The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers

Kua, Ee Hsiang Jonah; Wong, Chin‐Ho; Ng, Siew Weng; Tan, Kok Chai

doi:10.1016/j.bjps.2010.07.021

Cited by 14 publications

(6 citation statements)

References 10 publications

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“…Furthermore, we agree with Kua et al [19] and Wang et al [9], who recommend incising part of the anterior border of the vastus lateralis muscle in order to make a trough, for easy insetting of the flap pedicle. The amount of muscle to be excised depends on the situation.…”

Section: Discussionsupporting

confidence: 91%

The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

Hifny

2021

Arch Plast Surg

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Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author’s experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap.Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients’ demographic data, operative details, and postoperative complications were evaluated.Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13–45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed.Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

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Section: Discussionsupporting

confidence: 91%

The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

Hifny

2021

Arch Plast Surg

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“…The management of ischial ulcers in chair‐fast patients is quite intricate because of their tendency to develop recurrent ulcerations, which make conservative treatments not resolutive, hence requiring a surgical definitive approach. Many loco‐regional flaps have been used for this issue, but as recidivation rates often exceed 50%, proper flap selection according to the need for adequate bulk, vascularization and sensory recovery is fundamental . Tissue expansion has already been described by Neves et al; while in 2001, Thomson et al reported their experience in reconstruction of recurrent ulcers defects using fasciocutaneous sensate flaps with random vascular pattern from anterolateral/anteromedial thigh, on four patients affected by meningomyelocele .…”

Section: Discussionmentioning

confidence: 99%

“…The ALT flap has widely demonstrated its versatility and reliability, and the LCFN can be incorporated into the flap to provide sensation to reconstructed area . It has already been used for the coverage of pressure sores as a pedicled island flap including a cuff of vastus lateralis muscle, however, to the best of our knowledge, without sensitive innervation. Indeed, all cases reported in literature are on paraplegic patients, in which including sensitive branches within the flap would have been worthless.…”

Section: Discussionmentioning

confidence: 99%

“…However, in meningomyelocele patients with their injury below L2 these flaps are not available as sensate flaps, then tissue from the anterior thigh with conserved sensory perception becomes an ideal choice. Although previous authors reported the use of vastus lateralis myocutaneous flap for ischiatic sores, the incorporation of the lateral cutaneous femoral nerve (LCFN) to provide sensory perception at the ischiatic area has not been reported yet . Moreover, most of their spinal cord‐injured patients were paraplegic, thus not ambulatory, not suffering functional impairment because of the sacrifice of the vastus lateralis muscle, and no sensitive perception on the anterior thigh.…”

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confidence: 99%

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Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients

et al. 2014

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Recidivating pressure sores are a frequent complication in meningomyelocele patients because of their limitation in motility and their scarce ability to monitor the pressure applied on insensate areas while seated. We report the utilization of the sensate pedicled anterolateral thigh perforator flap for reconstruction of ischiatic sores in meningomyelocele patients. Between May 2011 and September 2013, five patients underwent transfer of a sensate pedicled anterolateral thigh flap, by an intermuscular passageway through the upper thigh, to reach the ischial defect. Flap was properly harvested from the thigh after assessment of the lateral cutaneous femoral nerve sensitive area with the Pressure-Specified Sensory Device. In all cases the flap reached the ischial defect harmlessly, healing was uneventful with no immediate nor late complications. Each patient showed persistence of sensitivity at the reconstructed area and no recurrent ischiatic sore was observed at mean follow-up of 26.4 months. The sensate pedicled anterolateral thigh flap is a valuable solution for coverage of recurrent ischial sores in meningomyelocele patients, in which pressure consciousness is fundamental. The intermuscular passageway allows to reduce the distance between flap's vascular pedicle origin and the ischial defect, hence to use the more reliable skin from the middle third of the anterolateral thigh.

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“…6 In 2011, Kua described an islanded, pedicled ALT flap tunnelled via a lateral subcutaneous tunnel for recurrent ischial ulcers. 4 Wang and Tzeng both described the reconstruction of trochanteric defects using a proximal pedicled ALT flap. 5,13 Here we describe use of the pedicled ALT flap-a…”

Section: Methodsmentioning

confidence: 99%

Reconstructing ‘dual-defect’ pressure sores in spinal patients

Shayan

Hurley

Neoh

et al. 2019

Australas J Plast Surg

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Background: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.Methods: Eleven consecutive patients with concurrent pressure sores (> grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded. Results: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (ischial). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded. Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.

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The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers

Cited by 14 publications

References 10 publications

The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients

Reconstructing ‘dual-defect’ pressure sores in spinal patients

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