Consideration of a Thin Flap as an Entity and Clinical Applications of the Thin Anterolateral Thigh Flap

Abstract

A defatted (thinned) anterolateral thigh flap was designed to reconstruct skin defects requiring thin flap coverage. We used this flap as a free flap for five cases of skin defects, and the outcomes of the reconstructions were all successful. The vascular pedicle of this flap, the cutaneous perforator of the lateral circumflex femoral artery, is about 8 cm long and 2 mm in diameter, and it is ideal for microvascular anastomosis. Thinning is performed in about 3 to 4 mm of thickness almost uniformly except for the vascular pedicle. It was ascertained as one of the useful donor sites of the free thin flap. The virtue of the thin anterolateral thigh flap is its uniform thinness compared with other thin flaps reported previously--the thin groin flap and the thin rectus abdominis musculocutaneous flap. We considered thin flaps as an entity, and they are classified into three types.

A New Plane of Elevation: The Superficial Fascial Plane for Perforator Flap Elevation

“…The knowledge of the superficial fascia and the plane between deep and superficial fat has opened a safe way to debulk a flap to a reasonable thickness. 5,15,16 So by using this plane, we can obtain a thin flap without the need for additional debulking after the elevation. Although anatomical reports have stressed the importance of the vascular communication between the deep fascia and the subdermal plexus, the role of perfusion in these communication has not been evaluated.…”

“…Immediate debulking procedures can follow but may result in partial loss of the flap. 5 Microdissection can be applied with better success to achieve a thin flap but may be too tedious and time consuming. 6 Thus, secondary debulking procedures are chosen to minimize the flap loss and procedures such as liposuction or surgical resection follows to achieve better contour of the reconstruction site.…”

Colgajo anterolateral del muslo: anatomía quirúrgica, técnica de disección y aplicaciones clínicas

“…Si lo basamos como un colgajo pediculado, lo podemos realizar a flujo reverso y cubrir zonas de la rodilla o 1/3 proximal de la pierna. Como pediculado a flujo directo alcanzaremos áreas del abdomen, zona inguinal, región isquiática y otras partes del muslo (12). Si nuestro planteamiento es como colgajo de perforantes local tipo "propeller" podemos cubrir defectos del muslo y evitar el sacrificio del eje vascular (Fig.…”

“…Algunos autores han descrito unas características determinadas que deben presentar estos colgajos para garantizar su supervivencia. Kimura explica que el colgajo puede adelgazarse hasta conseguir 2 ó 3 mm de grosor, siempre y cuando los límites laterales del colgajo se encuentren a menos de 9 cm del pedículo (12). Koshima por su parte sugiere mantener un grosor de 5 mm de tejido adiposo para proteger el plexo subdér-mico (4).…”

“…La reconstrucción de suelo de boca, lengua, esófa-go y otras zonas de la cabeza y cuello requiere colgajos finos y con un pedículo largo, características que este colgajo reúne; incluso en pacientes obesos, ya que es posible realizar una técnica de adelgazamiento del colgajo (4,12).…”