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. Recently, the alt flap has become a popular option for soft tissue reconstruction of the oral cavity2,3. Anterolateral thigh flap reconstruction of full thickness buccal defect samantha s. The full text of this article is available in pdf format. Application of reverse anterolateral thigh flap in infected.
We searched for perforators and elevated flaps under the fascia with the naked eye. Anterolateral thigh flap reconstruction of full thickness. This flap can be harvested irrespective of whether the skin vessels are septocutaneous or musculocutaneous. Modified design of anterolateral thigh flap for total. It has gained great popularity, especially in mainland china, japan and taiwan. Anterolateral thigh alt free flap surgery this leaflet has been written to help your understanding of anterolateral free flap surgery. One of the blood vessels supplies blood to the flap the artery and the other drains blood from it the vein. Pdf efficient design of split anterolateral thigh flap in. By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. Patients were followed up for an average of five years and various aspects of functional and aesthetic rehabilitation were assessed. Department of oral and maxillofacial surgery, louisiana state university health science center, shreveport, louisiana, usa.
If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or. An unusual anatomical variant of the vascular anatomy in the anterolateral thigh free flap. In 1984, song et al 5 first introduced the alt flap. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. Technical pearls in the harvest of the anterolateral thigh perforator flap are as follows. The vascular pedicle and its perforators have a varied anatomical course that has led to difficulties in flap harvest. Total posterior leg open wound management with free. 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. 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. Assessment of the perforators of anterolateral thigh flaps.
Anterolateral thigh flap harvest based on a single musculocutaneous perforator. Doctors often use this surgery to reconstruct an area in the head and neck. Groin reconstruction using a pedicled anterolateral thigh. From march 2001 to february 2012, five men were enrolled in the study. Anterolateral thigh flap vascular analysis youtube. It can provide abundant soft tissue coverage and minimal donor site morbidity. Chung the free anterolateral thigh alt flap is a versatile flap. Single perforator based anterolateral thigh flap for. In general, the flap receives its perfusion from branches of the lateral circumflex femoral artery lcfa. We performed a retrospective investigation including 21 functional alt flaps between november 2006 and december 2016. These perforating vessels are typically numbered 14 in a superior to inferior direction. The expanding role of the anterolateral thigh free. Free anterolateral thigh flap guang yang and kevin c.
Ramos, md1 1 department of otolaryngology head and neck surgery. Clinical application of the anterolateral thigh flap for. Posterior thigh perforator flap plastic surgery key. 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. Once the flap of skin is raised, it is transferred and sewn into the hole created by the. It in turn gives off the descending and transverse branches. 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 lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. Aesthetic outcome after reconstruction of complex soft. The flap allows for a large amount of tissue, thus coverage of a large defect. 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 clinical course of a 54yearold male patient presented with a mass of 7.
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. 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. 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. Fourniers gangrene, anterolateral thigh flap, perineum reconstruction introduction fourniers gangrene is the result of a highly lethal and rapidly progressive necrotizing. Advancing education, research, and quality of care for the head and neck oncology patient. Perforators can be marked with a pencil doppler to help design the outline of the flap. The anterolateral thigh flap is a reliable flap that supplies a large area of skin. If playback doesnt begin shortly, try restarting your device. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. Background defects after total pharyngolaryngectomy for hypopharyngeal cancer often require reconstruction via free tissue transfer. Chapter 61 anterolateral thigh perforator free flap. The alt flap has a large and long vascular pedicle, and because of the distance.
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. 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. Vascular anatomy of the anterolateral thigh flap keio. Note preservation of motor branches from the femoral nerve. Luo s, raffoul w, luo j, luo l, gao j, chen l, et al. Modified design of anterolateral thigh flap for total pharyn. The surgeon then sews the flap into place where tissue was removed in the head or neck. The distant metastasis was not detected in preoperative evaluation.
Additionally, it has a long pedicle with a suitable vessel diameter, which is able to anastomose with the recipient vessels beyond the injured. From september 2008 to february 2012, patients receiving alt flap tongue reconstruction were included in the study. 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. 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. Functional tongue reconstruction with the anterolateral thigh. Patients undergoing alt flap were compared with those undergoing similar surgery with radial forearm flap rff. Nov 25, 20 a retrospective study was conducted to evaluate the advantages of anterolateral thigh alt flap in tongue reconstruction. 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 general hospital, ulsan, south korea.
The anterolateral thigh free flap park and miles 265 figure 2 intraoperative photograph demonstrating tubed alt free. Using the pedicle anterolateral thigh flap as an optional. After the first description by song, it took several years until this flap became popular for different reconstructive purposes. 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. Despite this, there are case reports of specific donorsite complications following the raising of an alt flap. We present our experience with the anterolateral thigh flap in reconstructing a through and through defect of the buccal mucosa and cheek. However, designing and raising the alt flap has been traditionally recognized as being difficult, tedious, and technically demanding.
Radial forearm free flap what is a radial forearm free flap. Assessment of the perforators of anterolateral thigh flaps using 64section multidetector computed tomographic angiography in head and neck cancer reconstruction. This paper aims to clarify its vascular anatomy and high. 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. 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. 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. The mean number of perforators included in a single skin paddle was 2. Recently, the alt flap has become a popular option for soft tissue reconstruction of. The alt has a complex local vasculature, which can be of importance for the surgical approach. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were used for a variety of softtissue deficits. The anterolateral thigh flap was first described by dr.
Thus, the alt flap is a particularly useful source for the reconstruction of soft tissue defects in the hand. An unusual anatomical variant of the vascular anatomy in. The anterolateral thigh flap is a fasciocutaneous flap based on the descending branch of the lateral circumflex femoral artery. Anterolateral thigh perforator free flap pocket dentistry. Jan 18, 2015 chapter 61 anterolateral thigh perforator free flap. Lateral thigh and anterolateral thigh free tissue transfer. 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. Oct 17, 2014 the anterolateral thigh flap was first described by dr. However, the anatomic variations decreased its popularity.
The foot and ankle online journal open access publishing. The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work. Popularity of the anterolateral thigh flap in asia is reflected in the numerous reports from oriental authors. It is one of the most commonly used flaps for reconstruction of head and neck defects after ablation. Images gested reverseflow anterolateral thigh flap and the. Fasciae and muscles figures 1, 2 the fascia lata is the deep fascia of the thigh, and completely encircles the muscles of the thigh. A method of reconstructing soft tissue defects to various regions of the body. Anatomical variations and preoperative imaging technique. The anterolateral thigh flap can be considered to be one of the workhorses of perforator flaps. Sahar, md department of surgery, division of plastic and reconstructive surgery, university of california davis medical center, sacramento, calif. Anterolateral thigh flaps for reconstruction of head and neck.
The anterolateral thigh alt flap is now considered a workhorse for head and neck reconstruction in many centers. Anterolateral thigh flap for breast reconstruction. 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. Anterolateral thigh myocutaneous free flap harvest.
From january 2009 to may 2012, 10 patients with throughandthrough cheek defects resulting from resection of cheek tumor underwent reconstruction with the folded alt flap at sun yatsen university cancer center, guangzhou, china. 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. 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. 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. Once the flap of skin is raised, it is transferred and sewn into the hole created. Most importantly, the donorsite morbidity is minimal. Its ease of dissection together with the long and reliable pedicle make it extremely suitable as a freeskin flap. Total posterior leg open wound management with free anterolateral thigh flap. The lateral edge of the flap can be incised down to the muscle and elevated subfascially from lateral to medial, taking. Flowthrough anterolateral thigh flap for reconstruction. Surgical anatomy of the anterolateral thigh flap the lateral circum. The anterolateral thigh alt flap has widespread use throughout the body because of the many engineering options. Functional tongue reconstruction with the anterolateral.
Because the surgical fields are the hand and thigh, surgeries can be performed simultaneously using a two teamapproach, without repositioning the patient, which reduces the total time required. We did not perform preoperative image analysis of the vascular pedicle in all cases. Aesthetic outcome after reconstruction of complex soft tissue. Anterolateral thigh myocutaneous free flap harvest american. Anterolateral thigh perforator flap plastic surgery key. Pdf efficient design of split anterolateral thigh flap. The skin and fat layer in this region is removed the flap along with two blood vessels. Anterolateral thigh flaps for reconstruction of head and. 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.
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. 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. Reconstruction of complex soft tissue defects including. Reconstruction of throughandthrough cheek defects with. This flap presents good functional results at the recipient site, with the additional advantages of minimal donorsite morbidity, a very acceptable esthetic result, and a high level of patient. Application of reverse anterolateral thigh flap in. Clinical experience of 1284 free anterolateral thigh. The clinical application of anterolateral thigh flap.
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