scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

scholarly journals Pedicled anterolateral thigh flap for contralateral groin composite defect

2010 ◽  
Vol 43 (01) ◽  
pp. 103-105
Author(s):  
S. P. Bharath ◽  
G. Madhusudan ◽  
Suraj Manjunath
Keyword(s):  
Free Flaps ◽  
Anterior Superior Iliac Spine ◽  
Anterolateral Thigh Flap ◽  
Wide Resection ◽  
Vascular Pedicle ◽  
Anterolateral Thigh ◽  
Vascular Compromise ◽  
Femoral Vessels ◽  
Alt Flap ◽  
Composite Defect

ABSTRACTPedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.

ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

2019 ◽  
pp. 44-48
Author(s):  
Hong Phuc Le ◽  
Thiet Son Tran ◽  
Nghi Thanh Nhan Le
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Fasciocutaneous Flaps ◽  
Limb Reconstruction ◽  
Anterolateral Thigh ◽  
Lower Limb Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

ANTEROLATERAL THIGH FLAP IN LOWER LIMB RECONSTRUCTION

2019 ◽  
pp. 44-48
Author(s):  
Hong Phuc Le ◽  
Thiet Son Tran ◽  
Nghi Thanh Nhan Le
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Fasciocutaneous Flaps ◽  
Limb Reconstruction ◽  
Anterolateral Thigh ◽  
Lower Limb Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Introduction: Anterolateral thigh flap is one of the most researched and widely used perforator flaps in the recent decades in plastic surgery as a whole and in limb reconstruction, especially in cases with complex deflects, in particular. This report aimed to evaluate anterolateral thigh flap in reconstruction of complex lower limb soft tissue defects. Subjects and methods: From August 2014 to August 2015, at Hue University of Medicine and Pharmacy Hospital, 12 cases with complex soft tissue defects in lower limb were reconstructed and covered with ALT flaps: two distal based pedicle ALT flaps for popliteal and around knee joint defects and 10 composite ALT free flaps for lower leg reconstruction. Results: Twelve flaps used included: two peripheral pedicled fasciocutaneous flaps, ten complex free flaps (01 complex myo-fasciocutaneous flap providing muscle for deep space filled, fascial for tendon reconstruction and surface covering of the defect; 05 vastus lareralis myocutaneous flaps providing muscle for dead space filling and covering; 04 fasciocutaneous flaps involving the fascia lata for fascial reconstruction and covering). The size of flaps ranged from 8 to 27cm in length and from 6 to 13cm in width. The largest flap was 240cm2,the smallest was 50cm2. All 12 flaps survived. Short-term results at one month after surgery were consideredas good in eleven patients and fair in one patient. There were no special complications at donor sites. Paresthesia at the donor site was noted in two cases. Conclusion: ALT flap with its versatility as peripheral pedicled flap or free flap can be used in lower limb reconstruction with high success rate of 100% (12/12). Preoperative skin perforator mapping by Doppler was highly accurate (12/12) compared with intraoperative findings. Complex free ALT flap is suitable for reconstruction of major defects involving different type of tissue in lower limb with satisfied results. Key words: Anterolateral thigh flap, limb, ower limb

Reconstruction of a full-thickness buccal defect with anterolateral thigh flap – case report

2018 ◽  
Vol 7 (2) ◽  
pp. 39-42
Author(s):  
Małgorzata Czesak ◽  
Daniel Majszyk ◽  
Ewa Osuch-Wójcikiewicz ◽  
Kazimierz Niemczyk
Keyword(s):  
Squamous Cell Carcinoma ◽  
Case Report ◽  
Tumor Resection ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Full Thickness ◽  
Simultaneous Reconstruction ◽  
Anterolateral Thigh ◽  
Alt Flap ◽  
Tissue Defects

Extensive tissue defects resulting from tumor resection within the head and neck require simultaneous reconstruction. One of the most commonly used free flaps in reconstruction oral cavity is the free anterolateral thigh flap. A case of a 57-year-old woman with squamous cell carcinoma of the cheek has been presented, in which the reconstruction of the full thickness of the cheek with a folded free anterolateral thigh flap has been performed. The authors provide treatment methods and the possibility of using ALT flap.

scholarly journals Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Siti Handayani ◽  
Shelly Madona Djaprie
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Anterolateral Thigh ◽  
Wide Range ◽  
Reconstructive Microsurgery ◽  
One Year ◽  
Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Reece Moore ◽  
Donna Mullner ◽  
Georgina Nichols ◽  
Isis Scomacao ◽  
Fernando Herrera
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
False Positive ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Preoperative Imaging ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

scholarly journals Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

2021 ◽  
Vol 07 (03) ◽  
pp. e237-e240
Author(s):  
Ricardo Horta ◽  
Margarida Mendes ◽  
Diogo Barreiro ◽  
Alexandre Almeida ◽  
Mariana Jarnalo ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Wound Dehiscence ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Salvage Procedure ◽  
Penile Amputation ◽  
Anterolateral Thigh ◽  
Circumferential Reinforcement ◽  
Complex Wounds ◽  
Alt Flap

AbstractReconstruction of complex penile defects is always challenging, as some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded in complex wounds. We present a case of a 63-year-old otherwise healthy man, who underwent transurethral resection of the prostate for benign prostatic hyperplasia. After the procedure, he developed panurethral necrosis with consequent stricture. Three urethroplasties for reconstruction of the bulbar and distal urethra using buccal mucosa grafts, a preputial flap, and penile skin were performed by urology team in different institutions, but serious urinary fistulization and carbapenemase-producing Klebsiella pneumoniae (KPC) infection translated in a chronic wound, urethra necrosis, and near-total penile amputation. A composite anterolateral thigh flap and vascularized fascia lata were used with success together with a perineal urethroplasty in different stages, improving the ischemic wound condition. The extended segment of fascia lata was used for Buck's fascia replacement and circumferential reinforcement to cover the erectile bodies of the penis. The postoperative period was uneventful and after 12 months, there were no signs of recurrence or wound dehiscence. He was able and easily adapted to void in a seated position through the perineal urethrostomy that was made. To the best of our knowledge, this procedure has not been reported previously as a salvage procedure in a fistulizated and KPC infected penis, but it may be considered to avoid penile amputation in chronic infected and intractable wounds.

scholarly journals Reconstruction of Complex Soft-Tissue Defects in Buttock Using The Proximally Based Anterolateral Thigh Flap: An Alternative Algorithm

2021 ◽  
Author(s):  
Danying Wang ◽  
Mengqing Zang ◽  
Shan Zhu ◽  
Bo Chen ◽  
Shanshan Li ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Melanocytic Nevus ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Defect Reconstruction ◽  
Reconstruction Methods ◽  
Circumflex Femoral Artery ◽  
Anterolateral Thigh ◽  
Tissue Defects

Abstract Background Local and free flaps are most widely used in buttock reconstruction. However, local flaps and free flaps may not be appropriate for all complex soft tissue defects in buttock. In this study, we propose an alternative approach for buttock reconstruction and provide preliminary assessment in clinical efficacy of using a proximally based anterolateral thigh flap for buttock reconstruction. Methods In this study, we retrospectively analyzed the data of the patients with medium- to large-sized defects of buttock. All patients underwent buttock defect reconstruction using a proximally based anterolateral thigh flap between August 2012 and December 2020. Results Eight pedicled anterolateral thigh flaps were used to reconstruct buttock defects after tumor ablation in six patients, scar revision in one patient, melanocytic nevus resection in one patient. Flap size ranged from 25 × 8 cm to 30 × 12 cm, with pedicle length ranging from 12 to 20 cm. Flaps were elevated based on the distal musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery and completely survived without any perfusion-related complications. We achieved satisfactory results from both the functional and aesthetic point-of-view at the 6-month follow-up in all cases. Conclusions The proximally based anterolateral thigh flap can be a valuable reconstructive option with sufficient tissue and a long vascular pedicle for buttock defect reconstruction.

Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps

2017 ◽  
Vol 34 (02) ◽  
pp. 121-129 ◽  
Author(s):  
Pierre Moullot ◽  
André M. Gay ◽  
Baptiste Bertrand ◽  
Régis Legré ◽  
Nathalie Kerfant ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Free Flaps ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Aesthetic Outcome ◽  
Anterolateral Thigh ◽  
Alt Flap

Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. Methods We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap. Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05). Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.

Aesthetic and functional outcomes of thinned anterolateral thigh flap in reconstruction of complex wounds of the upper limb

2021 ◽  
pp. 175319342198960
Author(s):  
Mohamed A. Ellabban ◽  
Amr A. Gomaa ◽  
Amr M. Moghazy ◽  
Mohamed A. Elbadawy ◽  
Osama A. Adly
Keyword(s):  
Upper Limb ◽  
Functional Results ◽  
Anterolateral Thigh Flap ◽  
Self Assessment ◽  
Level Of Evidence ◽  
Anterolateral Thigh ◽  
Before And After ◽  
The Mean ◽  
The Aesthetic ◽  
Anterolateral Thigh Flaps

We studied outcomes of reconstruction of complex upper limb wounds using thinned anterolateral thigh flaps. There were 18 patients with a mean age of 27.5 years. The mean thickness of the flap before and after thinning was 23 mm and 5 mm, respectively. Two patients had partial tip necrosis that was treated conservatively. Aesthetic and functional evaluations were performed using a 5-point Likert scale, QuickDASH score, passive range of motion and power grip at 12 months after surgery. The study showed good results in the aesthetic evaluation by a panel of plastic surgeons (mean score: 19.7) and patient self-assessment (mean score: 18.1). There was a significant correlation between the total scores of the panel and the patients. The mean QuickDASH score was 21, with a high percentage in the middle category ‘had a problem but working’. The thinned anterolateral thigh flap is versatile and safe in upper limb reconstruction with good aesthetic and functional results. Level of evidence: IV

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