Free anterolateral thigh flap
Abstract
Background: For reconstruction of soft tissue defects in reconstructive microsurgery after ablation of tumors or following trauma flaps having following characteristics are being searched for: large surface, long vascular pedicle with large diameter of vessels, possibility of transfer of multiple tissues (skin, muscle, fascia, tendons, bone) on the same nutrient vessels, independent movement of different components of the flap in space, harvesting in supine position and primary donor site closure. Many of these characteristics are being met by the radial forearm flap however its main dissadvantage remains donor site closure by split thickness skin grafts. This can be avoided by the use of the anterolateral thigh (ALT) flap.
Methods: The ALT flap is raised, like other perforator flaps, arround the septocutaneous perforator, which is located by Doppler ultrasound at midpoint on the line connecting anterior superior iliac spine and upper lateral border of patella or arround musculocutaneous perforators. Vascular pedicle can be made longer by harvesting of the descendent branch of the lateral circomflex femoral artery.
Results: We report the first successfull free ALT flap transfer for soft tissue reconstruction of oral cavity and cheek after ablation of a recurrency of a malignant tumor in Slovenia.
Conclusions: Because of its proprieties the ALT flap is suitable for reconstruction of defects on head and neck and extremities following tumor ablation or trauma. Because of its advantages it will replace also in our country the radial forearm flap which is the most popular flap in Slovenija for these indications.
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References
Kuo YR, Seng-Feng J, Kuo FM, Liu YT, Lai PW. Versatility of the free anterolateral thigh flap for reconstruction of soft tissue defects: review of 140 cases. Ann Plast Surg 2002; 48: 161–6.
Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998; 102: 1517–23.
Xu DC, Zhong SZ, Kong JM, Wang GY, Liu MZ, Luo LS, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 1988; 82: 305–10.
Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL.Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000; 105: 2349–57.
Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109: 2219–26.
Wolff KD, Plath T, Hoffmeister B. Primary thinning of the myocutaneous vastus lateralis flap. Int J Oral Maxillofac Surg 2000; 29: 271–6.
Ji Y, Li T, Shamburger S, Jin J, Lineaweaver WC, Zhang F. Microsurgical anterolateral thigh fasciocutaneous flap for facial contour correction in patients with hemifacial microsomia. Microsurgery 2002; 22; 34–8.
Huang WC, Chen HC, Jain V, Kilda M, Lin YD, Cheng MH, et al. Reconstruction of through-and-through cheek defects involving the oral commisure, using chimeric flaps from the thigh lateral femoral circumflex system. Plast Reconstr Surg 2002; 109: 433–41.
Cipriani R, Contedini F, Caliceti U, Cavina C. Three-dimensional reconstruction of the oral cavity using the free anterolateral thigh flap. Plast Reconstr Surg 2002; 109: 53–7.
Kline RM, Khoobehi K, Levine E. Trunk reconstruction with the free vastus lateralis flap. J Reconstr Microsurg 1998; 14: 217–22.
Hallock GG. Discussion of: Chang SC, Miller G, Halbert CF, et al. Limiting donor site morbidity by suprafascial dissection of the radial forearm flap. Microsurgery 1996; 17: 136–40. Plast Reconstr Surg 2002; 109: 2227–30.
Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh flap. Ann Plast Surg 1995; 34: 585–92.
Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92: 421–8.
Wolff KD, Howaldt HP. Three years of experience with the free vastus lateralis flap: an analysis of 30 consecutive reconstructions in maxillofacial surgery. Ann Plast Surg 1995; 34: 35–42.
Luo S, Raffoul W, Luo J, Juo L, Gao J, Chen L. et al. Anterolateral thigh flaps; a review of 168 cases. Microsurgery 1999; 19: 232–8.
Song YG, Chen GZ, Song YL. The free thigh flap: A new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37: 149.
Cormack GC, Lamberty BGH. Thigh. In: McCormack GC, Lamberty BGH, eds.The arterial anatomy of skin flaps. Edinburgh, Scotland: Churchill Livingstone; 1986. p. 208–23.
Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Han SP, et al. The versatile anterolateral thigh flap: a musculocutaneous flapin disguise in head and neck reconstruction. Br J Plast Surg 2000; 53: 30–6.
Celik N, Wei FC, Lin CH, Cheng MH, Chen HC, Jeng SF, et al. Technique and strategy in anterolateral thigh perforator flap surgery based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 2002; 109: 2211–6.
Pa-Chuen X, Shi-Zhen Z, Ji-Ming K, Guo-Ying W, Muzhi L, Li-Sheng L, Jian-Hua G. Applied anatomy of the anterior lateral femoral flap. Plast Reconstr Surg 1988; 82: 305,.
Koshima I, Fukuda H, Utumomiya R, Soedi S. The anterolateral thigh flap: Variations in its vascular pedicle. Br J Plast Surg 1989; 42: 260.
Thou G, Qiao Q, Chen GY, Ling YC, Swift R. Clinical experience in surgical anatomy of 32 free anterior lateral thigh flap transplantations. Br J Plast Surg 1991; 44: 91.
Koshima I, Hosoda M, Moriguchi T, Ishii R, Orita Y, Yamamoto H. Three-dimensional combined flaps for reconstruction of complex facialdefects following cancer ablation. J Reconstr Microsurg 1997; 13; 73–80.
Lutz BS. Advantages of the anterolateral thigh flap in functional and esthetical reconstruction of tumor related scalp defects. Microsurgery 2002; 22: 258–65.
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