Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps

Abstract

Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT-FC, eight ALT-MC, and nine VL-MC flaps were performed. All flaps survived. Venous congestion occurred in three VL-MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision-making.

Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

“…Groin, mons pubis, vaginal or urethral defects are often present in gynecologic surgery for vulvar cancer; this creates singular geometries of defects that must be considered tridimensionally as one single shape, in order to correctly choose the flap for reconstruction. Few papers in literature consider perforator flaps for vulvoperineal reconstruction [789]; and a true algorithmic approach, including the complete broad armamentarium of traditional and perforator flaps, has not been published. These flaps can be technically demanding but preferable in many cases, because of the longer pedicle, better mobility, and decreased donor site morbidity.…”

The Versatility of Pedicled Anterolateral Thigh Flap: A Tertiary Re-ferral Center Experience from India

“…Many authors focussed the utility of pedicled ALT for various soft tissue defects pertaining to specific anatomical regions [4][5][6][7]. To the best of our knowledge, very few articles described the diverse anatomical locations where pedicled ALT flap was used, including the abdomen, groin, trochanteric region, and the knee [8].…”

Coverage of supraumbilical abdominal wall defects: The tunnelled‐pedicled ALT technique

“…First, Kimata et al described ALT flap for abdominal wall coverage in 1999, and its principal advantages are that the blood supply to its distal portion is reliable and that the vascular pedicle is longer than that of the other musculocutaneous flaps, which have also been used for abdominal wall reconstruction. This rich blood supply makes the ALT flap an excellent tool, which increases resistance to infection and reduces the recovery time, when used for the reconstruction of abdominal wall defects . The ALT myocutaneous flap provides an increased amount of muscle and fascia and can be utilized in larger abdominal wall defects.…”

“…The most frequently utilized locorregional flaps include, but are not limited to, the external oblique muscle, rectus abdominis muscle, omental flaps, latissimus dorsi muscle, rectus femoris muscle, or tensor fasciae latae muscle . The anterolateral thigh flap (ALT flap) with or without a portion of vastus lateralis muscle has been also successfully employed, both as free or pedicled flap . Pedicled flap use has been limited to groin, perineal, and lower abdominal defects, and is usually not considered for supraumbilical defects coverage in the most recent algorithms .…”