Reverse Anterolateral Thigh Flap to Revise a Below-knee Amputation Stump at the Mid-tibial Level

Sadigh, Parviz; Wu, Chia-Chang; Shih, Hsin-Nung; Jeng, Seng‐Feng

doi:10.1097/gox.0000000000000030

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…In the present study, we chose anterolateral thigh flaps for the soft tissue reconstruction in these patients. As we know, the advantages of anterolateral thigh flap includes consistent and reliable anatomy, long pedicle, being far from the ablative site, and allowing two-team approach [ 15 , 16 ]. Besides, it is feasible to create multiple skin paddles by recruiting additional perforators and reconstruct composite defect with chimeric flap by recruiting different tissue types based on a single pedicle [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Soft tissue repair for tibialis anterior tendon ruptures using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation

Mao

2015

J Orthop Surg Res

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BackgroundTraumatic ruptures of the tibialis anterior tendon are rare but can cause substantial functional deficiencies. This study aimed to evaluate the feasibility of a surgery for soft tissue repair of traumatic rupture of the tibialis anterior tendon by using a plate and screw fixation repair in combination with the free anterolateral thigh flaps transplantation.MethodsEight consecutive patients with anterior tibialis tendon ruptures who visited orthopedics departments from February 2008 to February 2012 were included in our study. The ruptured tendon was reconstructed with plate and screw fixation technique, and the tissue defects were repaired with anterolateral thigh free flaps. The complications and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were evaluated. Postoperative manual strength test was performed using a 0 to 5 scale.ResultsAll flaps survived without any complications. The average preoperative and postoperative AOFAS ankle-hindfoot scores of the patients were 51 and 95, respectively. Good ankle dorsiflexion strength against strong resistance was observed in eight ankles postoperatively (manual strength of one patient was 4/5, the others were 5/5), and a substantial improvement in strength was noted compared with the preoperative examination.ConclusionSoft tissue repair for tibialis anterior tendon rupture using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation is a feasible technique and yield satisfactory results.

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Section: Discussionmentioning

confidence: 99%

Soft tissue repair for tibialis anterior tendon ruptures using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation

Mao

2015

J Orthop Surg Res

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“…First described by Song and Lou in 1984, the anterolateral thigh (ALT) flap quickly became a workhorse in myriad indications [ 10 ]. Available as free or pedicled flap, the ALT flap has been successfully used in the reconstruction of defects in various locations including lower/upper extremities, trunk, and head and neck [ 11 , 12 ]. Advantages of the ALT flap include long pedicle, minimal donor site morbidity, its potential to be harvested using a 2-team approach, reliable flap anatomy, and multiple flap components (skin, fat, fascia, muscle, tendon, nerve), providing potential for tendon reconstruction and a neurovascular pedicle with sensate skin [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage

Bekarev

Goch

Geller

et al. 2018

Strategies in Trauma and Limb Reconstruction

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Wound coverage in the supra-patellar area presents a significant challenge for orthopaedic and reconstructive surgeons due to the need for preservation of knee joint function but the paucity of regional soft tissue flaps available. While many orthopaedic and reconstructive surgeons make use of the rotational gastrocnemius flap for coverage of peri-patellar defects, this flap has certain limitations. The goal of this study was to report a single-centre experience with the use of the distally based anterolateral thigh flap (ALT) and review the current literature on the use of the ALT for peri-patellar defects. In this report, both a single-centre experience using distally based anterolateral thigh (ALT) island flaps for supra-patellar wound coverage and the existing literature on this topic were reviewed. A systematic literature review was performed to assess the use of the ALT for peri-patellar wounds. Five patients with a mean age of 69 underwent a distally based ALT flap for coverage of peri-patellar defects. Four out of 5 flaps survived at the end of their respective follow-up. Based on this combined experience, the distally based reverse-flow anterolateral thigh island flap represents a useful but relatively underutilized option for appropriately selected supra-patellar wounds due to minimal donor site morbidity, multiple flap components, and predictable pedicle anatomy. The flap’s major weakness is its potentially unreliable venous drainage, requiring delay or secondary venous outflow anastomosis. Given the ALT flap’s favourable profile, the authors recommend consideration for its use when managing a peri-patellar coverage wound issue.

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“…This reduces the effective width of the donor site, thus allowing for direct primary closure. 9 Indeed, the reliability of reverse flow to nourish an ALT skin paddle is well established, 12 and this can be used when planning retrograde V-Y advancement flaps.…”

Section: Discussionmentioning

confidence: 99%

Achieving Direct Closure of the Anterolateral Thigh Flap Donor Site—An Algorithmic Approach

Suárez

Sadigh

Shih

et al. 2014

Plastic and Reconstructive Surgery Global Open

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Background:Minimizing donor-site morbidity after free flap harvest is of paramount importance. In this article, we share our experience with achieving primary closure of 58 anterolateral thigh (ALT) free flap donor sites using a simple algorithm in cases where primary closure would otherwise have not been possible.Methods:Between 2004 and 2010, 58 patients who underwent free ALT flap reconstruction were included in the study. The inclusion criteria were those who had flap width requirements that were wider than 16% of the thigh circumference and had achieved direct primary closure of the donor site by the use of our technique.Results:Primary closure of the donor sites was facilitated in all cases by the use of 3 distinct techniques. This included the use of the V-Y advancement technique in 13 patients, split skin paddle technique in 7 patients, and the tubed skin paddle design in 38 patients. No episodes of postoperative wound dehiscence at the donor site were encountered; however, 2 cases were complicated by superficial wound infections that settled with a course of antibiotics.Conclusions:Direct primary closure of the ALT donor site can be facilitated by the use of our simple algorithm. Certain strategies need to be adopted at the design stage; however, the techniques used are simple and reliable, produce superior cosmetic results at the donor site, save time, and spare the patient the morbidity associated with the harvest of a skin graft.

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Reverse Anterolateral Thigh Flap to Revise a Below-knee Amputation Stump at the Mid-tibial Level

Cited by 9 publications

References 20 publications

Soft tissue repair for tibialis anterior tendon ruptures using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation

Soft tissue repair for tibialis anterior tendon ruptures using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage

Achieving Direct Closure of the Anterolateral Thigh Flap Donor Site—An Algorithmic Approach

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