Anterolateral Thigh Flap Design by Using Suprafascial Course of the Perforator

Abstract

Objectives Recently, anterolateral thigh flap has become one of the most commonly used free flaps in reconstructive surgery. Although its pedicle has relatively sufficient length, it falls short in some circumstances. Eccentric perforator location can be used to lengthen the pedicle, but flap tip viability can be a problem in this case. In addition, partial flap loss can be encountered in perforator flaps. The aim of this study was the use of multidetector computed tomographic angiography in preoperative mapping to overcome these problems. Materials and Methods Anterolateral thigh perforator flap was planned for various soft-tissue reconstructions in 19 patients. There were 15 males and 4 female patients with ages ranging from 19 to 65 years. These patients were evaluated with preoperative multidetector computed tomographic angiography to choose and to trace the course of the perforators. Flaps were designed according to the suprafascial course of the perforators. Perforators were safely located eccentrically when needed. Pedicle length and complications, such as infection, wound dehiscence, and partial or total flap loss, were recorded. Results Perforators were located eccentrically in 8 patients and centrally in the other 11 patients. Eleven flaps were used in lower leg reconstruction, 2 flaps in popliteal region, and 6 flaps in head and neck. All flaps survived and any partial or total loss did not occur. There was not any infection and wound problem. Conclusions Multidetector computed tomographic angiography can reveal the suprafascial course of the perforator and help design anterolateral thigh perforator flap. By using this kind of mapping, perforators can be safely located eccentrically to lengthen the pedicle and partial flap loss can be prevented.

Preoperative Computed Tomography Angiography for ALT Flaps Optimizes Design and Reduces Operative Time

“…The findings from our study, which to our knowledge is the largest series of patients undergoing preoperative CTA for ALT planning, are consistent with previous reports in the literature 5 10 15 17 19 20 22 23 that preoperative CTA accurately predicts ALT perforator course by confirming congruency between imaged anatomy and operative findings in 70% of cases. We also identified a high rate of dominant perforator asymmetry between lower extremities in 32 patients (40.5%), a finding shared by several anatomic studies.…”

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

“…Past studies of the sensitivity of CTA for perforator identification are widely variable (27.7–99.4%) compared with CDU (73.3–99.2%). 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 The report by Wang et al is a notable outlier in regard to CTA sensitivity due to their significantly reduced sensitivity for traditional CTA (27.7%) compared with catheter-based CTA. 25 In our meta-analysis, CDU (95.3%, 95% CI: 90.9–97.6%) had a greater sensitivity for ALT flap perforator identification compared with CTA (90.4%, 95% CI: 74.4–96.9%) ( Fig.…”

Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

“…In our study we see that in the first 10 years radial flaps were primarily being used, then SCIP flaps, and in the last 10 years mostly ALT. Almost 80% of the articles included were published in the last decade, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] indicating that this a very contemporary subject in reconstructive surgery (Figure 2).…”