Identification of a single donor site capable of providing all the components of the soft tissue envelope and the ability to selectively harvest a subset of these components are central requirements for the microvascular reconstruction of the trauma patient. The authors hypothesized that the topography of the anterolateral thigh based on the lateral circumflex arterial system possesses the capacity to fulfill this role.
In order to investigate potential versatility of the anterolateral thigh region donor site, a retrospective chart review was conducted of all trauma patients treated by the plastic surgery service at the R. Adams Cowley Shock Trauma Center, who required microsurgical free flap coverage between July 2002 and March 2005. Fifty-one patients underwent reconstruction of traumatic deformities with tissue from the anterolateral thigh region. Formal approval for this study was obtained through the IRB of the University of Maryland School of Medicine.
From July 2002 to March 2005, 51 patients had 53 microsurgical reconstructions with tissue from the anterolateral thigh region. Two patients had a second free flap due to the loss of their first free flap. Of the 51 patients, 36 were male and 15 were female, with an average age of 39 years (range: 13 to 74 years). Analysis of flap anatomy revealed 33 fasciocutaneous, 13 myocutaneous, 2 adipofascial, 3 muscle, and 2 adipocutaneous flaps. Six flaps were based on septocutaneous perforators (11%); the remainder contained myocutaneous perforators. The average number of perforators used in each flap was 1.6 (range: 1 to 4). The thigh donor sites required a split-thickness skin graft (19%), while 43 could be closed primarily (81%). The size of the flaps ranged from 36 cm2 to 600 cm2, with an average of 185 cm2.
The anterolateral thigh region provides all required components of the soft tissue envelope for reconstructing patients in a Level I trauma center with a multiplicity of complex deformities. In most cases, the donor site could be primarily closed, and the anterolateral thigh flap also often allowed primary skin closure of the reconstructed wound, which was especially valuable in the distal lower extremity and ankle. It is a predictable donor site which facilitates a two-team approach. Results suggest that the anterolateral thigh region is a warehouse of reliable tissues and could become an ideal donor site for management of complex traumatic wounds in the head and neck, torso, and extremities in the United States.
