Short Interposed Pedicle of Flow-Through Anterolateral Thigh Flap for Reliable Reconstruction of Damaged Upper Extremity

ABSTRACT

In microvascular reconstructive surgery, the recipient vessel in free flap transfer is often sacrificed to provide the vascular pedicle anastomosis. As the recipient vessel is likely to be necessary for distal circulation in the damaged upper extremity, preserving its patency is critical. Flow-through anastomosis is one method that preserves the recipient vessel's patency. We present here eight patients who underwent upper-extremity reconstructions with a free flow-through anterolateral thigh flap. The flap's short vascular pedicle was interposed into a division of the radial artery and anastomosed on both sides of the pedicle's T-shaped arterial segment. The flow-through flap has various advantages, not only making it possible to reconstruct both vessels and soft tissues but also preserving recipient vessels and balancing the blood supply or pressure in the flap. In clinical situations that do not require reconstruction of the artery, the short interposed pedicle of the free anterolateral thigh flow-through flap offers a versatile and reliable option for microsurgical reconstruction of defects in the upper extremities.

KEYWORDS

Flow-through - anterolateral thigh flap - short interposed pedicle - microsurgical reconstruction - upper extremity

REFERENCES

• 1 Soutar D S, Scheker L R, Tanner N SB, McGregor I A. The radial forearm flap: a versatile method for intra-oral reconstruction.  Br J Plast Surg. 1983;  36 1-8
• 2 Foucher G, van Genechten F, Merle N, Michon J. A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap.  Br J Plast Surg. 1984;  37 139-148
• 3 Costa H, Guimaraes I, Cardoso A, Malta A, Amarante J, Guimaraes F. One-staged coverage and revascularization of traumatized limbs by a flow-through radial mid-forearm free flap.  Br J Plast Surg. 1991;  44 533-537
• 4 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
• 5 Koshima I, Nanba Y, Tsutsui T, Takahashi Y. New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities.  Ann Plast Surg. 2003;  51 30-36
• 6 Ceulemans P, Hofer S OP. Flow-through anterolateral thigh flap for a free osteocutaneous fibula flap in secondary composite mandible reconstruction.  Br J Plast Surg. 2004;  57 358-361
• 7 Kim J T, Kim C Y, Kim Y H. T-anastomosis in microsurgical free flap reconstruction: an overview of clinical applications.  J Plast Reconst Aesthet Surg. 2008;  61 1157-1163
• 8 Koshima I, Kawada S, Etoh H, Kawamura S, Moriguchi T, Sonoh H. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities.  Plast Reconstr Surg. 1995;  95 252-260
• 9 Koshima I, Fujitsu M, Ushio S, Sugiyama N, Yamashita S. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects.  Plast Reconstr Surg. 2005;  115 155-162
• 10 Keynton R S, Rittgers S E, Shu M CS. The effect of angle and flow rate upon hemodynamics in distal vascular graft anastomoses: an in vitro model study.  J Biomech Eng. 1991;  113 458-463
• 11 Ojha M, Ethier C R, Johnston K W, Cobbold R SC. Steady and pulsatile flow fields in an end-to-side arterial anastomosis model.  J Vasc Surg. 1990;  12 747-753
• 12 Staalsen N H, Ulrich M, Winther J, Pedersen E M, How T, Nygaard H. The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo.  J Vasc Surg. 1995;  21 460-471
• 13 Adani R, Tarallo L, Marcoccio I, Cipriani R, Gelati C, Innocenti M. Hand reconstruction using the thin anterolateral thigh flap.  Plast Reconstr Surg. 2005;  116 467-473 discussion 474-477
• 14 Kesiktas E, Yavuz M, Dalay C, Kesiktas N, Özerdem G, Acartürk S. Upper extremity salvage with a flow-through free flap.  Ann Plast Surg. 2007;  58 630-635
• 15 Miyamoto S, Okazaki M, Ohura N, Shiraishi T, Takushima A, Harii K. Comparative study of different combinations of microvascular anastomoses in a rat model: end-to-end, end-to-side, and flow-through anastomosis.  Plast Reconstr Surg. 2008;  122 449-455
• 16 Sananpanich K, Tu Y K, Kraisarin J, Chalidapong P. Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injury: anatomical study and case report.  Injury. 2008;  39(Suppl 4) 47-54