Perforator flap from adjacent thigh skin to improve the repair of the donor site of the anterolateral thigh flap

Abstract Background Preoperative knowledge of themicrovascular anatomy of a patientmay improve safetyand efficacy and reduce morbidity. Today, with the advancement in technology, ultrasound can provide minute details of the structures within the body, which makes this technology very helpful in preoperative evaluation of the traditional perforator flaps as well as thin, superthin, and pure skin perforator flaps. Methods In this article, we will describe the design of one of the most popular perforator flaps, the anterolateral thigh (ALT) flap, using high-frequency and ultrahigh-frequency ultrasound technology. Results Ultrasound technology allows to study preoperatively the ALT donor-site and its microvascular anatomy by using different US modalities in order to provide a virtual surgical plan to the operating surgeon. Conclusion Ultrasound technology allow to expand preoperative knowledge of flap microvascular anatomy and its course within the subcutaneous tissue up to and within the dermis, allowing to select the best perforator for the given reconstruction and the plane of elevation for thin, superthin and pure skin perforator flap.

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Free anteromedial thigh perforator flap: Complementing and completing the anterolateral thigh flap

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_161_16 ◽

2017 ◽

Vol 50 (01) ◽

pp. 016-020 ◽

Cited By ~ 2

Author(s):

Dushyant Jaiswal ◽

Amol Ghalme ◽

Prabha Yadav ◽

Vinaykant Shankhdhar ◽

Akshay Deshpande

Keyword(s):

Head And Neck ◽

Donor Site ◽

Perforator Flap ◽

Anterolateral Thigh Flap ◽

Head And Neck Reconstruction ◽

Neck Reconstruction ◽

Circumflex Femoral Artery ◽

First Choice ◽

Anterolateral Thigh ◽

Alt Flap

ABSTRACT Objective: Theobjective of this study was to determine the indications, utility, advantages and surgical approach for the anteromedial thigh (AMT) flap. Materials and Methods: We reviewed the records of the patients in whom the AMT flap was used for head and neck reconstruction. We use an anterior approach to harvest the anterolateral thigh (ALT) flap with a non-committal straight line incision. This preserves both ALT and AMT flap territories intact, and further decision is based on the intraoperative anatomy of perforator and pedicle. The ALT flap was usually used as the first choice when available and suitable. Results: Free AMT skin flaps were harvested in 24 patients. All flaps were used for the head and neck reconstruction. Two flaps had marginal flap necrosis. One flap was lost due to venous thrombosis. Discussion: The thigh is an excellent donor site as it has large available skin territory, expendable lateral circumflex femoral artery system and low donorsite morbidity. The ALT flap is the most commonly used flap for reconstruction of soft-tissue defects. However, it is characterised by variable vascular pedicle and perforator anatomy. The AMT flap is an excellent alternative when the ALT flap is not available due to variable perforator anatomy, injury to perforator, when an intermediate thickness is needed between distal and proximal thigh or a chimeric flap is needed. Conclusion: The AMT flap offers all the advantages of the ALT flap without increasing donor-site morbidity. The anterior non-committal approach keeps both the ALT and the AMT flap options viable.

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