The Clinical Application of Anterolateral Thigh Flap

Lee, Yao-Chou; Chiu, Hui‐Fen; Shieh, Shyh‐Jou

doi:10.1155/2011/127353

Cited by 19 publications

(14 citation statements)

References 35 publications

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“…The ALT flap has become the modern workhorse flap for reconstruction throughout the body given its consistency and versatility. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, achieving an ideal reconstruc-tion in the distal extremity using a free ALT flap remains challenging, as the traditional ALT can often be too bulky to provide a one-stage definitive reconstruction. [14][15][16] Immediate flap debulking to improve contour prior to inset may result in partial flap loss due to interruption of the flap's microcirculation.…”

Section: Discussionmentioning

confidence: 99%

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

Seth

Iorio

2017

J reconstr Microsurg

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The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. A total of 25 patients underwent suprafascial ( = 14) or super-thin ( = 11) ALT flap reconstruction for primarily lower extremity wounds ( = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m, respectively. Follow-up was 6.3 months. Comorbidities included smoking ( = 7), diabetes ( = 8), peripheral vascular disease ( = 6), and hypertension ( = 8). The presence of hardware ( = 9), trauma ( = 10), and chronic infection ( = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% ( = 16) taken on one perforator. Forty-eight percent ( = 12) were end-to-side anastomoses and 62% ( = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% ( = 6) complication rate. There were no partial or complete flap losses. The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.

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Section: Discussionmentioning

confidence: 99%

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

Seth

Iorio

2017

J reconstr Microsurg

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“…The free ALT flap represents a highly versatile soft-tissue flap that can be utilized in various clinical situations [2]. Due to its low donor-site morbidity, ease of harvest, and versatility, the ALT has become the workhouse flap for soft-tissue reconstructions from head to toe [4].…”

Section: Introductionmentioning

confidence: 99%

The vascularized fascia lata free flap: an anatomical study and clinical considerations

Janik

Hirtler

Traxler

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap. Methods We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined. Results Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo-or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6-60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm 2. In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL. Conclusion We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.

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“…In recent decades, free flap reconstruction has become the gold standard for repairing defects resulting from head and neck cancer ablation (Wehage & Fansa, 2011). Despite the availability of multiple free flap options for reconstruction (Chana & Odili, 2010; Wong & Wei, 2010), the free anterolateral thigh (ALT) flap has gained popularity as a workhorse and ideal flap (Hsieh, Yang, Chen, Kuo, & Jeng, 2009; Khadakban et al, 2016; Lee, Chiu, & Shieh, 2011; Wei et al, 2002). Its main advantages include a long and favorable caliber of the pedicle, large soft tissue provided, low donor‐site morbidity, possible use as a chimeric flap with a muscle or fascia portion, and ability to be harvested by two teams simultaneously (Agostini, Lazzeri, & Spinelli, 2013; Amin et al, 2006; Lin, Miguel, Chew, Kuo, & Yang, 2014; Weise et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity‐score‐matched patient cohorts

Moltedo

Lin

et al. 2020

Microsurgery

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Background The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction. Methods A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications. Results Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well‐balanced pairs of propensity‐score‐matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026). Conclusion This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity‐score‐matched cohorts.

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The Clinical Application of Anterolateral Thigh Flap

Cited by 19 publications

References 35 publications

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

The vascularized fascia lata free flap: an anatomical study and clinical considerations

Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity‐score‐matched patient cohorts

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