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J Reconstr Microsurg 2012; 28(04): 227-234
DOI: 10.1055/s-0032-1306370
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lower Extremity Reconstruction with the Anterolateral Thigh Flap

Naveed Nosrati
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Albert H. Chao
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
David W. Chang
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Peirong Yu
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
Further Information

Publication History

25 July 2011

09 November 2011

Publication Date:
07 March 2012 (online)

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Abstract

The versatility and location of the anterolateral thigh (ALT) flap make it well suited for lower extremity reconstruction. The purpose of this study was to evaluate surgical and functional outcomes by specific anatomic regions in the lower extremity to better define the role of the ALT flap in lower extremity reconstruction. A retrospective review of patients undergoing lower extremity reconstruction with an ALT flap between July 2002 and December 2010 was performed. Total 46 patients underwent lower extremity reconstruction with an ALT flap, of whom 29 (63%) had a pedicled flap and 17 (37%) a microvascular free flap. Defects were located in the hip/buttocks (n = 8), groin (n = 13), thigh (n = 8), knee (n = 5), leg (n = 6), and foot/ankle (n = 6). The mean postoperative follow-up was 4 months. Total flap loss occurred in two patients (4%). There were 11 recipient site complications (24%). The most common complication was recipient site seroma, which occurred in five patients (11%), all of whom had hip/buttock or groin defects. Overall, 38 patients (83%) returned to their preoperative functional status. The ALT flap is an effective method of lower extremity reconstruction. It can be performed as a pedicled or free flap, with good surgical and functional outcomes.

Keywords

reconstruction - ALT flap - lower extremity
 

  • 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) 149-159
    CrossrefPubMedSearch in Google Scholar
  • 2 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004; 26 (9) 759-769
    CrossrefPubMedSearch in Google Scholar
  • 3 Celik N, Wei FC, Lin CH , 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 (7) 2211-2216 , discussion 2217–2218
    CrossrefPubMedSearch in Google Scholar
  • 4 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) 161-166
    CrossrefPubMedSearch in Google Scholar
  • 5 Nasajpour H, Steele MH. Anterolateral thigh free flap for “head-to-toe” reconstruction. Ann Plast Surg 2011; 66 (5) 530-533
    CrossrefPubMedSearch in Google Scholar
  • 6 Elliott RM, Weinstein GS, Low DW, Wu LC. Reconstruction of complex total parotidectomy defects using the free anterolateral thigh flap: a classification system and algorithm. Ann Plast Surg 2011; 66 (5) 429-437
    CrossrefPubMedSearch in Google Scholar
  • 7 Yu P. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck 2004; 26 (12) 1038-1044
    CrossrefPubMedSearch in Google Scholar
  • 8 Yu P, Hanasono MM, Skoracki RJ , et al. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010; 116 (7) 1718-1724
    CrossrefPubMedSearch in Google Scholar
  • 9 Yu P, Sanger JR, Matloub HS, Gosain A, Larson D. Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction. Plast Reconstr Surg 2002; 109 (2) 610-616 , discussion 617–618
    CrossrefPubMedSearch in Google Scholar
  • 10 Wong S, Garvey P, Skibber J, Yu P. Reconstruction of pelvic exenteration defects with anterolateral thigh-vastus lateralis muscle flaps. Plast Reconstr Surg 2009; 124 (4) 1177-1185
    CrossrefPubMedSearch in Google Scholar
  • 11 Maxhimer JB, Hui-Chou HG, Rodriguez ED. Clinical applications of the pedicled anterolateral thigh flap in complex abdominal-pelvic reconstruction. Ann Plast Surg 2011; 66 (3) 285-291
    CrossrefPubMedSearch in Google Scholar
  • 12 Lee N, Roh S, Yang K, Kim J. Reconstruction of hand and forearm after sarcoma resection using anterolateral thigh free flap. J Plast Reconstr Aesthet Surg 2009; 62 (12) e584-e586
    CrossrefPubMedSearch in Google Scholar
  • 13 Gravvanis A, Tsoutsos D, Karakitsos D, Iconomou T, Papadopoulos O. Blood perfusion of the free anterolateral thigh perforator flap: its beneficial effect in the reconstruction of infected wounds in the lower extremity. World J Surg 2007; 31 (1) 11-18
    CrossrefPubMedSearch in Google Scholar
  • 14 Kuo YR, Kuo MH, Chou WC, Liu YT, Lutz BS, Jeng SF. One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment. Ann Plast Surg 2003; 50 (2) 149-155
    CrossrefPubMedSearch in Google Scholar
  • 15 Heller L, Kronowitz SJ. Lower extremity reconstruction. J Surg Oncol 2006; 94 (6) 479-489
    CrossrefPubMedSearch in Google Scholar
  • 16 Yildirim S, Gideroğlu K, Aköz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg 2003; 19 (4) 225-233
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Park JE, Rodriguez ED, Bluebond-Langer R , et al. The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma. J Trauma 2007; 62 (1) 162-165
    CrossrefPubMedSearch in Google Scholar
  • 18 Demirtas Y, Neimetzade T, Kelahmetoglu O, Guneren E. Comparison of free muscle and perforator skin flaps for soft tissue reconstruction of the foot and ankle. Foot Ankle Int 2010; 31 (1) 53-58
    CrossrefPubMedSearch in Google Scholar
  • 19 Hong JP, Kim EK. Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg 2007; 119 (1) 186-193
    CrossrefPubMedSearch in Google Scholar
  • 20 Ng RW, Chan JY, Mok V, Li GK. Clinical use of a pedicled anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2008; 61 (2) 158-164
    CrossrefPubMedSearch in Google Scholar
  • 21 Friji MT, Suri MP, Shankhdhar VK, Ahmad QG, Yadav PS. Pedicled anterolateral thigh flap: a versatile flap for difficult regional soft tissue reconstruction. Ann Plast Surg 2010; 64 (4) 458-461
    CrossrefPubMedSearch in Google Scholar
  • 22 Gravvanis AI, Tsoutsos DA, Karakitsos D , et al. Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee. Microsurgery 2006; 26 (6) 432-438
    CrossrefPubMedSearch in Google Scholar
  • 23 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 2006; 118 (4) 928-933 , discussion 934–935
    CrossrefPubMedSearch in Google Scholar
  • 24 Ver Halen J, Yu P. Reconstruction of extensive groin defects with contralateral anterolateral thigh-vastus lateralis muscle flaps. Plast Reconstr Surg 2010; 125 (3) 130e-132e
    CrossrefPubMedSearch in Google Scholar
  • 25 Uygur F, Duman H, Ulkür E, Celiköz B. Are reverse flow fasciocutaneous flaps an appropriate option for the reconstruction of severe postburn lower extremity contractures?. Ann Plast Surg 2008; 61 (3) 319-324
    CrossrefPubMedSearch in Google Scholar
  • 26 Liu TY, Jeng SF, Yang JC, Shih HS, Chen CC, Hsieh CH. Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: cases report. Ann Plast Surg 2010; 64 (2) 198-201
    CrossrefPubMedSearch in Google Scholar
  • 27 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010; 125 (1) 209-214
    CrossrefPubMedSearch in Google Scholar
  • 28 Colterjohn NR, Davis AM, O'Sullivan B, Catton CN, Wunder JS, Bell RS. Functional outcome in limb-salvage surgery for soft tissue tumours of the foot and ankle. Sarcoma 1997; 1 (2) 67-74
    CrossrefPubMedSearch in Google Scholar