Perineum Reconstruction With Pedicled Anterolateral Thigh Fasciocutaneous Flap

Abstract

Eighteen pedicled anterolateral thigh perforator island flaps were used for complex perineal reconstructions between May 2003 and May 2005. The patients' average age was 48.6 years (range, 32 to 64 years), and the average follow-up period was 8 months (range, 2 to 13). In 7 cases, the perforator was septocutaneous and in 11 it was intramuscular. The application of the pedicled anterolateral thigh fasciocutaneous flap is described perineum reconstruction. The size of the perineum defects ranged from 6 x 9 cm to 16 x 17 cm, and the size of the transferred flap ranged from 8 x 11 cm to 18 x 20 cm. All flaps survived. One patient developed minor wound dehiscence in the posterior aspect of the perineal wound because of fecal contamination and skin maceration. The esthetic appearance of the reconstructed perineum was good. Despite a variable vascular anatomy that can give rise to some surgical challenge in raising the flap, the authors conclude that this is a safe and reliable flap for perineal reconstruction.

Vulva reconstruction after pelvic exenteration, using a unique combination of two flaps

“…It has a reliable vascularisation and therefore a low complication rate. One of the main advantages is that it can provide sensory innervation 9 10. A tensor fascia lata muscle or a vastus lateralis muscle can be added to the fasciocutaneous flap to provide more bulk if necessary.…”

Customized reconstruction with the free anterolateral thigh perforator flap

“…7,22,23 Advantages of the free ALT flap, such as a long pedicle, reliable anatomy, [24][25][26][27][28][29][30][31] suitable vessel diameter, the availability of different tissues with large amounts of skin, skin-to-skin closure, its adaptability as a sensate and/or compound (composite and combined) flap, 9 adaptable volume and thickness, 34 no repositioning of the patient during operation and simultaneously working in two teams, and good esthetic outcome, are well known. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][32][33][34][35][36] Disadvantages such as challenging dissection of musculocutaneous perforators with a prolonged operation time and unsatisfactorily esthetic outcome if the donor site has to be skin-grafted were taken deliberately into consideration.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Similar to the well-recognized donor site of the subscapular artery system, 21 the lateral circumflex femoral artery (LCFA) system with its main transverse and descending branches offers multiple possibilities for the reconstruction of complex three-dimensional defects. 7,22,23 Advantages of the free ALT flap, such as a long pedicle, reliable anatomy, [24][25][26][27][28][29][30][31] suitable vessel diameter, the availability of different tissues with large amounts of skin, skin-to-skin closure, its adaptability as a sensate and/or compound (composite and combined) flap, 9 adaptable volume and thickness, no repositioning of the patient during operation and simultaneously working in two teams and good esthetic outcome, are well known [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]…”

Aesthetic scrotal reconstruction following extensive Fournier’s gangrene using bilateral island pedicled sensate anterolateral thigh flaps: A case report

“…6,18,19 Muscle flaps, such as gracilis, covered by skin grafts are an alternative, but lack sensation; if the muscle flaps are innervated to preserve bulk, they may cause unwanted contraction; conversely, if they are denervated, they can atrophy over time. 14,[20][21][22][23][24] Additionally, there may be concern regarding sperm production in the setting of skin grafting. 18,[25][26][27][28] One recent study by Demir and colleagues compared testicular function following groin flap coverage versus skin graft coverage in a rat model.…”