J Reconstr Microsurg 2003; 19(4): 225-234
DOI: 10.1055/s-2003-40578
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Anterolateral Thigh Flap: Ideal Free Flap Choice for Lower Extremity Soft-Tissue Reconstruction

Serkan Yildirim, Kaan Gideroğlu, Tayfun Aköz
  • Department of Plastic and Reconstructive Surgery, Kartal Dr. Lütfü Kirdar Education and Research Hospital, Istanbul, Turkey
Further Information

Publication History

Publication Date:
14 July 2003 (online)

ABSTRACT

This article presents the authors' experience with the anterolateral thigh free flap for lower extremity reconstruction. Twenty-one consecutive anterolateral thigh flaps were transferred for reconstruction of soft-tissue defects of the lower extremity from March 2000 to May 2002. Total flap survival was 90.5 percent, with two partial failures. Venous congestion was observed in one flap (4.7 percent) and the venous anastomosis was revised immediately in the postoperative second hour. The mean follow-up time was 13.4 months (range: 5 to 26 months). The cutaneous perforators were consistently found and presented as musculocutaneous in 19 patients (90.5 percent) or septocutaneous in two other patients (9.5 percent). A thinned anterolateral thigh flap was used in 11 patients. Sensate flaps were used in four patients (19.05 percent) for the reconstruction of amputation stumps. Five flaps (23.8 percent) were used also as flow-through flaps. All patients were satisfied with the cosmetic and functional results. The anterolateral thigh flap has many advantages over other free flap donors in lower extremity reconstruction. These include a long and large caliber vascular pedicle, large and pliable skin paddle, good color and texture matching, and minimal donor-site morbidity. Moreover, the flap can be used successfully and safely as a sensate, thin, or flow-through flap. The anterolateral thigh flap can be accepted as an ideal free flap choice for lower extremity reconstruction because it has maximal reconstructive capacity and produces minimal donor-site morbidity.

REFERENCES

  • 1 Swartz W M, Mears D C. The role of free tissue transfers in lower extremity reconstruction.  Plast Reconstr Surg . 1985;  76 364-373
  • 2 Gooden M A, Gendile A T, Mills J L. et al . Free tissue transfers to extend the limits of limb salvage for lower extremity tissue loss.  Am J Surg . 1997;  174 644-649
  • 3 Kaplan I, Ada S, Özerkan F. et al . Reconstruction of soft tissue and bone defects in lower extremity with free flaps.  Microsurgery . 1998;  18 176-181
  • 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
  • 5 Koshima I, Fukuda H, Utunomiya R. et al . The anterolateral thigh flap: variations in its vascular pedicle.  Br J Plast Surg . 1989;  42 260-262
  • 6 Koshima I, Fukuda H, Yamamato H. et al . Free anterolateral thigh flaps for reconstruction of head and neck defects.  Plast Reconstr Surg . 1993;  92 421-430
  • 7 Zhou G, Qiao Q, Chen G Y. et al . Clinical experience and surgical anatomy of 32 free anterolateral thigh flap transplantations.  Br J Plast Surg . 1991;  44 91-96
  • 8 Pribaz J J, Orgill D P, Epstein M D. et al . Anterolateral thigh free flap.  Ann Plast Surg . 1995;  34 585-592
  • 9 Koshima I, Hosoda M, Moriguchi T. et al . A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full thickness defect of the mental region.  Ann Plast Surg . 1993;  31 175-180
  • 10 Kimata Y, Uchiyama K, Ebihara S. et al . Versatility of free anterolateral thigh flap for reconstruction of head and neck defects.  Arch Otolaryngol Head Neck Surg . 1997;  123 1325-1331
  • 11 Demirkan F, Chen H C, Wei F C. et al . The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction.  Br J Plast Surg . 2000;  53 30-36
  • 12 Sasaki K, Nozaki M, Nakazawa H. et al . Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap.  Plast Reconstr Surg . 1998;  102 2244-2252
  • 13 Kimata Y, Uchiyama K, Sekido M. et al . Anterolateral thigh flap for abdominal wall reconstruction.  Plast Reconstr Surg . 1999;  103 1191-1197
  • 14 Kimata Y, Uchiyama K, Ebihara S. et al . Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases.  Plast Reconstr Surg . 1998;  102 1517-1523
  • 15 Luo S, Raffoul W, Luo J. et al . Anterolateral thigh flap: a review of 168 cases.  Microsurgery . 1999;  19 232-238
  • 16 Ao M, Nagase Y, Mae O. et al . Reconstruction of posttraumatic defects of the foot by flow-through anterolateral or anteromedial thigh flaps with preservation of posterior tibial vessels.  Ann Plast Surg . 1997;  38 598-603
  • 17 Kuo Y R, Jeng S F, Kuo M H. et al . Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site.  Plast Reconstr Surg . 2001;  107 1766-1771
  • 18 Kimura N, Satoh K, Hasumi T. et al . Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients.  Plast Reconstr Surg . 2001;  108 1197-1208
  • 19 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;  97 985-992
  • 20 Shieh S S, Chiu H Y, Yu J C. et al . Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation.  Plast Reconstr Surg . 2000;  105 2349-2357
  • 21 Cipriani R, Contedini F, Caliceti V. et al . Three-dimensional reconstruction of the oral cavity using the free anterolateral thigh flap.  Plast Reconstr Surg . 2002;  109 53-57
  • 22 Huang W C, Chen H C, Jain V. et al . Reconstruction of through and through cheek defects involving the oral comissure using chimeric flaps from the thigh lateral circumflex femoral system.  Plast Reconstr Surg . 2002;  109 433-442
  • 23 Wei F C, Çelik N, Chen H C. et al . Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects.  Plast Reconstr Surg . 2002;  109 45-52
  • 24 Luo S, Raffoul W, Piaget F. et al . Anterolateral fasciocutaneous flap in the difficult perineogenital reconstruction.  Plast Reconstr Surg . 2000;  102 171-173
  • 25 Yu P, Sanger J R, Matloub H S. et al . Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction.  Plast Reconstr Surg . 2002;  109 610-616
  • 26 Rajajic N, Gang R J, Krishnan J. et al . Thin anterolateral thigh free flap.  Ann Plast Surg . 2002;  48 252-257
  • 27 Yildirim S, Avci G, Aköz T. Soft tissue reconstruction using a free anterolateral thigh flap: an experience of 28 cases (in press).  Ann Plast Surg. 2003; 
  • 28 Yildirim S, Avci G, Akan M. et al . Anterolateral thigh flap in the management of postburn flexion contractures of the knee.  Plast Reconstr Surg . 2003;  111(5) 1630-1637