Free Anterolateral Thigh Flap for Extremity Reconstruction: Clinical Experience and Functional Assessment of Donor Site

Abstract

From August of 1995 through July of 1998, 38 free anterolateral thigh flaps were transferred to reconstruct soft-tissue defects. The overall success rate was 97 percent. Among 38 anterolateral thigh flaps, four were elevated as cutaneous flaps based on the septocutaneous perforators. The other 34 were harvested as myocutaneous flaps including a cuff of vastus lateralis muscle (15 to 40 cm3), either because of bulk requirements (33 cases) or because of the absence of a septocutaneous perforator (one case). However, vastus lateralis muscle is the largest compartment of the quadriceps, which is the prime extensor of the knee. Losing a portion of the vastus lateralis muscle may affect knee stability. Objective functional assessments of the donor sites were performed at least 6 months postoperatively in 20 patients who had a cuff of vastus lateralis muscle incorporated as part of the myocutaneous flap; assessments were made using a kinetic communicator machine. The isometric power test of the ratios of quadriceps muscle at 30 and 60 degrees of flexion between donor and normal thighs revealed no significant difference (p > 0.05). The isokinetic peak torque ratio of the quadriceps and hamstring muscles, including concentric and eccentric contraction tests, showed no significant difference (p > 0.05), except the concentric contraction test of the quadriceps muscle, which revealed mild weakness of the donor thigh (p < 0.05). In summary, the functional impairment of the donor thighs was minimal after free anterolateral thigh myocutaneous flap transfer.

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

“…Donor site complications are rare after harvesting the anterolateral thigh flap. 17,18,20,26,27 Although the radial forearm flap donor site morbidities are generally minor, tendon exposure and adhesions, sensory nerve damage, minor functional deficits, and a highly visible scar on the forearm [28][29][30][31] are frequent complaints. The radial forearm flap also has a reputation of having a high fistula rate, ranging from 17% to 50%.…”

A systematic review of anterolateral thigh flap donor site morbidity

“…The vastus lateralis is the biggest of these muscles and, if damaged, could result in patella and knee instability, as well as decreased knee extension (17,49). Perforator vessels to the ALT flap are septocutaneous (between rectus femoris and vastus lateralis) or musculocutaneous, the latter running through the vastus lateralis, and require intramuscular dissection with potential damage to the muscle (19,26,34).…”

“…Some authors have subjectively concluded that the degree of donor site dysfunction was related to the degree of vastus lateralis damage (14,19); however, others found no such differences (30). Two studies carried out quantitative functional assessments comparing thighs from which an ALT flap was harvested with normal thighs, and found no statistically significant differences in function (17,34).…”

“…T he anterolateral thigh (ALT) flap, first described as a septocutaneous perforator-based flap by Song et al (1) in 1984, has recently gained popularity and has become an important option for reconstruction of multiple anatomical locations such as the head and neck (3)(4)(5)(6)(7)9,10,(12)(13)(14)16,(18)(19)(20)(21)(22)(23)(25)(26)(27)(28)(29)(30)32,34,36,38,39,(41)(42)(43), upper (15)(16)(17)(18)(19)26,32,35,37,38,42) and lower (8,(16)(17)(18)(19)22,24,…”

Expert’s comment concerning Grand Rounds case entitled “Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period” (by Hui-Ren Tao et al. doi:10.1007/s00586-012-2519-1)

“…Subsequently, after being able to reattach amputated parts, surgeons learned to transfer tissue from one part of the body to another, so called autologous tissue transplantation. Coincidentally, the anterior lateral thigh flap was described by the Chinese, and has become the ''work horse'' soft tissue flap, particularly as it relates to vascularized skin transfer in the modern microsurgical world [6,7]. Previous skin flaps such as the radial forearm flap, the scapular flap, and the groin flap are all microvascular tissue transfers that can be performed, but do not provide the surface area that the anterior lateral thigh flap supplies.…”