Pedicled Anterolateral Thigh Flap

Abstract

Reconstruction of extensive oncosurgical defects of lower trunk, perineum and upper thigh, without the complexity of microsurgery, is a reconstructive challenge. Pedicled anterolateral thigh (ALT) flap offers many advantages over other regional flaps for this purpose, such as the large skin and soft tissue availability, the remarkable pedicle length and the reliability. However, there is paucity of literature describing the utility of pedicled ALT flaps for reconstruction of these difficult soft tissue defects. We present our experience of pedicled ALT flaps for various post oncosurgical defects. From January 2005 to August 2008, 85 pedicled ALT flaps were done in 78 patients for post oncological excision defects of lower trunk, groin, perineum, and upper thigh. Majority of patients were males, with locally advanced inguinal disease, underwent wide skin excision and en bloc nodal resection. Age group ranged from 22 to 81 years. The flap size ranged from 10 x 5 cm (50 cm) to 38 x 20 cm (760 cm). The length of the pedicle ranged from 8 to 14 cm. Satisfactory coverage was achieved in all patients, except one, where the flap had to be discarded due to absent artery in the vascular pedicle. Clinically, no functional deficit of knee extensor mechanism was seen in any of these patients during routine activities. Present study has shown the wide arc of rotation, large skin replacement potential, and reliability of pedicled ALT flap.

The Modified Extended Fleur-De-Lis Latissimus Dorsi Flap for Various Complex Multi-directional Large Soft and Bone Tissue Reconstruction

“…A total of 10 flaps were osteomyocutaneous and 19 were myocutaneous. The mean vertical size of the harvested skin paddle was 30.72 ± 4.57 cm (range: [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], and the mean horizontal size of the skin paddle was 8.69 ± 0.80 (range: 7-10) cm, with the mean maximum horizontal extensions of the flaps being 16.03 ± 1.18 (range: 14-18) cm. The flap survival rates were 100%.…”

“…One of these options is covering the wound with a large single flap. There are a few suitable donor sites for large flaps that include the thigh region for anterolateral thigh (ALT) flap and the lower abdominal area for rectus abdominis muscle myocutaneous flaps or deep inferior epigastric perforator (DIEP) flaps [20]. The literature presents some cases of very large flaps from these donor areas (e.g.…”

Metachronous carcinoma of rectum with reconstruction of a full-thickness abdominal wall defect using a pedicled anterolateral thigh flap

“…The majority of the perforators arise from the descending branch of the LCFA, with the remaining arising from the transverse branch, and less than 3% from the medial descending and ascending branch [ 7 ]. It has been used to reconstruct defects in different sites, such as lower abdomen, trochanteric region, thigh, groin and perineal region [ 8 , 9 ]. The ALT flap is associated with a high success rate of over 93–100% [ 1 , 2 ].…”

Reconstruction of Radiated Gluteal Defects following Sarcoma Resection with Pedicled Sensate Tensor Fascia Lata Flaps

“…Although in these cases microsurgical reconstruction may be considered, these two factors also often render the gluteal vessels (the only recipient vessels in proximity) unsuitable for free tissue transfer, thereby necessitating a significantly more complicated procedure involving vein grafts and position changes during surgery [ 2 , 3 ]. The anterolateral thigh (ALT) flap represents a pedicled option for reconstruction of gluteal defects; however, this is often limited to lateral defects since it is located further from the buttocks than the TFL flap [ 8 , 9 ]. In addition, in our experience, the TFL flap is more easily harvested from a lateral decubitus position compared to the ALT flap, to allow for simultaneous access to the gluteal defect.…”