PDF herunterladen
J Reconstr Microsurg 2014; 30(09): 599-606
DOI: 10.1055/s-0033-1361843
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Ultra-Thin, Fascia-Only Anterolateral Thigh Flap

Mohin A. Bhadkamkar
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Erik M. Wolfswinkel
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Daniel A. Hatef
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Steven B. Albright
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Anthony Echo
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Patrick W. Hsu
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Shayan A. Izaddoost
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
› Institutsangaben
Weitere Informationen

Publikationsverlauf

17. September 2013

06. Oktober 2013

Publikationsdatum:
19. Februar 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background While many potential donor sites have been described for fascial (fascia-only) flaps, a fascial flap harvested from the anterolateral thigh (ALT) donor site has not gained popularity, likely because of concerns regarding inadequate perfusion of the deep fascia. However, recent clinical experience demonstrates that the ALT fascia-only flap is a suitable option for reconstructions necessitating thin and pliable coverage.

Methods In this study a retrospective chart review was performed examining the clinical experience of two plastic surgeons with the fascia-only ALT perforator flap from 2008 to 2012. Each flap was initially raised as a standard ALT flap, but all the overlying skin and adipose tissue was excised off the deep fascia before the inset, resulting in the creation of a fascia-only ALT flap. Immediate split- or full-thickness skin grafts were used to cover the flap. The results are reported in this article.

Results Overall seven patients underwent reconstruction of wounds using either free (six) or pedicled (one) fascia-only ALT flaps (length, 10–20 cm, width, 5–10 cm). The following regions were successfully reconstructed using a fascia-only ALT flap: occipital scalp, lower extremity, upper extremity, and groin. All patients were followed for at least 6 months postoperatively.

Conclusions The fascia-only ALT flap was successfully used to reconstruct a variety of defects in seven patients. The authors experience demonstrates the viability of the fascia-only version of the ALT flap for reconstructions requiring thin coverage with good contour, and further adds to the versatility of the ALT as a donor site for flaps.

Keywords

fascial flap - ALT - anterolateral thigh - microsurgery
 

  • 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
    CrossrefPubMedSuche in Google Scholar
  • 2 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) 2349-2357 , discussion 2358–2360
    CrossrefPubMedSuche in Google Scholar
  • 3 Demirkan F, Wei FC, Chen HC, Chen IH, Hau SP, Liau CT. Microsurgical reconstruction in recurrent oral cancer: use of a second free flap in the same patient. Plast Reconstr Surg 1999; 103 (3) 829-838
    CrossrefPubMedSuche in Google Scholar
  • 4 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) 1517-1523
    CrossrefPubMedSuche in Google Scholar
  • 5 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996; 97 (5) 985-992
    CrossrefPubMedSuche in Google Scholar
  • 6 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 (5) 1197-1208 , discussion 1209–1210
    Suche in Google Scholar
  • 7 Hsieh CH, Yang CC, Kuo YR, Tsai HH, Jeng SF. Free anterolateral thigh adipofascial perforator flap. Plast Reconstr Surg 2003; 112 (4) 976-982
    CrossrefPubMedSuche in Google Scholar
  • 8 Zhang Q, Qiao Q, Zhou G, Robb GL. Anterolateral thigh adipofascial flap for correction of facial contour deformities and micromastia. J Reconstr Microsurg 2010; 26 (5) 341-345
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Schaverien M, Saint-Cyr M, Arbique G, Hatef D, Brown SA, Rohrich RJ. Three- and four-dimensional computed tomographic angiography and venography of the anterolateral thigh perforator flap. Plast Reconstr Surg 2008; 121 (5) 1685-1696
    CrossrefPubMedSuche in Google Scholar
  • 10 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
    CrossrefPubMedSuche in Google Scholar
  • 11 Agostini T, Agostini V. Further experience with adipofascial ALT flap for oral cavity reconstruction. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1164-1169
    CrossrefPubMedSuche in Google Scholar
  • 12 Agostini T, Agostini V, Lazzeri D. The versatility of the adipofascial anterolateral flap. Plast Reconstr Surg 2010; 126 (3) 1129-1130
    PubMedSuche in Google Scholar
  • 13 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
    CrossrefPubMedSuche in Google Scholar
  • 14 Xu DC, Zhong SZ, Kong JM , et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 1988; 82 (2) 305-310
    CrossrefPubMedSuche in Google Scholar
  • 15 Kimata Y, Uchiyama K, Ebihara S , et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000; 106 (3) 584-589
    CrossrefPubMedSuche in Google Scholar
  • 16 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
    CrossrefPubMedSuche in Google Scholar
  • 17 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989; 42 (3) 260-262
    CrossrefPubMedSuche in Google Scholar
  • 18 Sharabi SE, Hatef DA, Koshy JC, Jain A, Cole PD, Hollier Jr LH. Is primary thinning of the anterolateral thigh flap recommended?. Ann Plast Surg 2010; 65 (6) 555-559
    CrossrefPubMedSuche in Google Scholar
  • 19 Rose EH, Norris MS. The versatile temporoparietal fascial flap: adaptability to a variety of composite defects. Plast Reconstr Surg 1990; 85 (2) 224-232
    CrossrefPubMedSuche in Google Scholar
  • 20 Ueda K, Harashina T, Inoue T, Ohba S. Temporoparietal sandwich technique in acute avulsion injury of the hand. J Reconstr Microsurg 1996; 12 (1) 19-22
    Thieme ConnectPubMedSuche in Google Scholar
  • 21 Fassio E, Laulan J, Aboumoussa J, Senyuva C, Goga D, Ballon G. Serratus anterior free fascial flap for dorsal hand coverage. Ann Plast Surg 1999; 43 (1) 77-82
    CrossrefPubMedSuche in Google Scholar
  • 22 Colen LB, Pessa JE, Potparic Z, Reus WF. Reconstruction of the extremity with the dorsal thoracic fascia free flap. Plast Reconstr Surg 1998; 101 (3) 738-744
    CrossrefPubMedSuche in Google Scholar
  • 23 Smith PJ, Ross DA. Tubed radial fascial flap and reconstruction of the flexor apparatus in the forearm. J Hand Surg Am 1993; 18 (6) 959-962
    CrossrefPubMedSuche in Google Scholar
  • 24 Koshy CE, Evans J. Facial contour reconstruction in localised lipodystrophy using free radial forearm adipofascial flaps. Br J Plast Surg 1998; 51 (7) 499-502
    CrossrefPubMedSuche in Google Scholar
  • 25 Chen HC, Tang YB. Anterolateral thigh flap: an ideal soft tissue flap. Clin Plast Surg 2003; 30 (3) 383-401
    CrossrefPubMedSuche in Google Scholar
  • 26 Schwabegger AH, Hussl H, Rainer C, Anderl H, Ninković MM. Clinical experience and indications of the free serratus fascia flap: a report of 21 cases. Plast Reconstr Surg 1998; 102 (6) 1939-1946
    CrossrefPubMedSuche in Google Scholar
  • 27 Kuo YR, Jeng SF, Kuo MH , et al. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site. Plast Reconstr Surg 2001; 107 (7) 1766-1771
    CrossrefPubMedSuche in Google Scholar
  • 28 Valdatta L, Tuinder S, Buoro M, Thione A, Faga A, Putz R. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg 2002; 49 (2) 145-150
    CrossrefPubMedSuche in Google Scholar
  • 29 Kawai K, Imanishi N, Nakajima H, Aiso S, Kakibuchi M, Hosokawa K. Vascular anatomy of the anterolateral thigh flap. Plast Reconstr Surg 2004; 114 (5) 1108-1117
    PubMedSuche in Google Scholar
  • 30 Wang XC, Lu Q, Li XF , et al. Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects. Burns 2008; 34 (6) 868-872
    CrossrefPubMedSuche in Google Scholar
  • 31 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 (1) 182-193
    CrossrefPubMedSuche in Google Scholar
  • 32 Chen HC, el-Gammal TA. The lateral arm fascial free flap for resurfacing of the hand and fingers. Plast Reconstr Surg 1997; 99 (2) 454-459
    CrossrefPubMedSuche in Google Scholar
  • 33 Jeng SF, Wei FC, Noordhoff MS. The composite groin fascial free flap. Ann Plast Surg 1995; 35 (6) 595-600
    CrossrefPubMedSuche in Google Scholar