reconstructed using free ALT flap. Defects
were caused by RTA (8 cases), electrical burn (1 case), and
release of contractures (2 cases).
Results: All flaps survived completely except one case
suffered slowly progressive congestion ending in partial flap < br />loss, managed by debridement and skin grafting. Except for
one flap harvested as musculocutaneous, all flaps were fasciocutaneous.
Flaps perforator pattern were musculocutaneous
in 81.9% of cases and septocutaneous in 18.1% of cases. 9
flaps were based on a single perforator, 2 and 3 perforators
each vascularized one flap.
Conclusion: Free ALT flap is a reliable, versatile reconstructive
option for small to moderately large limb defects.
Donor site morbidity is minimal with direct closure.

Keywords

Main Subjects

References

1- Song Y.G., Chen G.Z. and Song Y.L.: The free thigh flap:
A new free flap concept based on the septocutaneous
artery. Br. J. Plast. Surg., 37: 149-159, 1984.
2- Xu D.C., Zhong S.Z., Kong J.M., et al.: Applied anatomy
of the anterolateral femoral flap. Plast. Reconstr. Surg.,
82: 305-310, 1988.
3- Koshima I., Fikuda H., Utumomiya R., et al.: The anterolateral
thigh flap: Variations in its vascular pedicle. Br.
J. Plast. Surg., 42: 260-262, 1989.
4- Wei F.C., Jain V., Celik N., et al.: Have we found an ideal
soft-tissue flap? An experience with 672 anterolateral
thigh flaps. Plast. Reconstr. Surg., 109: 2219-2226, 2002.
5- Chen H.C. and Tang Y.B.: Anterolateral thigh flap: An
ideal soft tissue flap. Clin. Plast. Surg., 30: 383-401,
2003.
6- Koshima I., Kawada S., Etoh H., et al.: Flow-through
anterior thigh flaps for one-stage reconstruction of softtissue
defects and revascularization of ischemic extremities.
Plast. Reconstr. Surg., 95: 252-260, 1995.
7- Zhang Q., Qiao Q., Yang X., et al.: Clinical application
of the anterolateral thigh flap for soft tissue reconstruction.
J. Reconstr. Microsurg., 26: 87-94, 2010.
8- Koshima I., Yamamoto H., Hosoda M., et al.: Free combined
composite flaps using the lateral circumflex femoral
system for repair of massive defects of the head and neck
regions: An introduction to the chimeric flap principle.
Plast. Reconstr. Surg., 92: 411-427, 1993.
9- Lin C.H., Wei F.C., Lin Y.T., et al.: Lateral circumflex
femoral artery system: Warehouse for functional composite
free-tissue reconstruction of the lower leg. J. Trauma, 60:
1032-1036, 2006.
10- Brody R.M., Pandey N.C., Bur A.M., et al.: Anterior
lateral thigh osteomyocutaneous free flap reconstruction
in the head and neck: the anterolateral thigh osteomyocutaneous
femur bone flap. Head Neck, 38 (12): 1788-93,
2016.
11- Worley M.L., Patterson T.M., Graboyes E.M., et al.:
Association of the anterolateral thigh osteomyocutaneous
flap with femur structural integrity and assessment of
prophylactic fixation. JAMA Otolaryngol. Head Neck
Surg., 144 (9), 2018.
12- Seth A.K. and Iorio M.L.: Super-Thin and suprafascial
anterolateral thigh perforator flaps for extremity reconstruction.
J. Reconstr. Microsurg., 33 (7): 466-73, 2017.
13- Meky M.: Versatility of Anterolateral Thigh Flap in Dorsal
Hand Reconstruction. Egypt. J. Plast. Reconstr. Surg., 42
(2): 311-315, 2018.
14- Kholousy H.M., Elkafrawi H. and Farouk A.: The Versatility
of the Free Anterolateral Thigh Flap in Reconstruction
of Soft Tissue Defects in the Extremities. Egypt. J. Plast.
Reconstr. Surg., 43, (1): 25-29, 2019.
15- Abdel-Khalek A., Allam A., Hendy A., et al.: Clinical
Evaluation of Free Anterolateral Thigh Flap in the Reconstruction
of Major Soft Tissue Defects in the Leg and
Foot. Egypt. J. Plast. Reconstr. Surg., 27 (2): 173-180,
2003.
16- Zakaria Y.: Anterolateral Thigh Perforator Flap for Reconstruction
of Lower Extremity Soft Tissue Defects.
Egypt. J. Plast. Reconstr. Surg., 39 (1): 73-78, 2015.
17- Ayad W., ElGamal M., Farahat A. and El Batawy A.:
Microsurgical Reconstruction of Traumatic Lower Extremity
Defects in Pediatric Patients: Is Fasciocutanous
Flap A Versatile Tool to Replace Musculocutaneous Flap?
Egypt. J. Plast. Reconstr. Surg., 43 (1): 129-132, 2019.
18- Wong C.H., Wei F.C., Fu B., et al.: Alternative vascular
pedicle of the anterolateral thigh flap: The oblique branch
of the lateral circumflex femoral artery. Plast. Reconstr.
Surg., 123: 571-577, 2009

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