Clinical Application of the Anterolateral Thigh Flap for Soft Tissue Reconstruction

Qixu Zhang; Qun Qiao; Xinguo Yang; Hai Wang; Geoffrey L Robb; Gang Zhou

doi:10.1055/s-0029-1243292

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2010; 26(2): 087-094
DOI: 10.1055/s-0029-1243292

Clinical Application of the Anterolateral Thigh Flap for Soft Tissue Reconstruction

Qixu Zhang¹ ^, ² , Qun Qiao¹ , Xinguo Yang³ , Hai Wang³ , Geoffrey L. Robb² , Gang Zhou¹

¹Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
²Plastic Surgery Department, University of Texas MD Anderson Cancer Center, Houston, Texas
³Shengliyoutian Central Hospital, Shandong, China

Abstract

ABSTRACT

The purpose of this article is to describe the author's experience using the anterolateral thigh (ALT) flap for the reconstruction of a variety of soft tissue defects. The flap utility and donor site morbidity were evaluated in 126 cases from March 1985 to August 2007. The ALT flaps were harvested as either free fasciocutaneous, free adipofascial, fasciocutaneous island, or reversed fasciocutaneous island flaps to repair facial, neck, breast, trunk, and extremity defects. In 40 cases (32%), the skin vessels were found to be septocutaneous perforators, and in 86 cases (68%), they were found as musculocutaneous perforators. Of the 126 flaps, 121 survived completely, providing a success rate of 96.0%. There were four cases undergoing multidetector-row computed tomographic angiography (CTA) for preoperative perforator mapping, and all perforators were confirmed intraoperatively. In conclusion, the ALT flap is a versatile and reliable flap that could well be a priority option for soft tissue reconstruction. CTA can provide more valuable and accurate anatomic information about the pedicle and perforators, making it safer and faster to harvest a targeted ALT perforator flap with less donor site morbidity.

KEYWORDS

Anterolateral thigh flap - ALT flap - perforator flap - computed tomography angiography

Volltext

Referenzen

REFERENCES

1 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984; 37 149-159
2 Zhou G, Qiao Q, Chen G Y, Ling Y C, Swift R. Clinical experience and surgical anatomy of 32 free anterolateral thigh flap transplantations. Br J Plast Surg. 1991; 44 91-96
3 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; 92 421-428 discussion 429-430
4 Wei F C, Jain V, Celik N, Chen H C, Chuang D C, Lin C H. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002; 109 2219-2226 discussion 2227-2230
5 Luo S, Raffoul W, Luo J et al.. Anterolateral thigh flap: a review of 168 cases. Microsurgery. 1999; 19 232-238
6 Yu P R. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004; 26 759-769
7 Kaplan J L, Allen R J, Guerra A, Sullivan S K. Anterolateral thigh flap for breast reconstruction: review of the literature and case reports. J Reconstr Microsurg. 2003; 19 63-68
8 Pribaz J J, Orgill D P, Epstein M D, Sampson C E, Hergrueter C A. Anterolateral thigh free flap. Ann Plast Surg. 1995; 34 585-592
9 Ross G L, Dunn R, Kirkpatrick J et al.. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg. 2003; 56 409-413
10 Xu D C, Zhong S Z, Kong J M et al.. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg. 1988; 82 305-310
11 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg. 1989; 42 260-262
12 Wolff K D, Grundmann A. The free vastus lateralis flap: an anatomic study with case reports. Plast Reconstr Surg. 1992; 89 469-475 discussion 476-477
13 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 1517-1523
14 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; 118 928-933 discussion 934-935
15 Alonso-Burgos A, García-Tutor E, Bastarrika G, Cano D, Martínez-Cuesta A, Pina L J. Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience. J Plast Reconstr Aesthet Surg. 2006; 59 585-593
16 Masia J, Clavero J A, Larrañaga J R, Alomar X, Pons G, Serret P. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg. 2006; 59 594-599
17 Rozen W M, Ashton M W, Pan W R et al.. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery. 2009; 29 16-23
18 Mun G H, Kim H J, Cha M K, Kim W Y. Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer. Plast Reconstr Surg. 2008; 122 1079-1088
19 Zhou G, Zhang Q X, Chen G Y. The earlier clinic experience of the reverse-flow anterolateral thigh island flap. Br J Plast Surg. 2005; 58 160-164
20 Rubino C, Figus A, Dessy L A et al.. Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals. J Plast Reconstr Aesthet Surg. 2009; 62 e45-e49
21 Kimata Y, Uchiyama K, Ebihara S et al.. Comparison of innervated and noninnervated free flaps in oral reconstruction. Plast Reconstr Surg. 1999; 104 1307-1313
22 Wei F C, Celik N, Chen H C, Cheng M H, Huang W C. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg. 2002; 109 45-52
23 Koshima I, Yamamoto H, Moriguchi T, Orita Y. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the “mosaic” flap principle. Ann Plast Surg. 1994; 32 321-327
24 Kimura N, Satoh K, Hasumi T, Ostuka T. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg. 2001; 108 1197-1208 discussion 1209-1210
25 Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg. 2003; 112 1875-1885
26 Kimata Y, Uchiyama K, Ebihara S et al.. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg. 2000; 106 584-589
27 Mardini S, Tsai F C, Wei F C. The thigh as a model for free style free flaps. Clin Plast Surg. 2003; 30 473-480

Qixu ZhangM.D. Ph.D.

Plastic Surgery Department, University of Texas MD Anderson Cancer Center

Houston, TX 77030

eMail: lukeqixu@yahoo.com