The Clinical Course of Reverse-flow Anterolateral Thigh Flap: Need to Prepare for Venous Congestion and Salvage Operation

Kim, Il-Kug; Kim, Tae-Gon; Lee, Jun Ho; Kim, Yong Ha; Park, Ki Rin

doi:10.5999/aps.2012.39.3.262

Cited by 17 publications

(17 citation statements)

References 6 publications

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“…Acute venous congestion can be dealt with by flap delay, venous augmentation, vein grafting for bypass, or conversion to a free flap. Insidious development of venous congestion necessitates close monitoring with possible need for irrigation and debridement, negative pressure vacuum-assisted therapy, or venous supercharging [ 30 ]. This potential complication has also been reported to be successfully identified and prevented with preservation of a subcutaneous strip ranging from distal flap end to upper knee [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage

Bekarev

Goch

Geller

et al. 2018

Strategies in Trauma and Limb Reconstruction

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Wound coverage in the supra-patellar area presents a significant challenge for orthopaedic and reconstructive surgeons due to the need for preservation of knee joint function but the paucity of regional soft tissue flaps available. While many orthopaedic and reconstructive surgeons make use of the rotational gastrocnemius flap for coverage of peri-patellar defects, this flap has certain limitations. The goal of this study was to report a single-centre experience with the use of the distally based anterolateral thigh flap (ALT) and review the current literature on the use of the ALT for peri-patellar defects. In this report, both a single-centre experience using distally based anterolateral thigh (ALT) island flaps for supra-patellar wound coverage and the existing literature on this topic were reviewed. A systematic literature review was performed to assess the use of the ALT for peri-patellar wounds. Five patients with a mean age of 69 underwent a distally based ALT flap for coverage of peri-patellar defects. Four out of 5 flaps survived at the end of their respective follow-up. Based on this combined experience, the distally based reverse-flow anterolateral thigh island flap represents a useful but relatively underutilized option for appropriately selected supra-patellar wounds due to minimal donor site morbidity, multiple flap components, and predictable pedicle anatomy. The flap’s major weakness is its potentially unreliable venous drainage, requiring delay or secondary venous outflow anastomosis. Given the ALT flap’s favourable profile, the authors recommend consideration for its use when managing a peri-patellar coverage wound issue.

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Section: Discussionmentioning

confidence: 99%

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage

Bekarev

Goch

Geller

et al. 2018

Strategies in Trauma and Limb Reconstruction

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show abstract

“…But, more recent evidence has clarified the flap's physiology and confirmed that it is safe. [5][6][7][8][9] Anastomosis between the lateral circumflex femoral artery and lateral superior geniculate artery or profunda femoral artery in the knee joint is the vascular basis of the reverse ALT flap. 9 A cadevaric study revealed that the pivot point ranges between 3 and 10 cm above the superior lateral patella border, with the pedicle averaging 15 cm in length.…”

Section: Discussionmentioning

confidence: 99%

“…The reverse ALT has many merits including long pedicle length and large skin paddle. [5][6][7][8][9] In distal lower extremity reconstruction, several local flaps have been proposed. In patients with severe soft tissue defects, the free flap is the preferred option due to the large skin paddle and suitable thickness.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 In knee joint reconstruction, reverse (distally based) ALT flap has become one of the most popular choices for lower extremity surgeons. [5][6][7][8][9] We present the case of a patient who had simultaneous severe soft tissue defect in a knee and lateral malleolar area due to trauma. The knee and lateral malleolar area were reconstructed in one stage, without changing position, using a reverse ALT flap and ALT free flap from one donor site.…”

mentioning

confidence: 99%

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Knee and Ankle Reconstruction With Reverse Anterolateral Thigh and Free Anterolateral Thigh Flap From One Donor Site

Choi

Cho

Park

et al. 2016

The International Journal of Lower Extremity Wounds

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Traditionally, the anterolateral thigh (ALT) free flap is used in distal lower extremity reconstruction. Reverse ALT flap has become one of the most popular choices for knee joint soft tissue defects. A 53-year-old man sustained a degloving injury in the right lateral side of the lower extremity from the lateral malleolar area to the knee joint area. The contamination was severe, necessitating serial debridement and negative pressure wound therapy. After 4 weeks, no more soft tissue necrosis was evident. No more microorganism growth was confirmed by swab culture. ALT free flap using proximal perforator was planned for lateral malleolar area reconstruction and reverse ALT flap using distal perforator was planned to cover knee joint after confirming the pedicle length was sufficient for simultaneous knee and lateral malleolar area reconstruction.

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“…Venous supercharging physiologically addresses the arteriovenous imbalance inherent to reverse‐flow flaps. We relied on this concept with other reverse‐flow flaps with success, and venous augmentation has proven itself elsewhere . Our study has several built‐in controls that illustrate the benefit of antegrade venous flow.…”

Section: Discussionmentioning

confidence: 99%

The distally based, venous supercharged anterolateral thigh flap

et al. 2015

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The distally-based anterolateral thigh flap is an attractive option for proximal leg and knee coverage but venous congestion is common. Restoration of antegrade venous drainage via great saphenous vein supercharge to the proximal flap vein is proposed. The purpose of this study was to evaluate and compare outcomes of 18 large, distally-based anterolateral thigh flaps with and without venous augmentation on the basis of flap size, venous congestion, and clinical course. The average age of 12 men and 6 women was 35.9-year old (range, 16-50 years old). Wounds resulting from trauma, burn sequela, sarcoma, and infection were localized to the knee, proximal leg, knee stump and popliteal fossa. The mean defect was 17.6 × 9.4 cm(2) (range, 6 × 7 cm(2) to 22 × 20 cm(2) ). The mean flap size was 21.4 × 8.8 cm(2) (range, 12 × 6 to 27 × 12 cm(2)). There were 14 cases in the venous supercharged group and 4 cases in the group without supercharge. The mean size of flaps in the venous supercharged group was significantly larger than that in the group without supercharge (22.6 ± 3.8 × 9.1 ± 1.7 cm vs. 17.5 ± 4.4 × 7.8 ± 1.7 cm, P = 0.03). Venous congestion occurred in all four flaps without supercharge that lasted 3-7 days and partial flap loss occurred in two cases. There was no early venous congestion and partial flap loss in supercharged flaps but venous congestion secondary to anastomotic occlusion developed in two cases. Early exploration with vein grafting resolved venous congestion in one case. Late exploration in the other resulted in flap loss. Preventive venous supercharge is suggested for the large, distally-based anterolateral thigh flap.

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The Clinical Course of Reverse-flow Anterolateral Thigh Flap: Need to Prepare for Venous Congestion and Salvage Operation

Cited by 17 publications

References 6 publications

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage

Knee and Ankle Reconstruction With Reverse Anterolateral Thigh and Free Anterolateral Thigh Flap From One Donor Site

The distally based, venous supercharged anterolateral thigh flap

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