Use of Flow-Through Anterolateral Thigh Perforator Flaps in Reconstruction of Complex Extremity Defects

Abstract

Background The flow-through flap has been widely utilized for reconstruction of complex defects of the extremities as it can be used for arterial reconstruction and soft-tissue coverage simultaneously. This study describes our clinical experience with the application of the flow-through anterolateral thigh perforator (ALTP) flap for reconstruction of complex defects of the extremities.

Methods From January 2008 to June 2011, we retrospectively analyzed 16 patients with complex defects in the limbs. In two patients the defects occurred after undergoing wide excision of chronic ulcer, while 14 defects were due to trauma. All patients in this series underwent reconstruction with the flow-through ALTP flap. Applications of flow-through performed include preserving the recipient artery flow, rebuilding the major artery gap, bridging the artery and concomitant vein simultaneously, and combining the ALTP with another free flap.

Results Flow-through ALTP flaps were used to preserve recipient flow (n = 5), rebuild the vessel gap (n = 2), bridge the artery and concomitant vein simultaneously (n = 2), and in combination with another free flap (n = 7). Follow-up ranged from 3 to 36 months (mean, 12 months). All flaps were successful; only two combination flaps required reexploration because of vessel crisis, and two patients suffered minor degrees of wound-edge necrosis. The donor sites healed well in all cases, without any complications.

Conclusion Our experience showed that the flow-through ALTP flap is reliable and suitable for reconstruction of complex defects of the extremities, as well as for various other clinical purposes.

Keywords

anterolateral thigh perforator flap - flow-through - microsurgery

• References

• 1 Herter F, Ninkovic M, Ninkovic M. Rational flap selection and timing for coverage of complex upper extremity trauma. J Plast Reconstr Aesthet Surg 2007; 60 (7) 760-768
• 2 Kim CY, Kim YH. Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps. Plast Reconstr Surg 2012; 130 (1) 135-144
• 3 Lin YT, Lin CH, Wei FC. More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2006; 59 (6) 622-627
• 4 Wong CH, Ong YS, Wei FC. The anterolateral thigh - Vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg 2012; 65 (2) 235-239
• 5 Saint-Cyr M, Schaverien M, Wong C , et al. The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg 2009; 123 (4) 1245-1255
• 6 Kimura N, Saito M, Sumiya Y, Itoh N. Reconstruction of hand skin defects by microdissected mini anterolataral thigh perforator flaps. J Plast Reconstr Aesthet Surg 2008; 61 (9) 1073-1077
• 7 Hsiao YC, Yang JY, Chang CJ, Lin CH, Chang SY, Chuang SS. Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity. Burns 2013; 39 (3) 515-521
• 8 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 (2) 252-260
• 9 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 (6) 598-603
• 10 Sananpanich K, Tu YK, Kraisarin J, Chalidapong P. Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: anatomical study and case report. Injury 2008; 39 (4) S47-S54
• 11 Kim JT, Kim CY, Kim YH. T-anastomosis in microsurgical free flap reconstruction: an overview of clinical applications. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1157-1163
• 12 Malikov S, Magnan PE, Champsaur P, Casanova D, Branchereau A. Subscapular artery Y-shaped flow-through muscle flap: a novel one-stage limb salvage procedure. J Vasc Surg 2008; 48 (1) 159-166
• 13 Gooden MA, Gentile AT, Demas CP, Berman SS, Mills JL. Salvage of femoropedal bypass graft complicated by interval gangrene and vein graft blowout using a flow-through radial forearm fasciocutaneous free flap. J Vasc Surg 1997; 26 (4) 711-714
• 14 Devansh S. Lateral thigh free flap with flow-through vascular pedicle. Ann Plast Surg 2011; 67 (1) 44-48
• 15 Koshima I, Saisho H, Kawada S, Hamanaka T, Umeda N, Moriguchi T. Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs. Plast Reconstr Surg 1999; 103 (5) 1483-1490
• 16 Kawamura K, Yajima H, Kobata Y, Shigematsu K, Takakura Y. Anatomy of Y-shaped configurations in the subscapular arterial system and clinical application to harvesting flow-through flaps. Plast Reconstr Surg 2005; 116 (4) 1082-1089
• 17 Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004; 57 (7) 603-609
• 18 Longo B, Pagnoni M, Ferri G, Morello R, Santanelli F. The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Plast Reconstr Surg 2013; 132 (3) 656-665
• 19 Nasajpour H, Steele MH. Anterolateral thigh free flap for “head-to-toe” reconstruction. Ann Plast Surg 2011; 66 (5) 530-533
• 20 Soutar DS, Scheker LR, Tanner NSB, McGregor IA. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36 (1) 1-8
• 21 Foucher G, van Genechten F, Merle N, Michon J. A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap. Br J Plast Surg 1984; 37 (2) 139-148
• 22 Goldschlager R, Rozen WM, Ting JW, Leong J. The nomenclature of venous flow-through flaps: updated classification and review of the literature. Microsurgery 2012; 32 (6) 497-501
• 23 Bullocks J, Naik B, Lee E, Hollier Jr L. Flow-through flaps: a review of current knowledge and a novel classification system. Microsurgery 2006; 26 (6) 439-449
• 24 Valdatta L, Tuinder S, Buoro M, Thione A, Faga A, Putz R. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg 2002; 49 (2) 145-150
• 25 Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 2012; 130 (6) 1254-1268
• 26 Miyamoto S, Takushima A, Okazaki M, Shiraishi T, Minabe T, Harii K. Free pectoral skin flap in the rat based on the long thoracic vessels: a new flap model for experimental study and microsurgical training. Ann Plast Surg 2008; 61 (2) 209-214
• 27 Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg 2008; 121 (5) 1642-1649
• 28 Hwang JH, Kim ES, Kim KS, Kim DY, Lee SY. Latissimus dorsi muscle and its short perforator-based skin compound free flap. Ann Plast Surg 2007; 58 (4) 381-387
• 29 Tseng CY, Lang PO, Cipriani NA, Song DH. Pedicle preservation technique for arterial and venous turbocharging of free DIEP and muscle-sparing TRAM flaps. Plast Reconstr Surg 2007; 120 (4) 851-854
• 30 Boca R, Kuo YR, Hsieh CH, Huang EY, Jeng SF. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg 2010; 126 (5) 1558-1562
• 31 Nosrati N, Chao AH, Chang DW, Yu P. Lower extremity reconstruction with the anterolateral thigh flap. J Reconstr Microsurg 2012; 28 (4) 227-234
• 32 Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg 2014; 30 (7) 463-468
• 33 Koshima I, Yamamoto H, Moriguchi T, Orita Y. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the “mosaic” flap principle. Ann Plast Surg 1994; 32 (3) 321-327