Total aesthetic subunit reconstruction of the burned anterior abdomen using pre‐expanded pedicled anterolateral thigh flap—A case report

Abstract

Combination of tissue expansion and perforator flaps broadened the reconstructive options in burn cases with wide scar contractures. We report a case of total aesthetic subunit reconstruction of the anterior abdominal skin using a pre‐expanded pedicled anterolateral thigh (ALT) perforator flap in a patient with postburn contractures. Seventeen‐year‐old girl had a history of scalding burn to the anterior abdomen, resulting in tight contractures inhibiting her mobility. After an expansion period of 6 months, the flap of 27 × 30 cm was elevated at the suprafascial plane and tunneled to the anterior abdomen. The flap was used to resurface the defect from xyphoid process down to the mons pubis and bilaterally at linea semilunaris. Postoperative course was uneventful. A good quality aesthetic and functional reconstruction was achieved at the 10‐year follow‐up. Pre‐expanded pedicled ALT flaps may be considered as an option in extensive scarring requiring large amounts of tissue.

Extensive Defect Reconstruction With Pre-expanded Anterolateral Thigh Flap

“…The ALT flap has become the most widely used flap worldwide. In contrast, the pre-expansion of the ALT flap has a limited number of applications in the literature 4,7–12 . The present study represents a study of pre-expansion of ALT consisting of 38 patients who underwent reconstructive surgery with 48 free or pedicled pre-expanded ALT flaps.…”

“…In contrast, the pre-expansion of the ALT flap has a limited number of applications in the literature. 4,[7][8][9][10][11][12] The present study represents a study of pre-expansion of ALT consisting of 38 patients who underwent reconstructive surgery with 48 free or pedicled pre-expanded ALT flaps. We found that the peripheral expansion technique was reliable, with 100% flap elevation and 97.9% flap survival in this series.…”

“…To decrease donor-site morbidity, surgeons endeavored to achieve direct closure of the thigh donor site by using tissue expansion, 7 which has been performed before, after, or concurrently with the ALT flap transfer to maximize the overall result. 4,[7][8][9][10][11][12] If time is not of the essence, like in the patients with congenital melanocytic nevi, hemangioma, and postburn scar, pretransfer expansion is the best option because it will also provide a larger flap for reconstruction. 4 Tsai 12 pre-expanded a free ALT flap for postburn reconstruction by placing an expander under the flap beside the perforator, which was visualized intraoperatively.…”

Reconstructing Skin Defects of the Neck with Subfascial Expanded Anterolateral Thigh Flap: Report of Two Cases

“…Acarturk also used the subfascial expanded ALT free flap to reconstruct postburn cervical scar contracture. 7 , 8 Meanwhile, we placed the expander under the fascia, similar to the technique described by Tsai. 6 Unlike the two mentioned authors, the dissection in our case was carried out to determine the course of required perforators and potential anatomical variations.…”

“…Until now, subfascial ALT expansion has not been frequently used among surgeons in large defect reconstruction of the neck. 7 , 8 In this report, we present our experience in two clinical cases in which we used ALT subfascial expansion to increase the flap surface area, combined with thinning techniques to cover large anterior neck defects.…”