Pedicled chimeric sensitive fasciocutaneous anterolateral thigh (ALT) and vastus lateralis muscle (VLM) flap for groin defect reconstruction: A case report

Abstract

The anterolateral thigh (ALT) flap is one of the most commonly used flap worldwide, as both free flap and pedicled local flap. Here, we report the use of a pedicled chimeric sensitive ALT and vastus lateralis muscle (VLM) flap in a patient with a 12 cm × 8 cm contaminated soft tissue defect of the right inguinal region with exposed femoral vessels. The flap was harvested based on two perforators, one musculocutaneous and one pure muscular, each nourished separately a sensitive fasciocutaneous component and a vastus lateralis muscle component, respectively. The muscle part was tailored to wrap around the exposed vascular structures, while the innervated skin and fascia component of the flap provided a tension-free closure of the wound. The post-operative course was uneventful and the patient was discharged at 1 week post-operative. Even though it requires technical skills and experience in perforator dissection, we believe that the pedicled chimeric sensitive ALT and VLM flap may be one of the best solutions in case of exposed femoral vessels in contaminated wounds.

Total groin defect reconstruction by lymphatic flow‐through (LyFT) pedicled deep inferior epigastric artery perforator (DIEP) flap resorting to its superficial veins for lymphovenous anastomosis (LVA): A case report

“…The pedicled anterolateral thigh (ALT) flap was another interesting option because of its proximity to the groin region. It offers a long pedicle with low donor site morbidity, however, in this case we preferred to exclude it because it would have added further morbidity to the affected leg (Scaglioni, Franchi, & Giovanoli, 2018).…”

Combined pedicled superficial circumflex iliac artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for defect reconstruction and lymphedema–lymphocele prevention in thigh sarcoma surgery: Preliminary results

“…For these reasons nowadays it is the gold standard for autologous breast reconstruction and it is used in the most disparate regions 15,16 . Another option is the pedicled ALT flap, which, instead, is considered the first choice for groin reconstruction because of its closeness to the defect, the minimal donor site morbidity and the long pedicle 17 . However, we chose this option as an additional free tissue transfer only when a bigger amount of tissue was necessary and the patient did not match the requirements for a DIEP flap.…”

“…15,16 Another option is the pedicled ALT flap, which, instead, is considered the first choice for groin reconstruction because of its closeness to the defect, the minimal donor site morbidity and the long pedicle. 17 However, we chose this option as an additional free tissue transfer only when a bigger amount of tissue was necessary and the patient did not match the requirements for a DIEP flap. As a primary treatment, we decided to use the SCIP flap which is an increasingly attractive solution for many reconstructive problems.…”

Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy

“…Flaps that have been utilized for sensate breast reconstruction include the latissimus dorsi (LD) flap and the superior and inferior gluteal perforator (SGAP, IGAP) flaps . Sensate flaps that have been utilized for non‐breast reconstruction include the anterolateral thigh (ALT) flap and the tensor fascia lata (TFL) flap . Autologous breast reconstruction options that have yet to be utilized for any sensate reconstruction include the lateral thigh flap, the transverse myocutaneous gracilis (TUG) flap, medial circumflex femoral artery perforator (MCFA) flap, posterior medial thigh (PMT) flap, profunda artery perforator (PAP) flap, lumbar artery perforator (LAP) flap and Ruben's fat pad.…”

“…Flaps that have been utilized for sensate breast reconstruction include the latissimus dorsi (LD) flap and the superior and inferior gluteal perforator (SGAP, IGAP) flaps. 34,[42][43][44] Sensate flaps that have been utilized for non-breast reconstruction include the anterolateral thigh (ALT) flap [45][46][47][48][49][50][51][52] and the tensor fascia lata (TFL) flap. 53,54 Autologous breast reconstruction options that have yet to be uti- including the DIEP, lateral thigh, PAP, transverse musculocutaneous gracilis and SGAP.…”