Perforator variability in the anterolateral thigh free flap: a systematic review

Smith, Ross K.; Wykes, James; Martin, David T.; Niles, Navin

doi:10.1007/s00276-016-1802-y

Cited by 43 publications

(26 citation statements)

References 39 publications

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“…According to some studies, the ALT flap could be considered as the first choice for reconstructing wounds of children except for those with bone defects. The advantages of ALT flaps in adult have been summarized in the literature (21)(22)(23)(24). During the operation, we found the absolute size of the pedicle vessels of children to be smaller than that of adults, but their relative size in relation to the patient body was greater than that in adults, which is consistent with a previous report by Van Landuyt et al (5).…”

Section: Discussionsupporting

confidence: 90%

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Li¹,

Xiong²,

Li³

et al. 2021

Handchir Mikrochir Plast Chir.

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Background Microsurgical reconstruction of extremity defects with free flaps has been carried out for many years. The aim of this retrospective study is to characterize free flap surgery on children of 1 to 7 years old by evaluating a series of 20 cases of free flap surgeries that have been performed in pediatric patients. Methods From February 2014 to January 2018, 20 patients, 10 boys and 10 girls aged from 1 to 7 years (average, 4.6 years), were engaged in this study. Several types of free flaps were used, including anterolateral thigh flaps (ALT), inferior ulnar collateral artery flap, latissimus dorsi flap, medial plantar flap, fibular osteocutaneous flap and hallux toenail flap. After operations, follow-up period was at least for 2 years and the average follow-up period was 48.5 months. The long-term outcomes were estimated by questionnaires derived from the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI). Results A total of 21free-flap reconstructions were performed on 20patients, including 15 ALT, 3 composite flaps, and 3 other cutaneous flaps. The size of the tissue flap ranged from 1.5 to 280 cm2 (average, 74.1cm2). The diameter of the anastomosed artery of the flap ranged from 0.7 to 1.2 mm. Among the 21 flaps, 20 survived and the success rate was about 95 %. Contour adaption was achieved in all flaps. Fifteen children received a secondary operation for debulking or functional improvement. Secondary deformity was present in 3 children, among which ankle joint valgus was seen in two children and a flexion deformity of injured toe occurred in one child. The mean global functioning score of PODCI was 94 (ranging from 81 to 98, maximum 100). Conclusion The success rate of free-flap surgery in pediatric patients was comparable to that achieved in adults. Post-operative caring for pediatric patients was easier than expected. For pediatric patients, the final outcomes were not varied remarkably from different types of free tissue transfer.

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Section: Discussionsupporting

confidence: 90%

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Li¹,

Xiong²,

Li³

et al. 2021

Handchir Mikrochir Plast Chir.

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Section: Discussionmentioning

confidence: 99%

“…Multiple branches enter the flaps as the perforating branches to nourish the flaps 13 . In a systematic review with analysis on 1251 thighs described in 23 articles, Smith et al 27 revealed that the average number of perforating branches is 1.15-4.26. The lateral femoral muscle belongs to a single main artery muscle, and the muscular branches are constantly present in a multi-branch pattern.…”

Section: The Characteristic Of Chimeric Anterolateral Thigh Perforator Flapmentioning

confidence: 99%

Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap

Zeng

Yuan³

et al. 2021

Orthopaedic Surgery

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Objective: To evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.Methods: Clinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm Â 10 cm to 35 cm Â 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep-tissue injury of the soft-tissue defects. The skin flap and muscle flap were fanned out on the wound, and single-or two-staged split-thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post-operationally. Complications at both recipient site and donor site were carefully recorded. Results:The mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post-traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6-8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12-36 months post-operational follow-up. Conclusion:The chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space.

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“…Some reports have described the absence of cutaneous perforators arising from the descending branch of the lateral circumflex femoral artery in a small proportion of cases involving the ALT flap. 15 Identification of an available perforator might be facilitated by much more carefully searching for and dissecting the perforator as well as meticulously dissecting and separating the semitranslucent connective membrane encapsulating the stem vessel bundle. Although anatomical variations were encountered in the present study, planning the ALT flap based on established anatomical markers was still valid.…”

Section: Discussionmentioning

confidence: 99%

Medial versus lateral approach to harvesting of anterolateral thigh flap

Xie

2018

J Int Med Res

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ObjectiveThis study was performed to evaluate two classic procedures guided by anatomic markers for harvesting the anterolateral thigh (ALT) flap: one began with an incision on the lateral side to identify perforators emerging from the muscle to the superficial tissue and to track the perforators upward to the upper stem vessel, and the other began with an incision on the medial side to identify the vessel branch from the stem artery and to track it downward to the flap perforators.MethodsTwenty-eight consecutive patients with tissue defects repaired with ALT flaps were investigated; 13 and 15 patients underwent the lateral and medial incision technique, respectively. The surgeon’s subjective view regarding procedural difficulty and the operative times were statistically analyzed.ResultsAll flaps were harvested successfully. A two-paddle flap from one thigh in the medial group failed due to necrosis; all others survived completely. Subjectively, harvesting of flaps starting with a lateral incision was somewhat difficult, and the operative time was significantly longer using the lateral technique.ConclusionsClassic procedures to harvest the anterolateral thigh flap are still practicable, and starting with a medial incision is more efficient than starting with a lateral incision.Type of study/level of evidence: Therapeutic IV.

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Perforator variability in the anterolateral thigh free flap: a systematic review

Cited by 43 publications

References 39 publications

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap

Medial versus lateral approach to harvesting of anterolateral thigh flap

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