Application of Free Flow‐Through Anterolateral Thigh Flap for the Reconstruction of an Extremity Soft Tissue Defect Requiring Vascularization

Abstract

Patients with severe injury or vasculopathy of the extremities often require resurfacing of tissue defects as well as preservation of functional blood flow to distal areas. In conventional free flap transfer, the recipient vessel is sacrificed to facilitate pedicle anastomosis. On the other hand, a flow-through flap can provide blood flow to distal tissues. In this chapter, we present cases of successful salvage and reconstruction of the extremities using free flow-through flaps and highlight their advantages and applications. Free flow-through flap use should be a good option in the following cases: (1) Gustilo-Anderson IIIC type open fracture, (2) chronic ulcer resurfacing in the less vascularized extremities, and (3) additional blood supply for an ischemic flap. This flap facilitates not only the reconstruction of soft tissue defects, but also restores the functional vascular anatomy and maintains the original blood flow by interposing the T-portion of the vessel. This technique enables both vascular and soft tissue reconstructions simultaneously with minimal donor site problems. The anterolateral thigh flap is recommended as a free flow-through-type flap due to its advantages, including the variety of flap sizes, adequate calibers of the vascular pedicle, and the lack of a need for position changing.

“Fix after Flap” concept that covers exposed bone wounds on the day for suffering Gustilo-Anderson IIIB and C fractures

“…When performing immediate free flow-through flap transfer for GAIIIC fracture, we frequently use an anterolateral thigh flap as the first choice for flaps. The reason is that this flap is ideal for limb reconstruction as it can provide a large skin paddle, has long flow-through vessels, does not require intraoperative repositioning, and minimizes donor site sacrifice [19][20][21].…”

Introductory Chapter: General Remarks Regarding Limb Amputations

“…Treatment of patients with severe injury with vasculopathy of the extremities, such as trauma-related amputation and Gustilo-Anderson type IIIC fracture, is challenging, because it often requires the resurfacing of tissue defects as well as preservation of functional blood flow to distal areas [1]. Previously, patients with these severe limb injuries underwent amputation.…”

“…Developments of microsurgical techniques allows reimplantation in patients with severed hands, legs, and fingers (Figures 1 and 2). And flap transfer techniques have also allowed reconstruction of bone and soft tissue defects in the extremities following malignant neoplasm resection and severe open fractures (Figures 3 and 4) [1].…”

A Retrospective Analysis of Amputation Risk Due to Diabetic Foot and Angioplasty and Free Flap Transfer to Reduce Major Amputation

“…The anterolateral thigh (ATL) flap is often chosen because it is supplied by the descending branch of the lateral femoral circumflex artery, which has an external diameter of more than 2 mm at the proximal end with a pedicle of more than 8 cm in length [45,46]. This flap is also a perforator flap, so that a larger cutaneous or fasciocutaneous flap can be harvested from the thigh while avoiding the sacrificing of underlying muscle and large vessels [47,48].…”