Tissue Expansion Techniques to Minimize Morbidity of the Anterolateral Thigh Perforator Flap Donor Site

Background As understanding of the blood supply by superficial circumflex iliac artery (SCIA) to the skin and iliac bone has improved and the use of a perforator flap has become accepted, most previous drawbacks of SICA iliac osteocutaneous flaps, such as bulky flap, small diameter, and inadequate blood supply to bone, can now be overcome. Here, the authors present their experience of using such flaps for the reconstruction of complex defects in the foot and ankle with a focus on feasibility and safety. Methods A retrospective review of patients who underwent foot and ankle reconstruction using an SCIA iliac osteocutaneous flap between 2010 and 2015 was performed to assess outcomes. Results Four patients who underwent treatment with SCIA iliac osteocutaneous flaps and eight patients treated with fabricated chimeric iliac osteocutaneous flaps were identified. The iliac segment size ranged from 1 × 3 × 0.7 to 3 × 6 × 1 cm and the skin paddle size ranged from 1 × 4 to 8 × 16 cm. All flaps survived uneventfully except for marginal necrosis in one anterolateral thigh (ALT) flap and one iliac osteocutaneous flap. The median time to bone union was 4 months. All patients were able to walk in normal footwear and none developed significant complications at the donor site. Conclusion The use of free SCIA iliac osteocutaneous and fabricated chimeric iliac osteocutaneous flaps provides an alternative for treating small- and medium-sized bone defects (smaller than 8 cm) along with soft tissue defects in the foot and ankle region.

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Utilization of a Continuous External Tissue Expansion System to Assist in Primary Closure of a Large Anterolateral Thigh Donor Site Defect

Case Reports in Surgery ◽

10.1155/2014/860749 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Andrew G. Silver ◽

Richard C. Baynosa

Keyword(s):

Primary Closure ◽

Donor Site ◽

Tissue Expansion ◽

Skin Grafting ◽

Flap Coverage ◽

Anterolateral Thigh ◽

Expansion System ◽

Donor Site Defect ◽

Alt Flap

Primary closure of a large anterolateral thigh (ALT) flap donor site defect with the assistance of an external tissue expansion system is presented. The dimensions of this donor site (12 cm × 40 cm) and its percentage of leg circumference (34%) would make this site likely to require skin grafting or further flap coverage based on the results of previously published literature.

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Reconstruction of post-burn anterior neck contractures using a butterfly design free anterolateral thigh perforator flap

Archives of Plastic Surgery ◽

10.5999/aps.2019.00591 ◽

2020 ◽

Vol 47 (2) ◽

pp. 194-197

Author(s):

Alexandre G. Lellouch ◽

Zhi Yang Ng ◽

Victor Pozzo ◽

Tabrez Suffee ◽

Laurent A. Lantieri

Keyword(s):

Burn Injury ◽

Treatment Options ◽

Perforator Flap ◽

Tissue Expansion ◽

Skin Grafting ◽

Anterior Neck ◽

Anterolateral Thigh ◽

Flap Design ◽

Surrounding Areas ◽

Dermal Matrices

Anterior neck burns represent a major reconstructive challenge due to severe sequalae including restriction in movement and poor aesthetic outcomes. Common treatment options include skin grafting with/without dermal matrices, and loco-regional and distant free flap transfers with/without prior tissue expansion. Such variation in technique is largely influenced by the extent of burn injury requiring resurfacing. In order to optimize like-for-like reconstruction of the anterior neck, use of wide, thin and long flaps such as the anterolateral thigh (ALT) perforator flap have been reported with promising results. Of note, some patients have a tendency towards severe scar contractures, which may be contributed by the greater extent of inflammation during wound healing. We report our experience at 4 years’ follow-up after secondary reconstruction of severe, anterior neck burn contractures in two patients by harvesting the ALT flap with a butterfly design. This technique provides adequate wound resurfacing of the burned neck and surrounding areas, and provides good neck extensibility by addressing both anterior and lateral aspects of the scar defect simultaneously. Such a flap design reduces tension on wound edges and thus, the risk of contracture recurrence in what remains a particularly challenging type of burn reconstruction.

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Outcomes of using a modified anteromedial thigh perforator flap for repairing the anterolateral thigh free flap donor site

Medicine ◽

10.1097/md.0000000000010491 ◽

2018 ◽

Vol 97 (16) ◽

pp. e0491 ◽

Cited By ~ 3

Author(s):

Xiao Zhou ◽

Jin Wang ◽

Li Qiang ◽

Yongjun Rui ◽

Mingyu Xue

Keyword(s):

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Anterolateral Thigh

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Designing Anterolateral Thigh Flap Using Ultrasound

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740126 ◽

2021 ◽

Author(s):

Giuseppe Visconti ◽

Alessandro Bianchi ◽

Akitatsu Hayashi ◽

Marzia Salgarello

Keyword(s):

Subcutaneous Tissue ◽

Preoperative Evaluation ◽

Donor Site ◽

Perforator Flap ◽

The Body ◽

Anterolateral Thigh Flap ◽

Perforator Flaps ◽

Anterolateral Thigh ◽

Ultrasound Technology ◽

The Given

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

Microsurgery ◽

10.1002/micr.22076 ◽

2013 ◽

Vol 33 (3) ◽

pp. 249-250 ◽

Cited By ~ 3

Author(s):

Anı Cinpolat ◽

Özlenen Özkan ◽

Gamze Bektas ◽

Polat Biçici ◽

Ömer Özkan

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Anterolateral Thigh Flap ◽

Anterolateral Thigh

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Use of the Keystone Perforator Flap Closure for the Anterolateral Thigh Free Flap Donor Site

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1177/24727512211032867 ◽

2021 ◽

Vol 6 ◽

pp. 247275122110328

Author(s):

Pallavi A. Kumbla ◽

Ashley Q. Thorburn ◽

Shreyas Makwana ◽

Matthew Mino ◽

Joseph Zakhary ◽

...

Keyword(s):

Free Flap ◽

Operative Time ◽

Wound Care ◽

Donor Site ◽

Perforator Flap ◽

Skin Grafting ◽

Motor Deficits ◽

Anterolateral Thigh ◽

Average Operative Time ◽

Flap Closure

Objective: The anterolateral thigh (ALT) flap is a workhorse in microsurgical reconstruction. However, a flap width greater than 8 centimeters limits primary closure and discourages some surgeons from using this flap for larger defects to avoid a large and unsightly skin grafted donor site. ALT donor site closure can be made even more challenging when a more circular shaped flap is required. Methods: This study examines the use of the keystone perforator flap to close large ALT free flap donor sites in 6 patients who underwent reconstruction for various purposes who otherwise would have required donor site skin grafting. Results: Average flap dimensions were 10.5 cm × 17 cm and mean keystone flap dimensions were 12.2 cm × 22.5 cm. Average operative time of cases was 528.3 minutes and average BMI of patients was 24.8 kg/m2. There was 1 case of partial keystone flap dehiscence that required local wound care, and 1 case of drain replacement for thigh seroma. Conclusions: This series demonstrates that keystone perforator flap closure allows the thigh to maintain a relatively normal appearance, reduces postoperative pain associated with skin grafting, and can be performed in higher BMI patients with minimal complications and without increasing operative time or sensory or motor deficits. This series to date also has the largest defects closed with keystone flaps demonstrating the feasibility of this type of closure in very large ALT donor sites.

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