Distribution of Anterolateral Thigh Flap Perforator Vessels and Its Clinical Applications in Malaysian Population

Abstract

Purpose: Extensive studies regarding vascular anatomy and clinical applications of anterolateral thigh (ALT) flap has been conducted for many years. However, the ALT flap perforator vessels anatomy in the Malaysian population is not well-analyzed. The purpose of this study was to determine the distribution of ALT flap perforator vessels and its clinical applications in reconstructive surgery.Methods: This is a retrospective cross-sectional study conducted in two main centers of reconstructive surgery. A total of 142 cases of ALT flaps that used as an option for soft tissue reconstruction was selected. Vascular anatomy of ALT flaps was studied precisely including the origin of vessels, location of perforators, and types of perforator vessels intraoperatively during the flap harvest.Results: The distribution of ALT flap perforator vessels can be found at three specific locations on the thigh namely perforators A, B, and C. The highest number of cutaneous perforator vessels that supplied the ALT flap was musculocutaneous perforator with 72.3%, and dominantly at perforators B and C. The remaining perforator vessels were septocutaneous perforator with 27.7%, presented mainly at perforator A. A majority of cases involved the reconstruction of wound defects following tumor resection and trauma. The most area of reconstruction was the lower limb with 33.8%.Conclusion: The distribution of ALT flap perforator vessels can be predicted during flap harvest and can be applied in numerous clinical applications for wound defect coverage. The knowledge regarding vascular anatomy of ALT flap perforator vessels can aid plastic surgeons in reconstructive surgery.

Hand Reconstruction Using Anterolateral Thigh Free Flap by Terminal Perforator-to-Digital Artery Anastomosis: Retrospective Analysis

“…Also, there were differences in the achievable length of the perforators based on whether the perforator coursed perpendicularly or obliquely within the adipose tissue layer. [24] Despite its limitations, this study confirmed that the terminal perforator-to-digital artery anastomosis approach in digit reconstruction can not only reduce surgery time by reducing dissection, but also lower the risk of thrombosis, making the benefits outweigh the disadvantages of using smaller vessel diameters. Hence, when a digital defect occurs and a wider range is desired to be covered by a free flap rather than a glabrous skin flap, it could be argued that approaching from (Figure 1.B) rather than (Figure 1.A) and performing the division of the perforator only as much as necessary in a more superficial plane to anastomose with the digital artery could be beneficial.…”

“…Also, there were differences in the achievable length of the perforators based on whether the perforator coursed perpendicularly or obliquely within the adipose tissue layer. 24 …”

A comparative study of clinical outcome in ALT free flap reconstruction using superficial or deep and single or dual recipient vein anastomosis in different sites

“…In our study flap harvested was like or less than other studies. The pedicle is also long enough (Up to 15 CMS) (Suondoh et al, 2020) and its position is constant (Yu et al, 2015). The pedicle of the flap has not many branches thus harvesting of flap is less time consuming.…”

“…The anterolateral thigh flap has emerged as workhorse flap in soft tissue reconstruction of head and neck, upper and lower extremity defects. ALT (Antero-lateral thigh) flap was first introduced as septocutaneous perforator-based flap by Song et al (1984). It has several advantages (Lee et al, 2011) like, can be harvested as fascio-cutaneous, myo-cutaneous, adipo-fascial flap, can be harvested in less operative time, it has long pedicle length to anastomose the recipient vessels (avoids vein graft).…”