Harvesting the anterolateral thigh flap with non-sizable perforators

Zapata-Ospina, Alejandro; Chen, Jill; Tee, Richard; Jeng, Seng‐Feng; Karki, Bishal; Shih, Hsin-Nung

doi:10.1016/j.bjps.2020.10.063

Cited by 7 publications

(9 citation statements)

References 43 publications

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“…In our prior study, the 7.16% anterolateral thigh flaps harvested with thin-layered capillary nonsizable perforators and further flap splits have been proven feasible without serious complications or flap failures. 13 We further demonstrated that comparable flap survivals could be achieved in split segments supplied by capillary nonsizable perforators to those by sizable perforators, indicating secure and viable perfusion after such manipulation. However, we tend to place these capillary nonsizable perforators-supplied segments outside of reconstructions in critical parts such as intraoral, hypopharyngeal, or esophageal defects to avoid serious leakage or subsequent requirement of a second flap in case minor partial necrosis occurs.…”

Section: Discussionmentioning

confidence: 60%

“…A small segment of the vastus lateralis muscle of minimal 1.5cm in thickness was harvested as bordered by the pedicle medially and the areolar sleeve laterally." 13 One additional set of capillary non-sizable perforators was harvested in flaps of single sizable perforator (Type II) for supplying the other segment without a sizable perforator (Figure 4), and two sets of capillary non-sizable perforators in flaps of no sizable perforators (Type III) for supplying the intended segments respectively (Figure 5). Dissection of the remaining pedicle proximally was carried out as usual until the desired pedicle length or vessel caliber was achieved.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

Shih,

Chiu,

Jeng

et al. 2024

J Reconstr Microsurg

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Background: Split anterolateral thigh flap is a versatile reconstruction option, yet long underestimated as no practical perforator classification and no optimal strategy were present. Harvesting “capillary non-sizable perforators” could potentially expand flap splits to those with no existing multiple sizable perforators. Concerns over defect characteristics, recipient vessels, pedicle length, and split timing should all be weighted equally in designing the suitable flap. Refinement is thus required to enable precise reconstructions. Methods: All patients undergoing anterolateral thigh flap harvests between 2014 to 2021 performed by a single surgeon were included. The perforator patterns of sizable pedicle, course, origin and further successful flap-split methods were documented. Surgical outcome of flap survival was analyzed. Results: Anatomic variants of 134 (48.4%) dual, 123 (44.4%) single, and 20 (7.2%) no sizable perforators were found in a total of 277 anterolateral thigh flaps. The overall flap survival rate was 97.5%. Flap split was performed in 82 flaps, including 29 single and 5 no sizable perforator cases previously considered “un-splittable”, by utilizing a series of direct skin paddle split, capillary non-sizable perforators harvesting, and flow-through anastomosis technique. Comparable flap survivals were found between split and non-split flaps as well as between split segments supplied by sizable and capillary non-sizable perforators. Primary closure was achieved in 98.9% of the thigh donor sites. Conclusion: A new classification of the common anterolateral thigh flap anatomic variants was proposed and a comprehensive algorithm of split flap strategy was developed along with the innovative “fabricate” concept.

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Section: Discussionmentioning

confidence: 60%

Section: Accepted Manuscriptmentioning

confidence: 99%

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

Shih,

Chiu,

Jeng

et al. 2024

J Reconstr Microsurg

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“…To circumvent the issue of nonsizeable perforators, we previously published our technique of ALT flap harvest based on such perforators. 6 This technique bypasses the limitations of perforator anatomy and allows for reliable flap harvest on distal perforators, ameliorating the need for preoperative scans to analyze perforator caliber and location. Pushing this to the extreme to maximize reach, we can even raise the flap on nonsizeable perforators near the terminal branching of the pedicle, which occurs at 5–10 cm above the patella.…”

Section: Modifications To the Pedicled Anterolateral Flap And A Case ...mentioning

confidence: 99%

Pushing the Limits of Reach for the Pedicled Anterolateral Thigh Flap

Liang,

Chen,

Jeng

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: The pedicled anterolateral thigh flap, although tremendously versatile, may be limited in reach, especially in challenging clinical cases. Traditional methods to extend its reach may remain insufficient or unavailable. We describe two modifications to the conventional pedicled flap to extend its reach to the limits, namely (1) selecting a distal perforator supplemented by the nonsizeable perforator harvest technique, and (2) the double-pivot technique adding an additional rotation to the flap à la propeller perforator flap. The increased reach not only improves reconstructive success, but also opens up new applications for this workhorse flap.

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“…2 But recent literature shows that a perforator of equal to or more than 0.5 mm can be considered reliable, and a flap can be safely raised on it, 3 whereas in the case if it's <0.5 mm, at least two perforators should be included in the flap. 4…”

Section: Tablementioning

confidence: 99%