Reconstruction of the Skin Defect of the Knee Using a Reverse Anterolateral Thigh Island Flap

Abstract

A reverse anterolateral thigh island flap with the dimensions of 6 x 3, 15 x 6, and 26 x 8 cm, respectively, was elevated in 3 patients to repair the skin defects in the knee resulting from crush injuries. The pedicle of the flap was isolated in a retrograde fashion along the descending branch of the lateral circumflex femoral artery to obtain sufficient length until the pivot point was reached. The distal point of the defect to which the flap could reach for the reconstruction was 12 cm below the knee. All flaps survived, but skin necrosis occurred in the margins of those 2 large flaps. With a wide arc of rotation and sufficient skin paddle, the reverse anterolateral thigh island flap based on reverse flow is a good option for repairing skin defect around the knee; however, a staged or delayed operation might be considered in elevating a large flap.

Proximally Based Anterolateral-Thigh (ALT) Flap for Knee Reconstruction: An Advancement Propeller Perforator Flap

“…As Gravvanis et al stated, the reconstructive surgeon should always be alert for vascular compromise of the distally based flap, and thus for flap recharging [21]. However, Liu et al obtained very good results in three cases of knee coverage with distally based ALT flaps, reaching the remarkable skin paddle size of 26 9 8 cm [22]. Wong et al clearly highlighted the potential of this reconstructive unit for knee reconstruction, using it as a rotation flap, as a distally based one, as a propeller distally based or a free flap [23].…”

Lower Extremity Reconstruction with the Anterolateral Thigh Flap

“…1). 25,26 In this approach, the cutaneous perforators and the VL muscle are raised in a similar fashion as for an antegrade flap, the proximal descending branch is divided, and the distal descending branch and the surrounding VL muscle are left intact as the pedicle (►Fig. 1B).…”

Reconstruction of complex soft-tissue defects around the knee joint with distally based split vastus lateralis musculocutaneous flap: A new technique

“…7 The vascular basis of the flap is the reverse flow in the anastomosis between the DLCFA and the lateral superior genicular artery. 12 The venous drainage is by the pair of accompanying venae comitantes.…”