Versatility of the anterolateral thigh free flap in upper and lower extremities defects coverage reconstruction.
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Published:
Aug 19, 2018
Keywords:
Anterolateral thigh free flap, versatility, defect coverage, reconstructive surgery
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Abstract
IntroductionThe anterolateral thigh free flap is currently one of the most useful reconstructive options. A long pedicle with suitable vessel diameter, reliable anatomy and the availability of different tissues with large amounts of skin make this flap versatile. The purpose of this study was to evaluate the flap versatility in a series of patients with coverage defects in both, the upper and lower limbs.MethodsA retrospective study was performed. Inclusion criteria were patients with defects in the extremities to whom this flap was made as a reconstructive treatment. Preoperative, intraoperative and postoperative variables were analyzed.ResultsTwelve patients (7 men and 5 women) with an average age of 44 years were included. Defects were caused by oncological resection (9 patients) and trauma (3 cases). In 4 cases the defect was in the upper extremity and in 8 cases in the lower extremity. The average time between the defect and the reconstructive surgery was 8 days. The survival rate of the flap was 92%, with only one failure. Donor site presented no complications and primary closure was performed in all cases, except for two requiring closure with skin graft.Conclusions Anterolateral thigh free flap is a valid and very useful resource for coverage of defect of different etiologies in the upper and lower limbs since its versatility allows its successful adaptation in defects of varied location and size.
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How to Cite
Bennice, J., Puig Dubois, J., Gallucci, G. L., De Carli, P., & Boretto, J. G. (2018). Versatility of the anterolateral thigh free flap in upper and lower extremities defects coverage reconstruction. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(3), 167-178. https://doi.org/10.15417/issn.1852-7434.2018.83.3.812
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Clinical Research
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References
1. 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(2):149-59.
2. Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Hau SP, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg. 2000;53(1):30-6.
3. Park CW, Miles BA. The expanding role of the anterolateral thigh free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2011;19(4):263-8.
4. Kimata Y, Uchiyama K, Ebihara S, Yoshizumi T, Asai M, Saikawa M, et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg. 1997;123(12):1325-31.
5. 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(3):421-8; discussion 9-30.
6. Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir. 2002;34(4):239-44.
7. Horn D, Jonas R, Engel M, Freier K, Hoffmann J, Freudlsperger C. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region. J Craniomaxillofac Surg. 2014;42(8):1551-6.
8. Mureau MA, Posch NA, Meeuwis CA, Hofer SO. Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient- and donor-site outcome. Plast Reconstr Surg. 2005;115(4):1077-86.
9. 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(7):2349-57; discussion 58-60.
10. Bibbo C, Nelson J, Fischer JP, Wu LC, Low DW, Mehta S, et al. Lower Extremity Limb Salvage After Trauma: Versatility of the Anterolateral Thigh Free Flap. J Orthop Trauma. 2015;29(12):563-8.
11. Wang HT, Fletcher JW, Erdmann D, Levin LS. Use of the anterolateral thigh free flap for upper-extremity reconstruction. J Hand Surg Am. 2005;30(4):859-64.
12. Javaid M, Cormack GC. Anterolateral thigh free flap for complex soft tissue hand reconstructions. J Hand Surg Br. 2003;28(1):21-7.
13. Engel H, Gazyakan E, Cheng MH, Piel D, Germann G, Giessler G. Customized reconstruction with the free anterolateral thigh perforator flap. Microsurgery. 2008;28(7):489-94.
14. 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(2):161-6.
15. 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(7):2219-26; discussion 27-30.
16. Dayan JH, Lin CH, Wei FC. The versatility of the anterolateral thigh flap in lower extremity reconstruction. Handchir Mikrochir Plast Chir. 2009;41(4):193-202.
17. Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg. 1991;27(2):126-31.
18. Zheng X, Zheng C, Wang B, Qiu Y, Zhang Z, Li H, et al. Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap. Int J Surg. 2016;26:25-31.
19. Kim SW, Kim KN, Hong JP, Park SW, Park CR, Yoon CS. Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction. Microsurgery. 2015;35(8):634-9.
20. Alkureishi LW, Shaw-Dunn J, Ross GL. Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br J Plast Surg. 2003;56(4):401-8.
21. Diamond S, Seth AK, Chattha AS, Iorio ML. Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity. J Reconstr Microsurg. 2017.
22. Adani R, Tarallo L, Marcoccio I, Cipriani R, Gelati C, Innocenti M. Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg. 2005;116(2):467-73; discussion 74-7.
23. 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(5):1517-23.
24. Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg. 1989;42(3):260-2.
25. Kimata Y, Uchiyama K, Ebihara S, Sakuraba M, Iida H, Nakatsuka T, et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg. 2000;106(3):584-9.
26. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg. 2013;41(1):15-21.
2. Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Hau SP, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg. 2000;53(1):30-6.
3. Park CW, Miles BA. The expanding role of the anterolateral thigh free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2011;19(4):263-8.
4. Kimata Y, Uchiyama K, Ebihara S, Yoshizumi T, Asai M, Saikawa M, et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg. 1997;123(12):1325-31.
5. 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(3):421-8; discussion 9-30.
6. Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir. 2002;34(4):239-44.
7. Horn D, Jonas R, Engel M, Freier K, Hoffmann J, Freudlsperger C. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region. J Craniomaxillofac Surg. 2014;42(8):1551-6.
8. Mureau MA, Posch NA, Meeuwis CA, Hofer SO. Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient- and donor-site outcome. Plast Reconstr Surg. 2005;115(4):1077-86.
9. 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(7):2349-57; discussion 58-60.
10. Bibbo C, Nelson J, Fischer JP, Wu LC, Low DW, Mehta S, et al. Lower Extremity Limb Salvage After Trauma: Versatility of the Anterolateral Thigh Free Flap. J Orthop Trauma. 2015;29(12):563-8.
11. Wang HT, Fletcher JW, Erdmann D, Levin LS. Use of the anterolateral thigh free flap for upper-extremity reconstruction. J Hand Surg Am. 2005;30(4):859-64.
12. Javaid M, Cormack GC. Anterolateral thigh free flap for complex soft tissue hand reconstructions. J Hand Surg Br. 2003;28(1):21-7.
13. Engel H, Gazyakan E, Cheng MH, Piel D, Germann G, Giessler G. Customized reconstruction with the free anterolateral thigh perforator flap. Microsurgery. 2008;28(7):489-94.
14. 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(2):161-6.
15. 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(7):2219-26; discussion 27-30.
16. Dayan JH, Lin CH, Wei FC. The versatility of the anterolateral thigh flap in lower extremity reconstruction. Handchir Mikrochir Plast Chir. 2009;41(4):193-202.
17. Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg. 1991;27(2):126-31.
18. Zheng X, Zheng C, Wang B, Qiu Y, Zhang Z, Li H, et al. Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap. Int J Surg. 2016;26:25-31.
19. Kim SW, Kim KN, Hong JP, Park SW, Park CR, Yoon CS. Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction. Microsurgery. 2015;35(8):634-9.
20. Alkureishi LW, Shaw-Dunn J, Ross GL. Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br J Plast Surg. 2003;56(4):401-8.
21. Diamond S, Seth AK, Chattha AS, Iorio ML. Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity. J Reconstr Microsurg. 2017.
22. Adani R, Tarallo L, Marcoccio I, Cipriani R, Gelati C, Innocenti M. Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg. 2005;116(2):467-73; discussion 74-7.
23. 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(5):1517-23.
24. Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg. 1989;42(3):260-2.
25. Kimata Y, Uchiyama K, Ebihara S, Sakuraba M, Iida H, Nakatsuka T, et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg. 2000;106(3):584-9.
26. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg. 2013;41(1):15-21.