Anterolateral Thigh Flap for Lower Extremity Reconstruction under Epidural Anesthesia

Abstract

Despite improved surgical techniques, partial or total loss of the free flaps remains an obstacle for the lower extremity reconstruction. The risk factors of flap failure involve thrombosis, atherosclerosis, and vasospasm. In 1999, we performed nine cases of the lower leg reconstruction with the free anterolateral thigh flap under epidural anesthesia. There were eight male and one female aged from 45 to 76 years old (mean 59). The etiologies included open fracture (3), crush (3), diabetic ulcer (2), and electric burn (1). The underlying medical diseases included the hypertension (7), diabetes mellitus (4), and chronic obstructive pulmonary diseases (4). Bupivacaine was used for lumbar epidural anesthesia. Eight of the nine flaps survived (89%). One flap for reconstructing open fracture of the knee joint developed secondary infection and turned into complete necrosis later. Partial necrosis of the flap occurred in one flap (11.1%) and the STSG was done for resurfacing. Epidural anesthesia has the advantages of avoiding the risk of the prolonged general anesthesia, and achieving both pain relief and vasodilatation. The versatility of the flap design, providing various components of tissues, and minimal donor-site morbidity make the free anterolateral thigh flap very useful in the lower extremity reconstruction.