The Anterolateral Thigh Flap is Highly Effective for Reconstruction of Complex Lower Extremity Trauma

Park, Julie E.; Rodriguez, Eduardo D.; Bluebond-Langer, Rachel; Bochicchio, Grant V.; Christy, Michael R.; Bochicchio, Kelly; Scalea, Thomas M.

doi:10.1097/01.ta.0000250599.84033.1f

Cited by 49 publications

(41 citation statements)

References 12 publications

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“…15 Most studies of outcomes of lower extremity reconstruction with the ALT flap have focused on its use as a free flap for relatively distal defects. [16][17][18][19] The ALT flap has also been used as a pedicled flap for repair of more proximal lower extremity defects, though studies of this use often included patients with defects of the abdominal wall, perineum, and back. [20][21][22] In this study, we review our experience with the use of the ALT flap, in pedicled and free forms, for the repair of defects ranging from the hip to the foot.…”

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confidence: 99%

Lower Extremity Reconstruction with the Anterolateral Thigh Flap

Nosrati

Chao

Chang

et al. 2012

J reconstr Microsurg

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The versatility and location of the anterolateral thigh (ALT) flap make it well suited for lower extremity reconstruction. The purpose of this study was to evaluate surgical and functional outcomes by specific anatomic regions in the lower extremity to better define the role of the ALT flap in lower extremity reconstruction. A retrospective review of patients undergoing lower extremity reconstruction with an ALT flap between July 2002 and December 2010 was performed. Total 46 patients underwent lower extremity reconstruction with an ALT flap, of whom 29 (63%) had a pedicled flap and 17 (37%) a microvascular free flap. Defects were located in the hip/buttocks (n = 8), groin (n = 13), thigh (n = 8), knee (n = 5), leg (n = 6), and foot/ankle (n = 6). The mean postoperative follow-up was 4 months. Total flap loss occurred in two patients (4%). There were 11 recipient site complications (24%). The most common complication was recipient site seroma, which occurred in five patients (11%), all of whom had hip/buttock or groin defects. Overall, 38 patients (83%) returned to their preoperative functional status. The ALT flap is an effective method of lower extremity reconstruction. It can be performed as a pedicled or free flap, with good surgical and functional outcomes.

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confidence: 99%

Lower Extremity Reconstruction with the Anterolateral Thigh Flap

Nosrati

Chao

Chang

et al. 2012

J reconstr Microsurg

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“…It may be used for reconstruction of the chest wall (9), oropharynx (10-13), head and neck (14,15), hand (16)(17)(18), lower extremity (19)(20)(21), phallus (22) and abdominal wall (23). Use of the flap for breast reconstruction was originally described by Wei et al (1) …”

Section: Discussionmentioning

confidence: 99%

Anterolateral thigh flap salvage following failed deep inferior epigastric artery perforator breast reconstruction

Krochmal¹,

Rebecca

Casey

et al. 2011

J Plast Surg

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T he transverse rectus abdominis myocutaneous and deep inferior epigastric artery perforator (DIEP) flaps are currently the workhorses for autologous tissue breast reconstruction following mastectomy. However, situations may arise in which these flaps are not available. Contraindications to abdominal flaps include soft tissue inadequacy, previous abdominoplasty, scar presence and, controversially, plans for future pregnancy (1). Approximately 15% of women are not candidates for abdominal flap reconstruction (2). The gluteal artery perforator flap is often the second choice; however, the flap has inferior fat quality compared with abdominal flaps, offers short pedicles and necessitates an intraoperative position change (1). In these situations, the anterolateral thigh (ALT) flap has been used in breast reconstruction with satisfactory results (1-3). Simultaneous harvest of the bilateral flaps is possible, intraoperative position change is unnecessary, and the flap is soft and pliable (1,3).Wei et al (1) described five cases using ALT flaps in women with failed DIEP flaps or inadequate abdominal bulk. Overall, outcomes were rated as 'good'. Kaplan et al (2) described three cases in which women did not have adequate abdominal flaps (previous DIEP, abdominoplasty and obesity-related contraindication for DIEP). Bernier et al (3) presented a case report of bilateral breast reconstruction using bilateral ALT flaps, also with good results. We present our experience using the ALT flap for failed DIEP flap salvage. AnAtomyThe ALT flap is of moderate thickness, with a large cutaneous area, and provides a long vascular pedicle. The flap area may be up to 21 cm × 35 cm (4), with a vascular pedicle of up to 20 cm (5). Innervation is via the anterior branch of the lateral femoral cutaneous nerve (L2-3).The lateral femoral circumflex system usually originates from the profunda femoral artery and divides into the ascending, transverse and descending branches. The descending arterial branch is typically accompanied by two veins. This branch courses between the rectus femoris and vastus intermedius muscles. The first cutaneous perforator is usually the largest. It may be located near the midpoint of a line linking the anterior superior iliac spine and the superolateral patellar border. Approximately 90% of the perforators are found within 3 cm of this point, mostly inferolaterally (6).Luo et al (6) detailed pedicle variations of the ALT flap. Musculocutaneous perforators course through the vastus lateralis in 80.4% of cases. Perforator arteries run intermuscularly, between the rectus femoris and the vastus lateralis, in 9.5% of cases. In 8.3% of patients, the perforator is a direct cutaneous branch from a transverse branch of the lateral circumflex femoral artery or originates directly from the lateral circumflex femoral vessel proximal to the take-off of the descending branch. Tiny cutaneous perforators with diameters of 0.2 mm to 0.3 mm are found in 1.8% of patients (6). CAse presentAtions Case 1A 45-year-old woman presented wit...

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“…Koshima et al reported a potential surface area of 25 Â 18 cm in the nonthinned flap, while others have more recently described success with flaps of up to 35 cm Â 15 cm. 1,3,7 The long vascular pedicle of the ALT flap ensures flap viability in the traumatic foot by allowing for microvascular anastomosis to a healthy recipient vessel located sufficiently far away from the site of injury. In a patient who has suffered an injury to his foot, the intrinsic thickness of the subcutaneous fat layer in the ALT flap is helpful and sometimes requisite for primary reconstruction and stabilization.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

J Reconstr Microsurg Open

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The Anterolateral Thigh Flap is Highly Effective for Reconstruction of Complex Lower Extremity Trauma

Abstract: The ALT flap is a useful tool for trauma reconstruction in lower extremity salvage. We have shown that the ALT flap can be performed successfully in the traumatically injured patient even when harvested from the ipsilateral lower extremity.

Cited by 49 publications

References 12 publications

Lower Extremity Reconstruction with the Anterolateral Thigh Flap

Lower Extremity Reconstruction with the Anterolateral Thigh Flap

Anterolateral thigh flap salvage following failed deep inferior epigastric artery perforator breast reconstruction

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