Versatility of the Free ALT Flap for Upper and Lower Limbs Coverage Defects Reconstruction. A Consecutive Case Series

Abstract

The anterolateral thigh (ALT) flap has become the workhorse flap for soft-tissue reconstructions, mainly in head and neck surgery, due to its great versatility for soft tissue reconstructions [7, 8, 10]. Since Song et al. [19] introduced this flap in 1984, it has gained popularity because of several advantages. The flap can be harvested simultaneously as two-team work. The operation time could be shortened. The pedicle length is long enough to anastomosis with recipient vessels and could be lengthened by proximally eccentric placement of the perforator, so avoiding vein graft. The large caliber of pedicle vessels makes microsurgical anastomosis easier. ALT flap could serve as fasciocutaneous, adipofascial, or myocutaneous flap as needed, having great volume variability. Pliability could be achieved by primary thinning. Bulkiness could be added by incorporation of the deepithelialized skin or a portion of muscle cuff (vastus lateralis), furthermore the fascia lata can be included for sling or tendon reconstruction. A sensate flap can be harvested by including the lateral femoral cutaneous nerve; furthermore, the flap pedicle could bridge the vascular gap as flow-through flap, especially in mangled extremities. Last but not least, the donor site morbidity is minimal. We present our experience with free ALT flap for functional coverage of different upper and lower limb defects. Methods For the purpose of this retrospective study, we reviewed medical records of patients who had had upper and lower extremities soft-tissue defects reconstruction with a free ALT flap over a 6-year period at a large tertiary academic hospital. We followed the PROCESS guideline to report this case series [2]. Every patient gave their informed consent to be treated, understanding the risk and the objectives of the treatment. Demographic variables (gender, age and comorbidities), cause, size and site of the defect, and the time between the defect and the reconstructive surgery were recorded as preoperative variables. The intraoperative variables analyzed were flap type, arterial and venous anastomosis performed, recipient vessels used, type of donor site closure and, intraoperative complications.

Reconstructive microsurgery in upper limb reconstruction: 30 years’ experience of a single surgeon

“…Moreover, I used the ALT perforator flap as a flow-through flap in a piggy-back manner in complex cases with skin defects and amputated fingers (Georgescu and Ivan, 2003a; Georgescu and Matei, 2016, 2020; Georgescu et al., 2019a). Nowadays, for big defects, I prefer the ALT and thoracodorsal perforator flaps (Boretto et al., 2018; Chen, 2006), and for smaller defects the SCIP flap (Koshima et al., 2004). Coverage of a deeper major tissue defect.…”