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

Abstract

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.

Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series

“…Second, the optimal flap is chosen with a thorough understanding of the blood supply of the relevant thigh region. [9][10][11] In ambulatory patients who undergo Girdlestone resection due to certain conditions such as bone tumor or severe trauma, the VL muscle alone may provide sufficient volume to fill the cavities as described in previous studies 4 ; in paraplegic patients with muscle atrophy, adjacent muscles such as the VI, vastus medialis, and RF are usually required to complete the flap. Acarturk introduced the three-muscle flap technique in which the VL, VI, and RF were elevated in an en-bloc fashion, and the flap was bulky enough to close a very large defect.…”

“…First, the dead spaces need to be filled and the exposed surface covered with an adequate volume of soft tissue to prevent recurrence. Second, the optimal flap is chosen with a thorough understanding of the blood supply of the relevant thigh region 9–11 …”

“…Second, the optimal flap is chosen with a thorough understanding of the blood supply of the relevant thigh region. 9 , 10 , 11 …”

Pedicled ALT-flap for soft tissue reconstruction in the trochanteric area

“…The free microvascular flap is commonly used in cases where the pedicled ALT flap is not a feasible option, such as for more regional defects in the trochanteric or abdominal wall area [11,12,13].…”

Pedicled ALT-flap for soft tissue reconstruction in the trochanteric area

“…Commonly used as free microvascular ap for more distant, pedicled ALT ap is a feasible option for more regional defects such as the trochanteric or abdominal wall area [11][12][13]. Owing to complexity of the area, increased safety in tissue transfer can be provided by keeping the original perfusion of the ap without need for microvascular anastomosis.…”