Various surgical techniques to create an aesthetic appearance at the donor site of anterolateral thigh free flaps based on the oblique branch

Abstract

Rationale:Reducing the morbidity associated with anterolateral thigh (ALT) donor sites by performing aesthetic restoration has become a popular research topic. Various surgical techniques have been developed allowing for direct closure of the donor site. However, closure techniques for ALT donor sites based on the oblique branch have not been systematically reported.Patient concerns:Data from 21 patients (18 males, 3 females) undergoing operative reconstruction with an ALT free flap between January 2016 and December 2016. The mean age of the participants was 42 years (range, 18–60 years).Diagnoses:The soft-tissue defects resulted from a traffic accident in 9 patients, a fall injury in 7 patients, a machinery injury in 3 patients, an electrical injury in 1 patient, and a burn scar in 1 patient. The wound areas ranged from 6 × 3.5 to 28 cm × 10 cm.Interventions:Several surgical techniques, including the split skin paddle technique and utilization of an adjacent perforator flap or an ipsilateral groin flap, were utilized to facilitate direct closure of the ALT flap donor site.Outcomes:Of the 21 patients included in the study, the donor sites were directly sutured in 14 patients (8 of which required a split skin paddle technique). Four patients required an adjacent perforator flap, and 3 patients received an ipsilateral groin flap. The size of the adjacent perforator flaps ranged from 15 × 5 to 17 × 6 cm. The groin flaps ranged from 18 × 6 to 28 × 6 cm. All the flaps had excellent appearance and texture. A linear scar in the donor area was not conspicuous and achieved an aesthetic appearance.Lessons:The ALT flap donor site based on the oblique branch pedicle can be directly closed without skin grafts through the use of several surgical techniques.

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

“…23 While the oblique branch typically has a smaller vessel diameter and shorter pedicle length relative to the D-LCFA, its higher incidence of a septocutaneous course makes it preferable in certain situations due to an easier and quicker dissection. 24,25 Furthermore, it offers the additional advantage of being able to be raised as a single or multipaddle flap depending on recipient needs. 24,25 In a minority of cases, the oblique branch may be the only skin perforator, necessitating its preservation.…”

“…24,25 Furthermore, it offers the additional advantage of being able to be raised as a single or multipaddle flap depending on recipient needs. 24,25 In a minority of cases, the oblique branch may be the only skin perforator, necessitating its preservation. In addition to different pedicles, varying pedicle branching patterns have been described.…”

ALT Flap Single-Stage Donor Site Closure with Loco-Regional Flaps: A Systematic Review

“…In five manuscripts the ALT flap harvesting technique is reported [17,[21][22][23] and only in two of these cases, both by the same author, it is supra-fascial [17,21]. Three studies [17,24,25] report the supra-fascial dissection of the local flap used to close the ALT donor site, three studies describe the sub-fascial dissection [22,26,27], whereas in the others the technique was not specified.…”

Propeller flap donor site closure by means of another propeller flap: A case report and literature review

“…Donor site closure alternatives for a given large flap, have been extensively investigated. This is especially true for workhorse flaps such the anterolateral thigh flap and radial forearm flap, for which algorithms that collect different donor site closure options have been proposed and extensive reviews have been made (Deng et al, ; Pabst, Werkmeister, Steegmann, Hölzle, & Bartella, ; Pachón Suárez, Sadigh, Shih, Hsieh, & Jeng, ). Although skin grafting still represents the technically easiest solution when direct approximation of a given donor site's margins is not possible, it is often used as last resort due to the poor cosmetic and functional outcomes.…”