Customized reconstruction with the free anterolateral thigh perforator flap

Abstract

From April of 2003 through September of 2006, 70 free anterolateral thigh (ALT) flaps were transferred for reconstructing soft-tissue defects. The overall success rate was 96%. Among 70 free ALT flaps, 11 were elevated as cutaneous ALT septocutaneous vessel flaps. Fifty-seven were harvested as cutaneous ALT myocutaneous "true" perforator flaps. Two flaps were used as fasciocutaneous perforator flaps based on independent skin vessels. Fifty-four ALT flaps were used for lower extremity reconstruction, 11 flaps were used for upper extremity reconstruction, 3 flaps were used for trunk reconstruction, and 1 flap was used for head and neck reconstruction. Total flap failure occurred in 3 patients (4.28% of the flaps), and partial failure occurred in 5 patients (7.14% of the flaps). The three flaps that failed completely were reconstructed with a free radial forearm flap, a latissimus dorsi flap and skin grafting, respectively. Among the five flaps that failed partially, three were reconstructed with skin grafting, one with a sural flap, and one with primary closure. The free ALT flap has become the workhorse for covering defects in most clinical situations in our center. It is a reliable flap with consistent anatomy and a long, constant pedicle diameter. Its versatility, in which thickness and volume can be adjusted, leads to a perfect match for customized reconstruction of complex defects.

A Strategic Approach for Tongue Reconstruction to Achieve Predictable and Improved Functional and Aesthetic Outcomes

“…These defects were then classified into groups A to C with the respective flap harvesting for the tongue reconstructions. 2,11,[13][14][15][16]30,31 In group C, an anterolateral thigh myocutaneous flap was designed in a pentagonal shape to recreate the missing tongue (Figs. 16 and 17).…”

Perforator flap: A novel method for providing skin cover to lower limb defects

“…Its versatility in which thickness and volume can be adjusted, leads to a perfect match of customized reconstruction. 9 We used an islanded anterolateral thigh flap with some bulk of vastus lateralis to cover a deep defect in the groin following lymph node dissection and radiotherapy. It has been shown that with anterolateral thigh flap varying sizes of vastus lateralis can be harvested.…”

Soft Tissue Management of War Wounds to the Foot and Ankle

“…The use of the anterolateral thigh free flap has increased dramatically in recent years due to its recognized reliability, potential size, relative ease of harvesting, and minimal donor morbidity 55,56. Harvesting the flap with the patient in the supine position is an attractive feature of this flap that must not be underappreciated, particularly in the multiply injured war-wounded patient.…”