Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap

Kim, Jong-Ho; Yoo, Hyang Keun; Eun, Seok Chan

doi:10.1177/1534734620982238

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…But in our case, bimalleolar defects accompanying the anterior tibial defect created a complex defect like a triangle shape. We thought that trying to cover all defects as almost circumferential wrist and anterior tibial defects with the same flap and reaching the recipient vessels 8 cm superior to anterior defect with a single ALT might be risky in terms of flap perfusion because the extended ALT also has limitations such as perfusion problems, partial flap necrosis, and increased donor site problems due to large tissue harvest (Kim et al, 2022). So, we decided to use double ALT rather than its single extended version and used both long axis of flaps as inverted "T" shape.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one‐stage lower extremity reconstruction: A case report

2023

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Developments in the microsurgery have made perforator fasciocutaneous free flaps more popular in lower extremity reconstructions. They have acceptable donor site morbidities when compared to traditional methods. However; there are some possible limitations with these flaps such as anatomical variations and insufficiency to cover large and/or complex defects with a single flap. Anterolateral thigh flap (ALT), which has proven its advantages in the reconstruction of many regions of the body, is one of the versatile perforator fasciocutaneous flap options. We present our experience of using sequential double ALTs for complex lower extremity reconstruction. A 44‐year‐old patient, who had a history of multiple traumas as a result of a traffic accident, had interconnected anterior tibial (6 × 4 cm) and bimalleolar defects (4 × 4 cm, 4 × 5 cm) in his left lower extremity. Double ALT flaps (16 × 9 cm, 17 × 10 cm) were used to reconstruct three individual defects. The posterior tibial artery was the only uninjured artery perfusing the lower extremity, so the already occluded anterior tibial artery was chosen as the recipient to avoid disturbing the posterior tibial vessels. The dominant comitant vein of one of the flaps was leaving the pedicle too early and following an aberrant path with increased diameter. As it was understood that the other comitant vein had poor drainage, it was taken as an interposition vein graft to lengthen the dominant aberrant vein. The two flaps were customized as one by flow‐through anastomoses on the operating table. The anterior tibial artery was washed and debrided distal to proximal until arterial spurting was seen. At the distance of 8 cm superior, the artery was found as feasible and anastomoses were performed. The proximal flap was inset vertically and the distal flap was inset on the horizontal axis to reach the bilateral malleolar defect. No complications were observed in both flaps. The patient was followed‐up for 8 months. Despite the successful reconstruction, the patient is still unable to walk unaided due to multiple traumas and the rehabilitation process continues. We believe that the use of sequential double ALT may be a useful alternative to reconstruct large lower extremity defects with minimal donor site morbidity when a suitable single recipient vessel is available.

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Section: Discussionmentioning

confidence: 99%

Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one‐stage lower extremity reconstruction: A case report

2023

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“…Local flaps are limited in this situation because there is little expendable donor tissue for large wound coverage. Some authors reported using large flaps, such as anterolateral thigh (ALT) flaps and deep inferior epigastric perforator (DIEP) flaps to reconstruct large wounds 14 , 15 , 16 . However, donor site morbidities may limit the use of these large flaps.…”

Section: Discussionmentioning

confidence: 99%

Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity

Qing

et al. 2022

Orthopaedic Surgery

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The aim of the present study was to report a novel nomenclature system for extended latissimus dorsi musculocutaneous (LD) flaps. To evaluate the clinical application and surgical efficacy of the different extended LD flaps for large wounds in the extremities.Methods: From January 2004 to December 2018, 72 consecutive patients who received extended LD flaps were retrospectively analyzed. Patients' ages ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 cm Â 10 cm to 37 cm Â 21 cm. Forty-one wounds were located in the calf, 18 in the foot and ankle, six in the shoulder and upper arm, four in the thigh, and three at the knee joint. Twenty-eight patients had fractures, and six of these patients with segmental bone defects (ranging in size from 3 to 7 cm) required secondary orthopaedic procedures. Single-and double-wing extended LD flaps were designed and harvested according to the shape of the wounds. Results:The flaps received consisted of 64 single-wing and eight double-wing extended LD flaps, and the mean flap harvest time was 56.2 min. The donor sites were closed primarily for all patients. Additional subcutaneous veins were anastomosed to the recipient's vessels in 14 patients. The venous crisis was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re-exploration, and another two patients' flaps were necrosed. In these two patients, lower limb amputation and extended LD flap on the other side were used, respectively, for the final treatment. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Six patients had segmental bone defects that required secondary orthopaedic procedures, two patients were repaired with vascularized iliac crest bone grafts, and another four patients were reconstructed by the Ilizarov technique. All the patients' bone defects achieved union and most patients achieved good functional recovery at the recipient site. The mean follow-up was 15.7 months (range, 10-56 months). No significant donor site morbidities limiting patients' daily activities occurred during the follow-up. Eight patients developed a donor site hypertrophic scar, three patients on the back, and five on the anterolateral thigh. Conclusion:Single-and double-wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity, with good functional and aesthetic results.

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“…Beyond the necessity to warrant a prompt and stable wound healing, often a reconstruction of the tendinous extensor compartment of the foot is also required to give the patient the chance to walk again. The microsurgical anterolateral thigh (ALT) flap has proven to be an effective reconstructive tool in replacing large soft-tissue losses [ 1 ]. Significant advantages characterize the ALT flap as versatility, easy dissection, adequate size to cover large wounds, and an excellent perfusion.…”

Section: Introductionmentioning

confidence: 99%

Lower-Limb Salvage Procedure using Anterolateral Thigh Free Flap and Multiple Tendon Grafts in a Road Injury Patient: A Case Report

Brambullo,

Fanton,

Valotto

et al. 2024

jocr

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Introduction: The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of adequate recipient vessels when the tibial arteries result damaged. In this scenario, vein grafts can be interposed to connect a healthy recipient vessel to the ALT flap pedicle. Case Report: We present a report of a 19-year-old male who suffered a Gustilo fracture type IIIc after a road injury involving the right lower limb. After a failed first attempt of limb salvage with reconstruction of extensor tendons and a free ALT flap, a second procedure was performed using another ALT flap with interposed vein grafts to reach very proximal recipient vessels. Results: The patient demonstrated excellent recovery and restored ambulation. The effectiveness of the most complex reconstructive options for a high-demanding patient with no comorbidities is demonstrated in this case. Conclusion: The key to success in even the most complex injury cases is early intervention, meticulous surgical planning, and a multidisciplinary approach. Keywords: Anterolateral thigh flap, vein graft, gustilo fracture, ankle, tendon graft, limb salvage.

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Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap

Cited by 5 publications

References 30 publications

Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one‐stage lower extremity reconstruction: A case report

Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one‐stage lower extremity reconstruction: A case report

Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity

Lower-Limb Salvage Procedure using Anterolateral Thigh Free Flap and Multiple Tendon Grafts in a Road Injury Patient: A Case Report

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