No abstract

The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. A total of 25 patients underwent suprafascial ( = 14) or super-thin ( = 11) ALT flap reconstruction for primarily lower extremity wounds ( = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m, respectively. Follow-up was 6.3 months. Comorbidities included smoking ( = 7), diabetes ( = 8), peripheral vascular disease ( = 6), and hypertension ( = 8). The presence of hardware ( = 9), trauma ( = 10), and chronic infection ( = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% ( = 16) taken on one perforator. Forty-eight percent ( = 12) were end-to-side anastomoses and 62% ( = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% ( = 6) complication rate. There were no partial or complete flap losses. The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.

Mechanical prophylaxis plus subcutaneous heparin (unfractionated or low-molecular-weight heparin) conferred a statistically significant reduction in the rate of venous thromboembolism without a significant increase in bleeding versus mechanical prophylaxis alone. Subgroup analysis of patients placed on mechanical prophylaxis plus low-molecular-weight heparin revealed similar statistically significant findings. Outpatients placed on low-molecular-weight heparin chemoprophylaxis demonstrated excellent compliance and comfort with self-administration. Therefore, the use of mechanical prophylaxis supplemented with low-molecular-weight heparin is strongly recommended as the first-line regimen for thromboprophylaxis in plastic surgery patients at highest risk for venous thromboembolism.