A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect

ABSTRACT

Introduction: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage. Materials and Methods: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. Observations and Results: Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. Conclusion: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.

KEY WORDS

Flow through flap - vascular compromise - Salvage

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 Soutar DS, Scheker LR, Tanner NS, McGregor IA. The radial forearm flap: A versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36: 1-8
• 2 Lamberty BG, Cormack GC. The antecubital fascio-cutaneous flap. Br J Plast Surg 1983; 36: 428-33
• 3 Ao M, Nagase Y, Mae O, Namba Y. 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
• 4 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: 252-60
• 5 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: 149-59
• 6 Kimata Y, Uchiyama K, Ebihara S, Sakuraba M, Iida H, Nakatsuka T. et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000; 106: 584-9
• 7 Kuo YR, Jeng SF, Kuo MH, Huang MN, Liu YT, Chiang YC. et al. Free anterolateral thigh flap for extremity reconstruction: Clinical experience and functional assessment of donor site. Plast Reconstr Surg 2001; 107: 1766-71
• 8 Costa H, ães I, Cardoso A, Malta A, Amarante J, Guimarães F. One-staged coverage and revascularisation of traumatised limbs by a flow-through radial mid-forearm free flap. Br J Plast Surg 1991; 44: 533-7
• 9 Tseng WS, Chen HC, Hung J, Tasi TR, Chen HH, Wei FC. “Flow-through” type free flap for revascularization and simultaneous coverage of a nearly complete amputation of the foot: Case report and literature review. J Trauma 2000; 48: 773-6
• 10 Deutman HC, Hartman EH, Marres HA. A buried reversed radial forearm flap in pharyngeal reconstruction: Refinements and monitoring. Eur J Plast Surg 2000; 23: 204-7
• 11 Lee JW, Yu JC, Shieh SJ, Liu C, Pai JJ. Reconstruction of the Achilles tendon and overlying soft tissue using antero-lateral thigh free flap. Br J Plast Surg 2000; 53: 574-7
• 12 Luo S, Raffoul W, Luo J, Luo L, Gao J, Chen L. et al. Anterolateral thigh flap: A review of 168 cases. Microsurgery 1999; 19: 232-8
• 13 He XQ, Zhu YL, Wang Y, Mei LB, Jin T, Xu YQ. The role of the distal runoff vessel of the descending branch of the lateral circumflex femoral system in anterolateral thigh flap surgery: A case series and literature review. Ann Plast Surg 2015 [epub ahead of print]