Anterolateral thigh alt free flap surgery this leaflet has been written to help your understanding of anterolateral free flap surgery. The distant metastasis was not detected in preoperative evaluation. It can provide abundant soft tissue coverage and minimal donor site morbidity. We did not perform preoperative image analysis of the vascular pedicle in all cases. Anterolateral thigh perforator flap plastic surgery key. Posterior thigh perforator flap plastic surgery key. Single perforator based anterolateral thigh flap for. Anterolateral thigh myocutaneous free flap harvest. Most importantly, the donorsite morbidity is minimal.
The alt has a complex local vasculature, which can be of importance for the surgical approach. Yang wg, chiang yc, wei fc, feng gm, chen kt 2006 thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Flowthrough anterolateral thigh flap for reconstruction. The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work. A retrospective study was conducted to evaluate the advantages of anterolateral thigh alt flap in tongue reconstruction. This flap can be harvested irrespective of whether the skin vessels are septocutaneous or musculocutaneous. Since its introduction in 1984 by song et al, 1 the anterolateral thigh flap has gained widespread popularity, especially in asian countries, where it has replaced the radial forearm flap as being the workhorse in head and neck surgery. Anterolateral thigh myocutaneous free flap harvest american.
The vascular pedicle and its perforators have a varied anatomical course that has led to difficulties in flap harvest. Despite this, there are case reports of specific donorsite complications following the raising of an alt flap. Perforators can be marked with a pencil doppler to help design the outline of the flap. An unusual anatomical variant of the vascular anatomy in. Pdf efficient design of split anterolateral thigh flap. Anterolateral thigh flap reconstruction of full thickness buccal defect samantha s. Background defects after total pharyngolaryngectomy for hypopharyngeal cancer often require reconstruction via free tissue transfer. The free anterolateral thigh flap is one of the fasciocutaneous flaps in the thigh based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral and its venae commitantes.
Total posterior leg open wound management with free anterolateral thigh flap. Anatomical variations and preoperative imaging technique. Once the flap of skin is raised, it is transferred and sewn into the hole created. Chapter 61 anterolateral thigh perforator free flap. Application of reverse anterolateral thigh flap in. Patients were followed up for an average of five years and various aspects of functional and aesthetic rehabilitation were assessed. If playback doesnt begin shortly, try restarting your device. A combination of bovie cauterie and bipolar cauterie are used for perforator dissection and the lateral skin paddle incision is left intact until the entire pedicle is harvested. The clinical application of anterolateral thigh flap. The free alt flap has good pliability and can be folded for the reconstruction of both the inner and outer lining of throughandthrough cheek defects. Recently, the alt flap has become a popular option for soft tissue reconstruction of. Anterolateral thigh flap reconstruction of full thickness.
However, the anatomic variations decreased its popularity. Lateral thigh flap the lateral thigh free flap is a fascial or fasciocutaneous flap based on the smaller vessels that extend from the profunda femoris system to the skin. Patients undergoing alt flap were compared with those undergoing similar surgery with radial forearm flap rff. In 1989, maruyama and iwahira 4 documented a popliteoposterior thigh fasciocutaneous island flap based on a direct branch of the popliteal artery for coverage of a knee wound. Reconstruction of complex soft tissue defects including.
Free anterolateral thigh flap guang yang and kevin c. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. We present our experience with the anterolateral thigh flap in reconstructing a through and through defect of the buccal mucosa and cheek. Aesthetic outcome after reconstruction of complex soft. Surgical anatomy of the anterolateral thigh flap the lateral circum. In 1984, song et al 5 first introduced the alt flap. Sep 03, 2019 lateral thigh flap the lateral thigh free flap is a fascial or fasciocutaneous flap based on the smaller vessels that extend from the profunda femoris system to the skin. Anterolateral thigh flap harvest based on a single musculocutaneous perforator. The anterolateral thigh flap was first described by dr. Anterolateral thigh perforator free flap pocket dentistry. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were used for a variety of softtissue deficits. One of the blood vessels supplies blood to the flap the artery and the other drains blood from it the vein.
It in turn gives off the descending and transverse branches. Sahar, md department of surgery, division of plastic and reconstructive surgery, university of california davis medical center, sacramento, calif. We evaluated composite anterolateral thigh alt flaps including vascularized fascia lata fl, for stable soft tissue coverage and tendons restoration at various joint levels in a one. Doctors often use this surgery to reconstruct an area in the head and neck. Anterolateral thigh flaps for reconstruction of head and neck. Groin reconstruction using a pedicled anterolateral thigh. Application of reverse anterolateral thigh flap in infected. The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. From september 2008 to february 2012, patients receiving alt flap tongue reconstruction were included in the study. It is one of the most commonly used flaps for reconstruction of head and neck defects after ablation. Once the flap of skin is raised, it is transferred and sewn into the hole created by the. The anterolateral thigh flap is a reliable flap that supplies a large area of skin. The use of an anterolateral thigh flap based on a proximal vascular pedicle seems to be a simple straightforward solution for reconstruction of the skin and fascia of the inguinal region.
The anterolateral thigh flap can be considered to be one of the workhorses of perforator flaps. Functional tongue reconstruction with the anterolateral thigh. The lateral edge of the flap can be incised down to the muscle and elevated subfascially from lateral to medial, taking. Clinical application of the anterolateral thigh flap for. Using the pedicle anterolateral thigh flap as an optional. The flap allows for a large amount of tissue, thus coverage of a large defect. Celik n, wei fc, lin ch, cheng mh, chen hc, jeng sf, kuo yr 2002 technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. The expanding role of the anterolateral thigh free. These perforating vessels are typically numbered 14 in a superior to inferior direction. The skin and fat layer in this region is removed the flap along with two blood vessels. By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. Modified design of anterolateral thigh flap for total pharyn. The full text of this article is available in pdf format.
Luo s, raffoul w, luo j, luo l, gao j, chen l, et al. Oct 17, 2014 the anterolateral thigh flap was first described by dr. Fasciae and muscles figures 1, 2 the fascia lata is the deep fascia of the thigh, and completely encircles the muscles of the thigh. Total posterior leg open wound management with free. To harness its full potential, an indepth understanding of its vascular anatomy is a prerequisite. It can be harvested in the suprafascial plane if a thin flap is needed while the vastus lateralis and tensor. It has gained great popularity, especially in mainland china, japan and taiwan. The alt flap has a large and long vascular pedicle, and because of the distance. The mean number of perforators included in a single skin paddle was 2. Twentyfive of these flaps were used for lower extremity reconstruction, 10 were used in the upper extremity, and 9 were used in the head and neck. Our findings revealed that the free thin anterolateral flaps covered the defects over anterior and lateral aspects of the neck with good colour match and contour. From march 2001 to february 2012, five men were enrolled in the study.
Anterolateral thigh flaps for reconstruction of head and. Jan 18, 2015 chapter 61 anterolateral thigh perforator free flap. Functional tongue reconstruction with the anterolateral. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. Recently, the alt flap has become a popular option for soft tissue reconstruction of the oral cavity2,3. This paper aims to clarify its vascular anatomy and high.
Apart from the blood supply to the vastus lateralis muscle, the descending branch divides into the myo or septocutaneous branches, giving the anatomical basis of the myocutaneous vastus lateralis or septocutaneous anterolateral thigh perforator flap. Note preservation of motor branches from the femoral nerve. Clinical experience of 1284 free anterolateral thigh. Recently, anterolateral thigh alt flap has become the gold standard in many centers because of its advantages with respect to versatility, minimal donorsite morbidity, good speech quality, and relatively low fistula and anastomotic leakage rates. Nov 25, 20 a retrospective study was conducted to evaluate the advantages of anterolateral thigh alt flap in tongue reconstruction. Pdf efficient design of split anterolateral thigh flap in. After the first description by song, it took several years until this flap became popular for different reconstructive purposes. Mathan mohan, moni abraham kuriakose department of head and neck oncology, mazumdarshaw cancer center, narayana hrudayalaya, health city, bangalore, india. Modified design of anterolateral thigh flap for total. The anterolateral thigh flap has good pliability and can be designed as either a single skin paddle for one layer defect reconstruction or doubleskin paddles for throughandthrough defects by one perforator or multiple perforators. Anterolateral thigh flap vascular analysis youtube.
We aimed to assess the aesthetic outcome of surgical reconstruction by free alt flap using binocular singlerefraction magnifying glasses and a modified post operative surveillance protocol. Images gested reverseflow anterolateral thigh flap and the. Assessment of the perforators of anterolateral thigh flaps using 64section multidetector computed tomographic angiography in head and neck cancer reconstruction. Vascular anatomy of the anterolateral thigh flap keio. However, designing and raising the alt flap has been traditionally recognized as being difficult, tedious, and technically demanding. Popularity of the anterolateral thigh flap in asia is reflected in the numerous reports from oriental authors. The surgeon then sews the flap into place where tissue was removed in the head or neck. The foot and ankle online journal open access publishing. Assessment of the perforators of anterolateral thigh flaps using 64section multidetector computed tomographic angiography in head and neck cancer reconstruction shihyi chen, wenchiung lin, shoucheng deng, shuncheng chang, jupeng fu, nianntzyy dai, shaoliang chen, timmo chen, shyigen chen. The anterolateral thigh free flap park and miles 265 figure 2 intraoperative photograph demonstrating tubed alt free. The clinical course of a 54yearold male patient presented with a mass of 7. A method of reconstructing soft tissue defects to various regions of the body.
The area in your arm from which the surgeon took the flap will get a graft of skin from another area of your body such as the thigh. Lateral thigh and anterolateral thigh free tissue transfer. An unusual anatomical variant of the vascular anatomy in the anterolateral thigh free flap. This study is a first attempt to analyze the outcome of the flowthrough anterolateral thigh flap for reconstruction in acute electrical burns of the severely traumatized upper extremity. Anterolateral thigh flap for breast reconstruction.
The anterolateral thigh flap alt is one of the most common flaps used in reconstructive microsurgery, due to its demonstrated lower donorsite morbidity when compared to other sites. In general, the flap receives its perfusion from branches of the lateral circumflex femoral artery lcfa. Chung the free anterolateral thigh alt flap is a versatile flap. Briefly, the anterolateral thigh flap is a relatively new free tissue transfer and has been described for soft tissue coverage in other than the foot and ankle. The thigh flap, with its large and long neurovascular pedicle, can be used either as a free flap or as an island flap as an alternative to the lower abdominal flap, groin flap, tensor fasciae. This is surgery that removes a piece of skin from your inner forearm and uses it to replace tissue that was removed due to cancer. We performed a retrospective investigation including 21 functional alt flaps between november 2006 and december 2016.
Radial forearm free flap what is a radial forearm free flap. Reconstruction of throughandthrough cheek defects with. We searched for perforators and elevated flaps under the fascia with the naked eye. The anterolateral thigh alt flap has widespread use throughout the body because of the many engineering options. Ramos, md1 1 department of otolaryngology head and neck surgery. Aesthetic outcome after reconstruction of complex soft tissue. The anterolateral thigh flap is a fasciocutaneous flap based on the descending branch of the lateral circumflex femoral artery. The anterolateral thigh alt flap is now considered a workhorse for head and neck reconstruction in many centers. Application of reverse anterolateral thigh flap in infected knee defect reconstruction in a pediatric patient with developmental disability won ha, md1 kyu nam kim, md 2 chae ri park, bsc3 chi sun yoon, md2 1department of plastic and reconstructive surgery, dongkang. Additionally, it has a long pedicle with a suitable vessel diameter, which is able to anastomose with the recipient vessels beyond the injured.
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