TFL Perforator Flap Complementing and Completing the ALT–AMT Flap Axis

Abstract

Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator.

Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021.

Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed.

Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT–TFL can be harvested for large, complex, multicomponent, and multidimensional defects.

Keywords

tensor fascia lata perforator flap - TFL perforator flap - ALT flap - chimeric ALT harvest - chimeric flaps

Authors' Contributions

D.J., B.S., S.M., M.M., V.P., and A.B. performed the surgeries. D.J. and B.S. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. D.J. and B.S. wrote the manuscript. V.K.S. and P.Y. reviewed the manuscript.

Ethics Approval

The study is a retrospective analysis of cases operated by a proven standard procedure and hence no ethical approval was required.

The study was done with adherence to the Declaration of Helsinki protocol. Proper preprocedure consents were taken for surgery, documentation, and research purposes. The study was approved by the Institutional Ethics Committee. Data storage was performed in accordance with good clinical practice guidelines.

Patient Consent

Consent was taken from all patients regarding the inclusion of clinical data and photographs in this study for the purpose of academic and scientific publication.

Publikationsverlauf

Eingereicht: 25. August 2023

Angenommen: 21. April 2024

Accepted Manuscript online:
03. Mai 2024

Artikel online veröffentlicht:
14. Juni 2024

• 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 (02) 149-159
• 2 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 (05) 1517-1523
• 3 Nojima K, Brown SA, Acikel C. et al. Defining vascular supply and territory of thinned perforator flaps: part I. Anterolateral thigh perforator flap. Plast Reconstr Surg 2005; 116 (01) 182-193
• 4 Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 2012; 130 (06) 1254-1268
• 5 Jaiswal D, Ghalme A, Yadav P, Shankhdhar V, Deshpande A. Free anteromedial thigh perforator flap: complementing and completing the anterolateral thigh flap. Indian J Plast Surg 2017; 50 (01) 16-20
• 6 Hubmer MG, Schwaiger N, Windisch G. et al. The vascular anatomy of the tensor fasciae latae perforator flap. Plast Reconstr Surg 2009; 124 (01) 181-189
• 7 Powers JM, Martinez M, Zhang S, Kale SS. A description of the vascular anatomy of the tensor fascia lata perforator flap using computed tomography angiography. Ann Plast Surg 2018; 80 (6S Suppl 6): S421-S425
• 8 Hubmer MG, Justich I, Haas FM. et al. Clinical experience with a tensor fasciae latae perforator flap based on septocutaneous perforators. J Plast Reconstr Aesthet Surg 2011; 64 (06) 782-789
• 9 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 (07) 2219-2226 , discussion 2227–2230
• 10 Chen SY, Lin WC, Deng SC. et al. Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. Eur J Surg Oncol 2010; 36 (10) 1004-1011
• 11 Namgoong S, Yoon YD, Yoo KH, Han SK, Kim WK, Dhong ES. Alternative choices for anterolateral thigh flaps lacking suitable perforators: a systematic review. J Reconstr Microsurg 2018; 34 (07) 465-471
• 12 Hsieh CH, Yang JC, Chen CC, Kuo YR, Jeng SF. Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available. Head Neck 2009; 31 (05) 571-575
• 13 Lu JC, Zelken J, Hsu CC. et al. Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction. Plast Reconstr Surg 2015; 135 (05) 1476-1485
• 14 Tuinder S, Baetens T, De Haan MW. et al. Septocutaneous tensor fasciae latae perforator flap for breast reconstruction: radiological considerations and clinical cases. J Plast Reconstr Aesthet Surg 2014; 67 (09) 1248-1256
• 15 Contedini F, Negosanti L, Pinto V. et al. Tensor fascia latae perforator flap: an alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available. Indian J Plast Surg 2013; 46 (01) 55-58
• 16 Jaiswal D, Parekh H, Mathews S, Ghalme A. In-situ 'divide' and 'deliver': a simple technique to preserve nerves in chimeric anterolateral thigh flap harvest. Indian J Plast Surg 2023; 56 (01) 74-77
• 17 Nahai F, Silverton JS, Hill HL, Vasconez LO. The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1978; 1 (04) 372-379